Doctors propose stricter limits on drug industry's influence

Medical associations should stop accepting so much funding from pharmaceutical companies and device makers, a group of physicians in the U.S. said Thursday.

Writing in JAMA, the Journal of the American Medical Association, the authors called on professional medical associations, or PMAs, to find other ways to pay for medical conferences and continuing-education classes for doctors.

The proposal aims to prevent the appearance or reality of undue industry influence, the doctors said.

"The recommendations are rigorous and would require many PMAs to transform their mode of operation and, perhaps, to forgo valuable activities," the 11 authors wrote.

Medical groups may need to run fewer events or charge higher membership dues to make up the difference, the authors acknowledged.

"To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members and the larger society."

Examples of potential threats to integrity include:

• Disease treatment guidelines recommending certain drugs, which guidelines are written by doctors who own stock in the companies making the medications.
• Freebies at medical meetings, such as tote bags or pens, that are emblazoned with drug company logos.
• Research sponsorship with strings attached, such as drug makers deciding how to use the information.

"It has not always been flattering to see how physicians' relationships to industry appear to have coloured their judgment in matters of public health," said Dr. Steven Nissen, a former president of the American College of Cardiology and a co-author of the JAMA article.

The authors' proposal includes exceptions for instances where doctors can easily distinguish marketing from education, such as exhibits of devices at medical conferences, or advertising in medical journals.

The proposal's authors include JAMA editor in chief Dr. Catherine DeAngelis; Dr. James Scully, CEO of the American Psychiatric Association; and Dr. Gerald Thomson, former president of the American College of Physicians. It reflects their opinions.

The Pharmaceutical Research and Manufacturers of America, an industry trade group, said in a statement that there's no evidence that funding doctors' educational activities creates bias when guidelines are followed, and that the group has recently updated its code of conduct.

The American Medical Association restricts gifts from drug companies to physicians. In a written statement, Dr. Joseph M. Heyman, chairman of the AMA's board, did not indicate whether his group would consider the new proposal put forth in the JAMA article.

Dr. Jerome Kassirer, a long-time critic of ties between physicians and the pharmaceutical industry, praised the proposal but said it's unlikely that large medical groups would follow it fully, given their reliance on industry funding.