Most Physicians Seen to Have Industry Relationships

BY MARY ELLEN SCHNEIDER

Nearly all physicians have ties to the pharmaceutical or device industries ranging from accepting drug samples to serving on a speakers' bureau, according to a survey of physicians across six specialties.

The study found that 94% of physicians surveyed reported some type of relationship with industry. The most frequently cited interaction (83%) was receiving food in the workplace. A majority of physicians surveyed (78%) also reported accepting drug samples.

MOST FREQUENTLY CITED (83%) WAS RECEIVING FOOD IN THE WORKPLACE. A MAJORITY (78%) ALSO REPORTED ACCEPTING DRUG SAMPLES.

Fewer physicians, about 35%, reported accepting reimbursement for admission to continuing medical education (CME) meetings or other meeting-related expenses, and 28% said they received payments from industry for their professional services such as consulting, speaking, serving on an advisory board, or enrolling patients in clinical trials (N. Engl. J. Med. 2007;356;1742-50).

Physicians contacted by this news organization said that while the study raises important issues, it is not a cause for alarm since many of the industry interactions outlined in the study are essential and appropriate.

Eric G. Campbell, Ph.D., of the Institute for Health Policy at Massachusetts General Hospital-Partners Health Care System in Boston, and his colleagues surveyed 3,167 physicians working in the fields of anesthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics.

Of those physicians who were surveyed, 1,662 completed the questionnaire for an overall response rate of about 52%, he said. The study was supported by a grant from the Institute on Medicine as a Profession.

The type and extent of reported interaction with representatives of the pharmaceutical and device industries varied by specialty, the researchers found. For example, cardiologists were more than twice as likely as family physicians to receive payments for professional services, such as consulting or work on clinical trials.

Family physicians held the most meetings with industry representatives, on average about 16 meetings per month, according to the study.

Practice setting also was seen to play a role in the interaction between physicians and industry. Physicians in group practice, for example, were six times more likely to receive drug samples than were those physicians who worked in hospitals, clinics, or staff-model health maintenance organizations.

Physicians in group practice were also three times as likely to receive gifts and nearly four times as likely to receive payments for professional services.

The study did not assess the appropriateness of the relationships with industry; however, the researchers concluded that the variations in relationships by specialty may indicate a need for guidelines that are specific to specialties and various practice settings.

In an interview, Dr. James King, president-elect of the American Academy of Family Physicians, said, "I don't think it's a major cause for concern."

Additionally, Dr. King said he was not surprised by the survey findings, especially since it is a common practice for physicians to accept drug samples in an effort to save their patients money.

Most practices are likely operating within guidelines set out by the American Medical Association, he said.

The AMA guidelines recommend that gifts to physicians should primarily have a benefit to patients and not be of substantial value.

For example, modest meals and textbooks are acceptable under the AMA guidelines, but cash payments should not be accepted.

However, the relationship with industry should still continue to be watched and addressed, said Dr. King, and he recommended that physicians review their own ethical guidelines from time to time and that they should refuse to accept any gift that they believed would inappropriately influence their prescribing habits.

The main responsibility of physicians who do have relationships with industry is to ensure that patients' interests always come first and to disclose any financial conflicts, Dr. Jack Lewin, CEO of the American College of Cardiology, said in an interview.

For example, ACC has a policy requiring disclosure of industry relationships for anyone who is involved in the group's activities, he said. "We really do have a firewall."

However, many of the relationships between cardiologists and industry are necessary and appropriate, he said, since industry is the main source of research on new treatments.

But more can still be done to reduce the concerns about potential conflict of interest, Dr. Lewin added.

For example, an increase in the number of publicly funded independent reviews of drugs and devices and increases in federal research funding would help to clarify some of the gray areas of cardiovascular care, he said.