Global Nephrology: "One Of The Problems With Tainted Money Is There 'Taint Enough Of It"

At international meetings there are doctors whose travel and accomodation to the meeting is paid for by a pharma company. At the ASN meeting a contingent from the UK came courtesy of a major US pharmaceutical company. Likewise, there were doctors from Asia-Pacific supported by another multinational pharma company. While the practice of providing substantive gifts to physicians in the form of airline tickets or hotel stays might be common outside the US it is considered tainted inside the US because of the perception of conflict of interest. Even though the practice is not considered illegal. Indeed, taking doctors for golf outings or the like no longer happens in the US, at least to my knowledge, for the same reasons as providing gifts - it is tainted. The kickback is obvious - "I will pay for your travel and accommodation and I hope (expect) that you will preferentially prescribe more of my drug either in higher doses or to more patients."

Ramshaw and Murphy writing in the NY Times: "Drug companies pay medical professionals for a wide range of activities, from speaking engagements to consulting. While legal, the practice raises questions about potential conflicts, and whether the interests of patients may be compromised....The companies fly medical professionals to seminars and conferences and may also pay speaking fees."

“It’s important to state out of the gate the importance of these interactions, the value they bring to physicians, to health care professionals in general and ultimately to patients,” said Karl Uhlendorf, vice president of Pharmaceutical Research and Manufacturers of America.

But the financial relationships raise questions about the influence of drug companies on prescribing patterns or research results. 

In an article in americanmedicalnews, the 2009 Institute of Medicine recommendations that physicians should reject offers of meals and personal gifts from industry is discussed:

"Although the report makes recommendations for establishing or strengthening conflict-of-interest policies, it does not forbid all relationships between medicine and industry. Patients can benefit from physician-industry connections that move medical discoveries from research to clinical care, Dr. Lo said."

American Medical Association policy says physicians should refuse gifts that do not benefit patients or are worth more than $100, disclose financial conflicts and refuse company stock when doing clinical research, and never put their financial interests before the welfare of patients

"The AMA was one of the first organizations to address concerns about the ethical implications of medicine's interaction with industry, and we believe that a transparent relationship, guided by ethics, benefits patients and physicians," Rebecca J. Patchin, MD, chair-elect of the AMA Board of Trustees, said in a statement.

The IOM report strengthens the arguments of the various organizations that have called for similar moves, said Howard A. Brody, MD, PhD, director of the Institute for the Medical Humanities at the University of Texas Medical Branch.

But Jerome Kassirer, MD, professor of medicine at Tufts University School of Medicine in Boston and former editor-in-chief of the New England Journal of Medicine, said the report doesn't go far enough. "I would have liked for the panel to say that physicians should take nothing from industry -- nothing," said Dr. Kassirer, author of the book On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health."

My take: Dr. Kassirer's perspective seems much too extreme. We need to strike the right balance. Most would agree that substantive gifts - like paying for travel or golf outings is wrong; but, research consulting, funding from industry for research or educational symposia or CME, or funding an endowed chair or supporting a foundation or society or even compensating for company board related activities is fine and should be encouraged. But, surely there is a double standard if a multinational pharmaceutical company incorporated and governed by US laws and business practices forbids the practice of paying travel for individual US doctors, but does exactly the opposite when it pays for travel or provides gifts for physicians from outside the US. And, this seems especially problematic if it's a payment targeted to some physicians and not others. Practices that are thought tainted in the US are surely tainted elsewhere also.