Medical groups should pare financial ties to drug companies, doctors say

Professional medical associations, which convene meetings of specialists to share study results, draft treatment guidelines and advocate for research, insurance coverage and attention for their fields, must wean themselves off a longstanding financial reliance on companies that make and market the tools of their trade, a group of prominent physicians said today.

"Gifts do matter, organizationally and individually," said David J. Rothman, president of Columbia University's Center on Medicine as a Profession, who led 10 prominent physicians in drafting a road map for doctors' groups to establish their financial independence from the makers and marketers of prescription medications and medical devices. Rothman said it will be "tough" for many physicians' groups to operate without drug and device makers' financial sponsorships. But, he added, "you do not want the piper calling the tune."

The group's road map, which urges medical associations to "work toward a goal of accepting $0 contributions from industry," is published in today's issue of the Journal of the American Medical Assn.It proposes that professional medical associations adopt what Rothman called "a much clearer firewall" between industry money and the continuing education the groups organize for their members. And it recommends that the professional medical associations' officials, leaders and members of essential committees "be free of industry support" so they can speak publicly on behalf of their professional colleagues without apparent or real conflicts of interest.

The JAMA article urges medical associations to take these steps over the next five years to disentangle themselves from drug and device makers' financial support. Though next year's budgets are largely set, the panel urged medical associations to set a goal the following year of having no more than a quarter of their operating budget come from industry sources. 

The published guidelines do not object to professional medical associations' acceptance of paid advertising from drug and device makers in their research journals, or to revenue from companies renting space to display their products during medical conventions. Such marketing efforts are clearly identifiable; while they generate revenue that can help support organizations' activities, physicians can fairly assess the information they provide and take account of the information's source, Rothman noted.

Drug and device companies' sponsorship of "continuing medical education" has become particularly controversial in recent years. In 2007, the Senate Finance Committee launched an inquiryinto the practice and estimated that drug and device makers had spent more than $1 billion in 2004 alone to sponsor continuing medical education -- most of it passing through professional medical organizations. Investigators and increasingly, physicians themselves, have charged that industry's support of medical education courses compromises the objectivity of the instruction, often in ways that are not evident to the physicians taking them.

The drug industry's financial ties to physicians and their groups regularly generate Senate inquiries and media investigations. Drug or device companies' gifts, travel expenses or payments made for consulting, research or speaking can amount to millions of dollars yearly for "key opinion leaders" -- many of them medical association officials -- and extra income for many doctors in regular practice. Few believe their clinical judgments are influenced by the payments. But a growing number of physicians have begun worrying that increasingly publicized financial conflicts either cloud physicians' judgments or erode their patients' trust -- or both.  

"Frankly, it has not been a very pretty sight," said Dr. Steven Nissen of the Cleveland Clinic, who served recently as president of the American College of Cardiology, and is one of the 11 authors of the JAMA guidelines released today.

-- Melissa Healy

Comments

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It is so bold that some of the authors preach to others what they should do on unrestricted grants, but don't adopt their own policies! I challenge JAMA to adopt the "Zero Dollar" policy and refuse ads from pharmaceutical companies. They can just use the subscription price that doctors pay AMA to cover publishing costs. Then, let's see what they say about this idea.

The JAMA editors will fight back and claim that the ads don't affect editorial policy. I agree with that position, and I believe it is also true for most large institutions, and organizations. But the authors argue otherwise in their paper - about others.
So, if JAMA wants others to adopt "Zero Dollar" policies -it must do it first.
The challenge is on!