Too Cozy

Pharmaceutical companies and medical device manufacturers have gotten too cozy with professional medical associations, threatening the integrity of continuing education programs and research, according to a paper published Wednesday in the Journal of the American Medical Association.

The paper, “Professional Medical Associations and their Relationships with Industry: A proposal for Controlling Conflict of Interest,” outlines a series of steps associations should take to separate themselves from the marketing efforts of private companies. Specifically, the paper suggests medical associations completely ban funding from industry, except for income from journal advertising and exhibit hall fees at conferences. The paper allows for these two exceptions because members can “easily distinguish these marketing activities from educational presentations and are free to ignore them."

David Rothman, one of seven of the paper’s authors, said in a telephone news conference Wednesday that the authors’ shared goal is to ensure that medical education and medical advice are not inappropriately influenced by private industry.

“We’re really asking for divorce,” Rothman said.

To erase real and perceived conflicts, the paper urges leaders of professional medical associations to be “completely conflict free during their tenure,” giving up any personal income or research money provided by industry.

The paper raises particular concerns about increasingly standard practices in the world of continuing medical education, which physicians are required to receive throughout their careers. It is now common for pharmaceutical and medical device companies to sponsor their own symposia, which doctors can attend for education credit, the paper says. Dr. Steven Nissen, one of the paper’s authors, said such conferences create a clear conflict of interest because they are often merely veiled marketing pitches. Physicians gather to discuss a medical problem, and the treatment is “almost always geared towards the sponsors’ drugs,” Nissen said.

“Those [conferences] are packed, particularly when there’s a free meal involved,” he said.

To boost attendance, companies frequently hold their symposia around the same time and at the same location as meetings for professional associations. The paper’s authors suggest associations not “endorse, facilitate, or accept funding” for these parallel conferences sponsored by industry.

“It’s really a matter of dollars and cents,” Nissen said. “Industry provides money for education because it furthers their marketing goals.”

The role drug companies play in medical education has received increasing scrutiny. At the University of Wisconsin-Madison, for instance, questions have been raised about companies funding education courses that promote their own products while downplaying the drugs’ side-effects, The Milwaukee Journal-Sentinel reported Sunday.

Sen. Charles Grassley, an Iowa Republican, has been particularly critical of ties between doctors and companies. The pressure from Congress and the public may be having an impact. On Wednesday, Stanford University announced a new policy that would require faculty to disclose financial ties to drug companies.

The Accreditation Council for Continuing Medical Education has some standards for continuing education programs, including a prohibition on industry choosing speakers for continuing education events. That regulation, however, isn’t enough, according to the paper. Professional medical associations should create their own committees, with members “free of all industry ties,” to select program topics and speakers, the paper suggests.

With regard to medical research, the authors suggest private industry not be permitted to provide grants for a specific project or influence data. The perception that companies have interfered in the research process has tarnished the public trust in medical research and the profession as a whole, the authors argue.

The paper suggests professional medical associations gradually wean themselves off of industry support, reducing contributions to no more than 25 percent of total operating revenue immediately. Over an unspecified time frame, the authors argue, industry funding should be reduced to zero.

It’s unclear to what extent pharmaceutical and medical device companies fund these associations, but the authors suggest the support is considerable. In other words, giving up these dollars won’t be easy.

“The recommendations are rigorous and will require many PMA’s to transform their mode of operation and perhaps give up activities of considerable value,” the paper states. “To maintain integrity, sacrifice may be required.”