Biting the hand that feeds them?

Biting the hand that feeds them?An article in tomorrow's JAMA (Health Industry Practices That Create Conflicts of Interest) takes a dim view of pharmaceutical company practices that influence physicians. The authors call for the prohibition or major modification of many standard industry practices. The rationale for their radical suggestions: even small gifts affect behavior and disclosure of conflicts is not a sufficient remedy.They recommend:

• Banning gifts of any size or amount
• Replacing samples with vouchers for low-income patients
• Banning physicians with drug company relationships from serving on formulary or device purchasing committees. (They note that such physicians are more likely to recommend inclusion of products.)
• Prohibiting support of accredited Continuing Medical Education (CME) programs
• Banning direct funding of physician travel
• That faculty members of academic medical centers not serve as members of speakers bureaus
• Shifting consulting contracts from no-strings attached arrangements to contracts with specific deliverables that are not related to marketing

These recommendations are not likely to be accepted, at least in the short run. If they are adopted, there will be a significant shakeout as whole industries --including CME companies whose entire funding comes from pharma companies-- and job categories within the pharmaceutical industry are eliminated.At a minimum, this article will provoke discussion and awareness among physicians of the motivations and pitfalls of industry marketing efforts.