Put drug makers at arm's length, doctors urged

WASHINGTON — Declaring that the pervasive influence of drug-industry money is distorting doctors' treatment decisions and scientific findings, a prestigious panel of medical experts Tuesday called for far-reaching new conflict-of-interest policies.

In an article published in the Journal of the American Medical Association, the group argued that voluntary efforts to limit corporate inducements have failed, resulting in the overprescribing of some medications and the withholding of negative discoveries about others. Highly publicized cases involving the anti-inflammatory drug Vioxx, antidepressants for children and spinal implants made by Medtronic — all occurring while voluntary guidelines were in place — highlight the need for stricter measures, they said.

"My mother told me never to accept gifts from strangers. If a stranger wants to give you a gift, it's very likely they want something in return," said Jordan Cohen, president of the Association of American Medical Colleges and a co-author of the new proposal. "We've become overly dependent on these kinds of blandishments to support our core activities, and that is jeopardizing public trust and scientific integrity."

Strict measures backed

The panel, which includes Cohen, officials from several medical schools and members of the Institute on Medicine as a Profession, urged the nation's 400 teaching hospitals to impose stringent measures, including an outright ban on accepting gifts, meals and drug samples and tight restrictions on outside income.

Spokesmen for the pharmaceutical industry said the extra steps are unnecessary and could deprive physicians of valuable information.

From their first rounds as residents, doctors travel in a world increasingly dominated by drug-company salespeople proffering meals, office supplies, entertainment and even cash to speak at conferences or sit on advisory boards.

Some physicians have been paid lucrative consulting retainers for no specific work; others are paid to put their names on articles ghost-written by industry.

"The problem has gotten worse and worse and worse," Cohen said. The relationships can prompt doctors to order unnecessary tests, prescribe more-expensive medicines or advocate adding certain medications to a hospital's preferred drug list, he said.

What studies show

Although most doctors say their relationships with drug makers do not affect medical decisions, numerous studies suggest otherwise.

"There is solid evidence it isn't the size of the gift, it's the gifting itself that creates a sense of loyalty and indebtedness," said Sharon Levine, associate executive director of Kaiser Permanente's Northern California group practice. The 6,000-doctor practice and Yale University School of Medicine are among the few institutions to implement policies similar to those outlined in JAMA.

"The industry is spending $13 billion per year on direct-to-physician promotion," she said. "That wouldn't be happening if it weren't resulting in changing patterns of utilization. It doesn't necessarily mean patients are getting bad care, but it does mean their influence is out there."

Based on the "grumbling" he has heard from physicians, Scott Lassman, assistant general counsel at the Pharmaceutical Research and Manufacturers of America, the industry's lobbying group, said voluntary guidelines seem to be working. Modest gifts such as lunch or pens may persuade a doctor "to listen to the presentation of information, not necessarily to prescribe that product." And having those discussions over a "working meal" is a time-saver for busy doctors, he said.

But the JAMA authors said it is a costly mistake to confuse marketing with scientific data.

"Drug companies spend $13,000 per physician annually," said co-author David Rothman, a professor of social medicine at Columbia University Medical Center. "Those marketing tactics are very, very effective at getting physicians to do what each drug company wants: to prescribe their product."