Doctors have stronger ties to drug and pharmaceutical industry than ever

Doctors and conflicts of interests with drug industry

Despite the potential for conflict of interest, virtually all practicing physicians 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 it's clich