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Senior Citizen Health & Medicine
Physician Ties to Drug Manufacturers are Standard
Practice, Finds Survey
Cardiologists, Group Practice Doctors Much More
Likely To Be Paid By Industry
April 25, 2007 Despite the potential for conflict
of interest, virtually all practicing physician in the U.S. have some
form of relationship with pharmaceutical manufacturers but the nature
and extent of those relationships vary, depending on the kind of
practice, medical specialty, patient mix, and professional activities,
reports a study in the April 26 issue of the New England Journal of
Medicine.
In the first national survey to gauge the
predictors and depth of relationships between industry and practicing
physicians, 94 percent of doctors report that they have at least one
type of relationship with the drug industry, mostly in the form of
receiving food in the workplace or prescription samples.
However, more than one third are reimbursed for
costs associated with professional meetings or continuing medical
education (CME), and more than a quarter receive honoraria for
consulting, lecturing or enrolling patients in clinical trials, say
researchers at Massachusetts General Hospital-Partners Health Care
System, Yale University, and the University of Melbourne and Royal
Melbourne Hospital in Australia.
Relationships with industry are a fundamental part
of the way medicine is practiced today. The real questions relate to
how much is too much and how far is too far.
It appears that these relationships benefit
physicians and industry but the important policy question is to what
extent do these relationships benefit patients in the terms of the care
they receive, says lead researcher and co-author Eric Campbell, Ph.D.,
an associate professor of medicine at the Institute for Health Policy at
Massachusetts General Hospital and Harvard Medical School.
The findings, from a survey of 1,662 practicing
physicians conducted in late 2003 and 2004, also show that drug and
device manufacturers pick and choose which doctors to form the strongest
ties with. For example, cardiologists are more than twice as likely as
family practitioners to receive direct payments from drug companies for
consulting and other services and are also significantly more likely to
be paid honoraria than pediatricians, anesthesiologists, or surgeons.
Cardiology is a highly influential specialty
within the medical profession. If the drug and device industry can
influence cardiologists, they can likely influence the prescribing
practices of other doctors, says Campbell.
Campbell and his co-authors, including Institute
for Health Policy Director David Blumenthal, MD, report that the idea
that companies target opinion leaders for marketing is further suggested
by the higher frequency of industry payments to physicians who have
developed clinical guidelines and who serve as mentors for doctors in
training.
I know its clichι, but if it didnt work, drug
companies wouldnt do it, says Blumenthal. It appears pretty clear
that industry forms tighter relationships with doctors who are really
the thought leaders, the ones who are likely to affect the behavior of
other doctors.
Researchers surveyed physicians in six specialties
(anesthesiology, cardiology, family practice, general surgery, internal
medicine, and pediatrics) to measure the extent of their financial
associations with industry and the factors that predict those ties. They
looked at what physicians receive from industry; how often they met with
industry representatives; and what characteristics determine the
frequency and nature of these relationships.
The study was funded by a grant from the New
York-based Institute on Medicine as a Profession. IMAP has made the
study of physician-industry relationships one of its main concerns.
The study found striking differences in the nature
of physician-industry relationships depending on the primary practice
location of the physician. For example, compared to physicians
practicing in hospitals, those in group practices were three times as
likely to receive gifts and nearly four times more likely to be paid for
professional services.
Group practice physicians along with solo or
two-person practices also met more frequently with industry
representatives such as drug detailers than did physicians practicing in
hospitals or clinics or staff model HMOs.
The authors suggest that the primary reason for
these differences is that hospitals may be more likely to have policies
and practices in place that limit physician contact with industry
representatives. It may also be that hospitals are more likely to
provide physician education through grand rounds and CME events,
rendering physicians in these facilities less dependent on industry
representatives as the source of medical education and information.
The survey also found that:
● Pediatricians and anesthesiologists were
significantly less likely than family practitioners to receive samples,
reimbursements and payments for professional services.
● Family practitioners reported the highest
average number of meetings with industry representatives (16 meetings a
month), followed by internists and cardiologists (9-10 per month,
respectively). Anesthesiologists had only 2 meetings a month.
● All specialties except anesthesiology appear to
be meeting more frequently with industry today as compared to 2000, when
the average was about 4.4 meetings per month. The authors say it could
reflect an intensification of industry marketing since the 1990s.
● Women physicians are less likely to receive
payment than their male counterparts.
● Physicians were more likely to receive payments
if less than 25 percent of their patients were uninsured or covered by
Medicaid.
Motivated by growing concern about
physician-industry relationships, a number of groups such as the
Pharmaceutical Research and Manufacturers of America, the American
Medical Association and the American College of Physicians have
recently instituted codes of conduct that set limits on gifts to
physicians from industry. PhRMA recommends that gifts not exceed $100
in value and should be only items that support a medical practice such
as a stethoscope. The AMA recommends that any gifts accepted by a
physician should primarily entail a benefit to patients and not be of
substantial value.
The authors say the findings should raise alarms
that more needs to be done. We have given physicians a lot of freedom
to govern themselves and to voluntarily follow guidelines set by the
profession. If they are unable to monitor and manage these practices,
there will be increasing pressure on government to do it for them, says
Blumenthal.
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