Academic journal article American Journal of Law & Medicine

Oversight of Marketing Relationships between Physicians and the Drug and Device Industry: A Comparative Study

Academic journal article American Journal of Law & Medicine

Oversight of Marketing Relationships between Physicians and the Drug and Device Industry: A Comparative Study

Article excerpt

ABSTRACT

Throughout the world, complex mutually-dependent relationships exist between physicians and pharmaceutical and medical device companies. This article focuses on one particular aspect of these relationships-payments made by drug and device companies to physicians and their organizations and institutions to market drugs and devices. It is widely believed that drug and device company marketing to physicians creates conflicts of interest that corrupt physician judgment and increase the cost of medical care. This article examines first the economic basis of physician/industry relationships that causes conflicts to arise. It next considers the measures that a number of developed countries have taken to respond to these relationships. Finally, it proposes an approach that would comprehensively address the problems caused by drug and device company marketing to physicians.

I. PROFESSIONAL INDUSTRY RELATIONSHIPS

Throughout the world, complex mutually-dependent relationships exist between physicians and pharmaceutical and medical device companies.1 These relationships are found in research, education, and clinical practice. They include, for example, drug and device company sponsorship of research, fellowships, and continuing professional education; industry payments to physicians for consulting; gifts of meals, pens, and coffee mugs to physicians, their office staffs, and medical students; and industry involvement in the formulation of clinical practice guidelines. Some physicians also hold equity interests in drug or device companies or intellectual property interests in their products. Physician-industry relationships present conflicts of interest because the physician's primary commitment to patients in clinical practice, students in education, and science (and patients) in research comes into conflict with a secondary commitment to a drug or device company that offers the physician an opportunity for financial gain.2

The literature on physician-industry conflicts of interest has generally viewed these relationships negatively. There is a concern that industry funding of research may bias research findings; obscure the source of information on research results or their interpretation; or at least delay or limit the release of research findings and sharing of data.3 Industry support of undergraduate, graduate, or continuing education may bias presentations to favor the products of sponsors. Physicians in clinical practice may order drugs and devices produced by firms that offer them consulting contracts or gifts or in which they hold an equity interest rather than the products that are most appropriate for a particular patient or most cost effective.4 Conflicts of interest may even infect clinical practice guidelines.5 Biases resulting from industryphysician relationships may result in bad research, patient injury, and high health care system costs.

But there are also arguments in favor of close working relationships between industry and physicians.6 In most countries, industry support for research is necessary if medical research is to continue. Support from government and from non-profit foundations is far from adequate to support continued medical progress, and is in any event usually focused on basic science rather than on clinical trials and product development. Industry support for medical education may provide much needed funds to make up for short-falls educational institutions would face if they had to depend solely on public support and on student tuition. Industry marketing and support for continuing professional education helps busy doctors in practice learn about new products that may prove very beneficial to their patients, but that they may not otherwise have learned about. Moreover, doctors are scientists trained to think critically- it should not be assumed that a gift of a meal or pen will distort their judgment, which a life-time of training tells them should consider only the welfare of their patients. …

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