Doctors' Ties to Drug Makers Need Tighter Rules

A group of medical leaders say the financial ties between doctors and drug companies need to be much more tightly regulated. In this week's Journal of the American Medical Association, they say patients need protection from their doctors' conflicts of interest, and they want medical schools to lead the way.

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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block. The financial ties between doctors and drug companies need to be much more tightly regulated. That's the opinion of a group of doctors and ethicists writing in this week's Journal of the American Medical Association. The group says patients need to be protected from their doctors' conflicts of interests, and they want doctors at medical schools to lead the way.

NPR's Snigdha Prakash reports.

SNIGDHA PRAKASH reporting:

By one estimate, drug companies spend up to $13,000 per practicing physician in efforts to influence prescribing behavior. That adds up to more than $5 billion a year. The drug industry, the federal government and the medical profession have all tried to curb that spending. But in recent years, federal prosecutors have brought to light many cases where companies use large payments to induce doctors to prescribe their medicines and medical devices. Troyen Brennan is the CEO of the Brigham and Women's Physicians Organization in Boston, and a professor of medicine at the Harvard Medical School.

Mr. TROYEN BRENNAN (CEO, Brigham and Women's Physicians Organization and Professor, Harvard Medical School): It suggests there's been some failure either of professional commitment or industry practices when you have the federal government feeling like the need to prosecute these cases because the methods that were used in the past of overseeing conflicts of interests aren't working.

PRAKASH: Brennan is the principal author of a policy proposal published in this week's Journal of the American Medical Association. He says new empirical research challenges the assumptions on which current conflict of interest guidelines are based.

Mr. BRENNAN: What that research is showing is that even small gifts do matter in terms of creating obligations on the recipients of those gifts.

PRAKASH: Brennan and the other authors of this proposal would band all gifts to doctors, pens for the office, free drugs samples, and open-ended consulting contracts. In addition, they say medical schools should stop funding their continuing medical education programs through grants from drug companies to individual departments and professors.

They advocate an arms length approach that they admit may lead drug companies to give less money. But they say it would lead to more objective information. Jordan Cohen is president of the Association of American Medical Colleges and one of the authors of the paper. He says universities probably won't like this recommendation.

Mr. JORDAN COHEN (President, Association of American Medical Colleges): I'm certain that there will be a good deal of push back and resistance because of the dependence that institutions have developed over the years on these funds.

PRAKASH: In recent years, there has also been increasing concern that research funded by drug companies is likely to be biased in favor of them. But industry money is now crucial to clinical research, and the authors of this proposal say they welcome it. To better manage potential conflicts, they propose that professors and universities disclose all contracts with drug companies on a public website. Sander Williams is dean of Duke University School of Medicine. He supports many of the group's proposals, but not this one, on privacy grounds.

Mr. SANDERS WILLIAMS (Dean, Duke University School of Medicine): I could not, without further study, endorse making all such things a matter of public record.

PRAKASH: None of these proposals may ever come to pass. And from the point of view of critics, such as John Calfee of the American Enterprise Institute, that would be a good thing.

Mr. JOHN CALFEE (American Enterprise Institute): I think the danger is when you try to eliminate conflicts of interest, you're usually going to throw out the baby with the bathwater. You're going to make it more difficult for doctors and researchers and academic institutions to do some of the things that actually are quite useful to society.

PRAKASH: For example, Calfee says, doctors need the continuing medical education programs that the drug industry finances.

Mr. CALFEE: It's very hard for anyone to keep up with what's going on in pharmaceutical research unless someone does something to greatly facilitate getting that information from all the journals, all the studies, all the clinical trials to the physician in a way where they can apply that.

PRAKASH: Calfee says most doctors are quite capable of managing financial conflicts of interests on their own.

Snigdha Prakash, NPR News, Washington.

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