Report calls for end of drug promotion to doctors

BMJ 2009; 338 doi: (Published 05 May 2009) Cite this as: BMJ 2009;338:b1852
  1. Bob Roehr
  1. 1Washington, DC

    Product promotion among doctors by drug companies and medical device manufacturers should be virtually eliminated, and remaining research and educational ties should become completely transparent, a new report from the US Institute of Medicine recommends.

    The institute’s president, Harvey Fineberg, said that the report “sets a new standard for comprehensiveness” across the spectrum of activity—from research and treatment guidelines to education and training of healthcare professionals and regular clinical practice.

    He said he was particularly pleased that the report focuses on “prevention and anticipation, as opposed simply to responding after the fact to these problems.”

    Bernard Lo, a medical ethicist at the University of California, San Francisco, chaired the committee that wrote the report. He said that conflicts of interest are “a vital issue that goes to the heart of patient trust.” The recommendations “reinforce and advance” those made by more than a dozen other groups over the past few years.

    Dr Lo said that the US government should require drug companies “to report through a public website all payments they make to physicians, researchers, and medical organisations. Such a public record will deter inappropriate relationships and undue industry influence.” Reporting should be standardised, with uniform categories and formats, to minimise the administrative burden.

    The report calls on all doctors to decline gifts from the industry (including meals), refuse to participate in activities and publications where content is controlled by the industry, and limit use of drug samples.

    The report acknowledges that policies on conflicts of interest “typically focus on financial gain because it is relatively more objective, fungible, and quantifiable. Financial gain can therefore be more effectively and fairly regulated than other secondary interests.”

    Committee member Wendy Baldwin, who used to manage extramural research conflicts at the US National Institutes of Health, said it is much more difficult to evaluate and police non-financial conflicts of interest. “We first need to address the financial ones in a coordinated way.”

    Creation of practice guidelines should not be funded by the industry, and professionals with conflicts of interest should be excluded from writing those guidelines, or at least movement should be made in that direction, the report says. But as Dr Lo acknowledged, “The reality is that there is not enough public funding for practice guideline development,” in the US, unlike in the UK.

    Another panel member, James Childress, an ethicist from the University of Virginia, admitted that it was not always possible to find the necessary expertise among healthcare professionals and researchers with no contacts with the industry. He said that the report details ways to minimise and document such participation.

    Eric Campbell, from Massachusetts General Hospital, added that it was difficult to learn from other industries about how to manage such conflicts because “medicine is unique in the extent to which relationships between physicians, researchers, and drug companies are ubiquitous.”

    He said that disclosure is paramount, “because you can’t manage what you don’t know about.”


    Cite this as: BMJ 2009;338:b1852


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