Medical Ethics Reform Urged
Issuing a sweeping call for ethical reform in medicine, a group of leading physicians and scholars said doctors shouldn't accept drug samples, junkets or even ballpoint pens from drug or medical-device companies.
In today's Journal of the American Medical Assn., or JAMA, 11 experts warned that the financial ties between physicians and drug and device vendors are undermining scientific integrity and patient care.
The authors said existing guidelines were ineffective and called on university-affiliated hospitals to take the lead in establishing stricter policies that would bar gifts, restrict corporate financial ties and require transparency in medical research contracts.
The recommendations mark the first high-profile effort from within the medical profession to broadly limit financial entanglements between doctors and companies.
Concerns about the influence of marketing on medical decisions have been on the rise, fueled recently by courtroom revelations about Merck & Co.'s lobbying of physicians for its now-banned blockbuster pain reliever Vioxx.
In February 2004, the National Institutes of Health announced strict ethics rules barring agency scientists from taking consulting fees from drug companies. For years the agency allowed its scientists to consult for biomedical firms despite the researchers' roles in overseeing clinical studies and making recommendations to doctors.
The authors of the JAMA article said doctors must embark on reforms or face increased government regulation.
"If you don't do it, it's going to be done to you," warned David J. Rothman, the group's co-chairman and president of the Institute on Medicine as a Profession at Columbia University.
The pharmaceutical industry spends about 90% of its $21-billion marketing budget on efforts aimed at physicians, the authors said. That is an average of $13,000 a year per doctor -- an outlay that the authors contend drives up the cost of medications and influences what gets prescribed.
"It's clear that voluntary disclosure is not working and even small gifts can influence behavior," said group co-chairman Dr. Troyen Brennan, a Harvard professor of medicine.
The work of the group, which spent two years preparing today's report, was sponsored by the institute at Columbia University and the ABIM Foundation, a nonprofit organization affiliated with the American Board of Internal Medicine.
