Today and for the rest of the week, I will be blogging from the Philadelphia Convention Center, where ACP will be holding its annual scientific meeting. Convention center workers are now doing all of the prep work for a successful medical convention, including setting up the exhibit hall.
I think it is timely then to think about the relationships between pharmaceutical companies, individual physicians, and physician membership organizations like ACP. There are some who argue that the links between industry and physicians should be severed - no funding for CME, no exhibit halls, no gifts, no free drug samples, no drug company symposia, nada. Others argue for a balanced approach, one that recognizes that industry support for CME and other professional activities can support a public good (such as making it possible for physicians to have access to top-notch CME at relatively low cost to them) but with controls over the inherent conflicts of interest that may be created.
The current issue of Health Affairs offers two interesting perspectives. Jonathan Han, MD, a family physician, writes about the unintended harm to indigent patients that resulted when his academic medical center prohibited distribution of free drug samples. His institution ended up backing off from an outright ban, cobbling together what Dr. Han calls a "morally suspect compromise" to ensure that patients get the medications they need. "It's ... untenable for doctors and other health care providers to be put in a position where you're damned if you do - and patients die if you don't," he laments.
Melinda Morton, a medical student, eloquently writes about her struggle in keeping her resolve not to accept free lunches and drug samples at her academic medical center, given what she calls the "pervasive" presence of freebies from drug companies.
For its part, the American College of Physicians continually re-examines its policies relating to physician-industry relations, and makes sure that every activity at its scientific meeting is fully in accord with such policies. ACP's current policy "strongly discourages" acceptance by individual physicians of industry gifts and calls on physicians "to gauge regularly whether any gift relationship is ethically appropriate and evaluate any potential for influence on clinical judgment. In making such evaluations, it is recommended that physicians consider such questions as 1) What would the public or my patients think of this arrangement? 2) What is the purpose of the industry offer? 3) What would my colleagues think about this arrangement? 4) What would I think if my own physician accepted this offer? In all instances, it is the individual responsibility of each physician to assess any potential relationship with industry to assure that it enhances patient care and medical knowledge and does not compromise clinical judgment."
Another ACP policy paper discusses the organizational relationships between physician organizations and industry. This paper says that acceptance of industry support from CME and other medical society activities is acceptable within strict guidelines to ensure the objectivity and transparency of any activities funded.
It is one thing to take the broad brush stance that acceptance of support from industry should be verboten, but bans can have unintended adverse consequences for patients, as Dr. Han found when his indigent patients could no longer get the free drug samples they depended upon. A premier scientific meeting like ACP's clearly services a public good (helping doctors keep up-to-date in their clinical knowledge and skills), and drug industry support, within strict guidelines, helps keep the meeting affordable. If industry support for CME was to be prohibited, I wonder where the money would come from to allow internists to continue to have access to CME at a price they can afford.
Today's questions: Should physicians be prohibited from distributing free drug samples to patients? What about drug industry support for CME programs like ACP's scientific meeting?