As the pressure mounts on the medical profession to distance itself from
the pharmaceutical industry, both the industry and medicine are trying to
answer allegations of a relationship so close that conflicts of interest are
In recent years the perceptions of lawmakers, the media, and the public
have turned increasingly negative toward the industry's relationship with
and influence on medical
The Pharmaceutical Research and Manufacturers of America (PhRMA), which
represents the major pharmaceutical companies in the United States, issued a
new set of guidelines in July, known as the "Code on Relationships with
U.S. Healthcare Professionals."
Beginning next year, sales representatives can no longer provide
entertainment and recreation, such as tickets to shows and sports events and
vacation trips, to health care professionals. Sales reps will also stop
handing out pens, notepads, mugs with company logos, or other items considered
unrelated to education.
The new code does not prohibit company sales reps from buying lunches for
medical students and faculty or providing education-related gifts such as
textbooks and anatomical models. Nor does it restrict industry funding for
continuing medical education (CME), another area of controversy. Pfizer
recently announced that it would stop funding CME programs created by
for-profit education companies, which is a more stringent policy than the code
requires (Psychiatric News, August 1).
And in an issue with perhaps a more direct impact on patient care, the code
does not prohibit or discourage companies from hiring practicing health care
professionals, especially those who serve on institutional committees and make
purchasing decisions, as speakers/consultants for promoting their products, as
long as these professionals disclose their industry-relationship to the
Although the PhRMA code is not legally binding, larger drug companies
generally adopt it as part of their internal policies, which may in turn be
used as models by other drug companies.
The Biotechnology Industry Organization, the industry trade organization
for biopharmaceutical companies such as Amgen and Genentech, has announced its
support for the PhRMA code.
Also responding to increasing criticism about too close a relationship with
industry, the medical community is debating whether the profession's
self-governance needs adjustment to protect, or perhaps reclaim, the
profession's reputation for integrity. Two guidelines on
conflict-of-interest policies, one released by the American Board of Internal
Medicine Foundation and the Institute on Medicine as a Profession (IMAP) in
2006 and the other by the Association of American Medical Colleges last April,
are available. Both recommend against physicians' accepting any kind of
gifts, including meals, from industry.
A number of medical schools and affiliated institutions have implemented
conflict-of-interest policies to regulate faculty relationships with industry.
Some, including Yale and Vanderbilt universities, have banned gifts and free
meals from industry.
Stanford University's medical school recently announced that effective
September 1, it would no longer accept topic-specific educational grants from
companies to fund its internal CME. The school does allow commercial funding
for CME if the money goes toward education within such broad areas as medical,
pediatric, or surgical specialties, diagnostic and imaging technologies, or
health policy. The sponsor cannot be linked to specific CME topics or
In September the IMAP made a searchable database available on its Web site
that posts the conflict-of-interest policies at the 125 U.S. academic medical
centers it surveyed. The database allows the public to search and compare the
policies of medical schools in areas such as accepting gifts and meals,
accepting funding for CME, consulting and speaking for drug companies,
ghostwriting of scientific articles, and allowing access by vendors and sales
reps. Institutions with no current policies on this issue are also listed. In
a September 10 IMAP announcement, such prestigious institutions as Brown,
Johns Hopkins, Harvard, and Tufts universities, among others, were cited as
lacking or having weak conflict-of-interest policies.
"We will periodically check the policies with the schools and update
the database," Lisa Patterson, IMAP program coordinator, told
Psychiatric News. The database does not include osteopathic
The IMAP database is supported by funding from the Pew Charitable Trust and
a grant from the Attorney General Consumer and Prescriber Grant Program.
Despite efforts by industry and medicine to self-regulate, lawmakers are
putting pressure on both sides to change the way business is conducted.
Federal legislation, known as the Physician Payments Sunshine Act, has been
proposed by Sens. Charles Grassley (R-Iowa) and Herb Kohl (D-Wis.) that would
require and standardize disclosure of industry gifts to physicians. It would
mandate that large pharmaceutical, biological, and medical-device companies
report data on physicians to whom they have provided gifts valued above $25
(not including research funding or drug samples), and this information would
be made publicly available.
Massachusetts recently enacted legislation that requires pharmaceutical and
device companies to publicly disclose all gifts to physicians with a value
above $50 and bans certain types of gifts such as sports tickets and free
travel, as also recommended in the PhRMA code. This legislation had been
fiercely opposed by business organizations, including the Biotechnology
Industry Organization, which argue that such laws could drive biotechnology
companies from the state, according to a report in the August 8 Boston
Globe. Nevertheless, Governor Deval Patrick (D) signed it into law on
IMAP's Conflict of Interest Policy Database is posted at<www.imapny.org/coi_database>.
The PhRMA code is posted at<www.phrma.org/files/PhRMA%20Marketing%20Code%202008.pdf>.▪