National report — Although the pharmaceutical industry and medical professional organizations have guidelines regarding physician relationships with industry, it is incumbent on individual professionals to apply those guidelines in such a way that they will maintain public trust and continue to serve their patients' best interests, says Stephen B. Webster, M.D., department of dermatology, Gundersen Lutheran Medical Center, La Crosse, Wis.
Common interest, different goalsThe opportunity for conflict of interest exists because physicians and the pharmaceutical industry share common interests but have different goals.
While both physicians and the pharmaceutical industry want to encourage effective and responsible use of existing drugs and support innovative research to develop new therapeutics, the emphasis for physicians is on patient care and scientific advances, whereas industry is primarily interested in commercial outcomes and benefit of the shareholder, Dr. Webster says.
"Physicians work in a professional world while the pharmaceutical industry operates in a business world where success is measured, in part, by financial gain," Dr. Webster says.
Physician in the middle
In order to achieve its goals, industry focuses the vast majority of its marketing efforts on the physician.
According to marketing data from a few years ago, the pharmaceutical industry spends $12 billion to $15 billion a year for product promotion and marketing. About $5 billion of that amount was used for pharmaceutical sales representative visits to office-based physicians, with an estimated $8,000 to $15,000 spent annually on each physician.
Those marketing efforts to physicians involved the distribution of a variety of gifts that cover a wide spectrum ranging from simple pens and notepads to expensive dinners and paid trips to resort locations.
"Regardless of its size, a gift is a gift, and its basic purpose is to identify the giver in the mind of the recipient. In that regard, any gift obligates the recipient to the giver," Dr. Webster says.
Gifts have potent impact
While many physicians would dispute that their prescribing patterns could be influenced by pharmaceutical industry gifts, results of a number of published studies demonstrate otherwise.
As an example, a study measuring physician prescribing patterns for two drugs showed there was a statistically significant increase in the mean units prescribed per physician after attendance at an all-expense paid visit to a popular sunbelt vacation site for an industry-sponsored symposium relative to the period prior to the trip. Notably, the post-meeting prescribing patterns of the physicians attending those symposia were also significantly different than the national usage patterns.
Furthermore, there is evidence that patients feel pharmaceutical gifts are more influential and less appropriate than do their physicians.
"Physicians need to consider that gifts from industry cost money and that the cost of the gift is ultimately passed on to patients without their explicit knowledge. Furthermore, physician acceptance of gifts may contribute to further erosion of the common perception that the medical professional serves the best interest of patients," Dr. Webster says.
Who will bell the cat?
Within their ethics codes, the American Academy of Dermatology, the American Medical Association and associations for other medical specialties contain statements regarding receipt of commercial support, gifts and other relations with industry. On the industry side, the Pharmaceutical Research and Marketing Association has established a Code of Interactions with Healthcare Professionals to control promotional efforts. However, Dr. Webster reminds his colleagues that those statements are guidelines, not laws.