A group of medical leaders this week urged the nation's academic medical centers to exert tighter control over what it calls 'a serious threat' to medical professionalism, over too-close-for-comfort ties between some physicians and drug and device makers. The giving of gifts and payments to doctors is undermining the legitimacy of the scientific community and endangering patients, the group added.

Formal recommendations from the group were published in the Jan. 25th issue of the Journal of the American Medical Association (JAMA). The physician and academic leaders that contributed to the publication agree that previous attempts to control such marketing activities have not worked especially well, or have not worked at all. The core problem: none of the previous measures creates monitoring mechanisms or pinpoints responsibility for compliance, according to the report.  

"Marketing and market values should not be allowed to undermine physicians' commitment to their patient's best interest or to scientific integrity," the working group states, which was co-funded by the ABIM Foundation and the Institute on Medicine as a Profession (IMAP).  

The group recommends several courses of action: barring the direct provision of drug samples, banning all gifts, and excluding physicians with financial ties from prescription drug formulary decisions.

"The data are overwhelming. Gifts, travel grants, consulting contracts, support for continuing medical education [CME] and speaking fees affect which drugs doctors prescribe for their patients," said David Rothman, PhD, president of the IMAP and co-chair of the working group, in a release. "The system has to change, and no one is in a better position to affect change than the academic medical center."

"It's clear that voluntary disclosure is not working and even small gifts can influence behavior," says Troyen Brennan, MD, JD, co-chair of the group and president of the Brigham and Women's Physicians Organization in Boston. "We're trying to appeal to a physician's sense of professionalism that current approaches to curing conflicts of interests are no longer defensible. The profession must exert tighter control over the relationships between manufacturers and physicians."   
    
In coming to its conclusions, the group devoted two years to reviewing industry marketing practices and literature regarding its influence on physician decision-making.  

Specifically, the group's policy proposal recommends:

• Banning Gifts - Drug and device makers should be prohibited from giving physicians any gifts, including free meals, payment for travel, and payment for participating in CME;
• Barring direct drug samples - The practice of providing drug samples to physicians should be replaced by a system of vouchers for low-income patients or other indirect distribution systems to distance company marketing from physicians;
• Centralizing funds for physician travel and consulting;
• Insulating CME - Establish a firewall set up between CME activities and direct industry support;
• Restricting formulary ties - Physicians with financial relationships to drug and medical device manufacturers should be excluded from hospital and medical group formulary committees and committees overseeing purchases of medical devices;
• Speaking and writing bans - Academic medical center faculty should not participate in speaker's bureaus for pharmaceutical or device makers and should be banned from publishing articles or editorials that are ghostwritten by industry employees; and
• Research Contract Transparency - more transparency and open communication in consulting and research grants is needed.