Subject: WSJ: Docs & Industry Too Cozy?
Wall Street Journal
April 5, 2005
FOLLOW THE MONEY
By SCOTT HENSLEY
Doctors, Drug Makers Too Cozy?
New Guidelines Fuel the Debate
April 5, 2005
Keeping the interactions between doctors and drug makers wholesome is one
subject of new ethics guidelines for internists, the doctors most adults see
first for medical care. Yet this noble goal faces constant corrosion from
financial temptation.
The American College of Physicians releases the fifth edition of its Ethics
Manual in the current issue of the Annals of Internal Medicine. These
guidelines strongly discourage doctors from accepting "gifts, hospitality,
trips and subsidies of all types" from industry, such as pharmaceutical
companies, cautioning physicians that small gifts have been shown to "affect
clinical judgment" and heighten "the perception (as well as the reality) of
a conflict of interest." For the first time, the manual also directs
professional societies, such as the ACP, that accept industry support to be
on guard for potential bias or conflict from such support.
But are guidelines and good intentions up to the task? The drug industry's
substantial support of the ACP's annual meeting raises concerns.
Later this month, the ACP will hold its annual meeting in San Francisco, a
gathering expected to draw 7,000 physicians, 4,000 exhibitors, guests and
other health-care providers. About half of the $4-million-plus budget for
the meeting comes from the sale of exhibition space and sponsorships --
companies can pay $60,000 to sponsor the meeting's tote bags, $50,000 to
sponsor the shuttle buses. Drug makers are the biggest spenders, as they are
at many medical conferences, despite the large number of recruiters,
publishers and educational institutions that rent modest booths.
The prospectus for exhibitors touts the meeting to pharmaceutical companies
explicitly, saying it "stands out from all other meetings you attend because
it offers an unparalleled opportunity to meet with physicians of power
-- *prescribing
power*."
John Mitas, executive vice president of the ACP, says the organization
enforces a bright line separating the sponsorship from the content of the
medical sessions that are the main purpose of the meeting. The ACP, he
notes, has turned down groups judged incompatible with its mission, such as
car makers eager to market their wares to well-heeled doctors.
Yet, the ACP has also turned down a request to exhibit from an organization
that should be compatible with the mission of avoiding conflicts -- No Free
Lunch, a grassroots group that encourages health-care decision based on
unbiased evidence rather than drug-industry promotion. On its Web site
nofreelunch.org <http://www.nofreelunch.org/>1, the group cheekily promotes
an amnesty program for the logo-covered pens given to doctors, along with
more serious information that can be used to teach medical students about
hidden conflicts.
Robert Goodman, a New York internist who runs No Free Lunch in his spare
time, called the ACP's decision not to let it exhibit "disturbing and
astounding" considering that it would prevent doctors from hearing an
important educational message to balance out the promotional spiels
elsewhere in the exhibit hall.
The ACP maintains that agitators from No Free Lunch caused trouble at its
2001 meeting, even sneaking in an undercover TV crew. Dr. Goodman says that
even if there were some problems, which he isn't sure is the case, that they
weren't orchestrated by the organization.
William Golden, chairman of the ACP's Ethics and Human Rights Committee,
says "the door is open for a better exchange of views." The ACP also says
Dr. Goodman is welcome to attend and participate in the meeting. "Our
members are very sympathetic to the issue that Dr. Goodman advocates," Dr.
Golden explains. "But there's a difference between exhibiting and activism."
Some doctors look beyond the shortcomings in their relationship with the
pharma industry. Prescription drugs remain among the most important tools
for treating illness, so doctors have an understandable respect for the
power of modern medicines. But while the recent controversy over the safety
of prescription pain pills has further dented the already poor reputation of
drug makers with consumers, many doctors remain sympathetic with the view
that pharmaceuticals companies are on the right path. This, despite the
shock from *Merck* & Co.'s withdrawal of Vioxx last year and intensified
worries earlier in 2004 about the role of antidepressants in suicide.
The divergent sentiment was captured in responses from doctors and patients
on the question in recent surveys of whether the pharmaceutical industry is
so flawed it needs to be overhauled. Almost twice as many consumers, or
three-quarters of those polled, agreed strongly with that notion as compared
with doctors, only 40% of whom said that was the case, according to surveys
conducted in February by NOP World Health and Roper Public Affairs, both
units of United Business Media PLC, a provider of business information
services based in London.
Doctors blame journalists for exaggerating drug risks, with 81% agreeing
completely or mostly with the statement that the media are overplaying the
problems. Consumers, too, were mistrustful of media reports, though not
quite as much as their doctors. Some 55% of consumers agreed completely or
mostly with the notion that the media exaggerate drug-safety problems.
The results come from phone interviews of about 1,000 consumers and Internet
questionnaires completed by 350 U.S. doctors, according to NOP World. The
error margin for consumers was plus or minus three percentage points and
plus or minus six percentage points for physicians. The polling wasn't
performed for a specific client, though NOP World hopes to sell the results
to pharmaceutical companies.
The enduring bond between drug makers and the medical profession fuels a
concern that the relationship remains too cozy. "There's no way that drug
safety is a problem primarily because the media is blowing it out of
proportion," says Paul Argenti, a professor of communications at Dartmouth
College's Tuck School of Business who reviewed the polling results. "All
this tells me is that physicians are being influenced by drug companies even
more than we thought."
The spat between doctors wearing white coats may seem almost comical. But
make no mistake, the soul of the medical profession and the primacy of
doctors' duty to their patients is under siege. For now, most consumers view
the drug makers very skeptically -- an opinion at odds with the one held by
most doctors. The relationship of trust that most patients still seek with
their doctors is at risk if physicians don't take a closer look at their own
relationship with the pharmaceutical industry.
*Write to* Scott Hensley at [EMAIL PROTECTED]
URL for this article:
http://online.wsj.com/article/0,,SB111264186340697348,00.html
*Hyperlinks in this Article:*
(1) http://www.nofreelunch.org
(2) mailto:[EMAIL PROTECTED] <[EMAIL PROTECTED]>
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