Physicians of power -- prescribing power

This week, Bob Goodman, founder of No Free Lunch -- took the American College of Physicians (ACP) -- the organization that represents physicians trained in internal medicine -- to TASK.

Here's some of the press release from No Free Lunch, an organization that educates physicians (and other health care professionals) about the influence of the pharmaceutical industry on our clinical and other decisions:

New York, NY – The American College of Physicians (ACP), the nation’s largest medical specialty society, will convene its Annual Meeting—billed as the “most comprehensive CME event in internal medicine,”—at San Francisco’s Moscone Center on Thursday, April 14th. In addition to its Scientific Program, the meeting will feature an exhibit hall almost 3 football fields long. The hall—which the ACP’s website calls “an extension of the learning environment of the ACP Scientific Program”—will be filled with enormous industry exhibits and countless sales reps displaying their wares and handing out trinkets to the physician-attendees. Additionally, there will be daily industry-sponsored symposia—from a breakfast session on the treatment of overactive bladder (supported by Indevus Pharmaceuticals, manufacturer of Sanctura,TM a treatment for overactive bladder) to a dinner session on the treatment of GERD (sponsored by Astra-Zeneca, manufacturer of the ubiquitous Purple Pill, Nexium.TM), daily raffles, and of course, free lunch. And in case all this is not enough to get the promotional message across, companies may sponsor just about every minute and inch of the program—from the morning coffee break ($6,000/day) to the Annual Session Tote Bag ($60,000). As the website boasts to prospective exhibitors, “The American College of Physicians Annual Session stands out from all other meetings that you attend because it offers an unparalleled opportunity to meet with physicians of power - prescribing power.”

Why is this newsworthy? Because in 2002, The ACP—whose stated mission is to “enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine”—published guidelines on Physician-Industry Relations that include the following:

“The dictates of professionalism require the physician to decline any industry gift that might be perceived to bias their judgment, regardless of whether a bias actually materializes.”

“The potential for bias in industry-prepared information becomes especially precarious when such information is accompanied by a gift or free service.”

“It is not just lavish amenities that are in question. The acceptance of even small gifts can affect clinical judgment and heighten the perception (as well as the reality) of a conflict of interest.”

“Ideally, physicians should not accept any promotional gifts or amenities, whatever their value or utility, if they have the ability to cloud professional judgment and compromise patient care.”

Well, you can have a gynormous exhibit hall filled with pharmaceutical industry folks and their expensive gifts to docs, and you can have policy that clearly states that physicians should decline gifts that may bias, but ya can't have it both ways (unless you want physicians to take "personal responsibility" to not take bias-ing gifts from the exhibit hall).

This week, the Wall Street Journal published an article by Scott Hensley on this very issue, entitled "Doctors, Drug Makers too Cozy?". Mentioned in the article was a February survey of consumers and physicians that found that 75% of consumers believe that the pharmaceutical industry is so flawed it needs to be overhauled, while only 40% of docs believe that. There can be a number of reasons why, but I'm sure conflict-of-interest has something to do with the difference in beliefs between consumers and docs.

Also, yesterday's New York Times has a piece about an upcoming meeting of physician experts who will recommend to the FDA whether or not to lift a ban on silicone breast implants. Documents show that up to 93 percent of such implants rupture within 10 years, and not enough is known about the health effects of silicone leaking into bodies. But:

Dr. Mark Jewell, president elect of the American Society of Aesthetic Plastic Surgery, said he was surprised that the agency had estimated that silicone implants failed so often.

"That's certainly news and does need to be addressed," said Dr. Jewell, who has consulted for Inamed and Mentor [companies that produce silicon breast implants]. "But I feel that the devices should be approved."

Hmm...

Anyway, back to medical organizations and pharmaceutical sponsorship. I'm proud that the American Medical Student Association's national convention last month had NO pharmaceutical influence in its exhibit hall or otherwise (and that AMSA has a Pharm-Free initiative too). Medical students passed such policy years ago, and thus they walk the walk instead of only talking the talk.

Lastly, at each of my interviews for residency, I inquired about the residency program's relationship with the pharmaceutical industry (free lunches sponsored by them, interactions with sales reps, etc). I heard a range of responses, and appreciated each of the program's reasons for either allowing or not allowing interaction with pharmaceutical sales reps, but I was especially pleased to hear from EACH program that more and more students are asking this question of them.

(thanks to the helix for the test question pictured here. Click on the picture for an enlarged version -- may be easier to read)