Thursday, April 26, 2007

New England Journal Study Shows Widespread Relationships of Physicians with Industry

The Institute on Medicine as a Profession at Columbia University is rapidly establishing itself as the 800-pound gorilla of the forces in medicine concerned about pharmaceutical industry influence. Their latest salvo comes in the form of a survey of about 3100 physicians in six different medical specialties, published in this week's New England Journal of Medicine, and available on line: For press coverage, see:,1,3419565.story (cannot guarantee how long this latter will remain up on the web).

The main take home message is that this is the first large-scale national survey of physicians conducted since the much touted PhRMA code of ethics went into effect in 2002, and supposedly put the kibosh on some of the more generous and outrageous forms of gift-giving. The authors of the study are appropriately cautious in drawing conclusions--after all, they did not do a before-and-after comparison survey--but imply that the "code of ethics" has not been very effective in altering the landscape of massive influence of the drug companies.

The major findings of interest: 94% of physicians surveyed took one form of benefit or another from industry; the most common were food in the workplace (83%) and "free" drug samples (78%). Twenty-eight percent received some form of payment, mostly for consulting or serving on a speaker's bureau. Among the specialties, monthly contacts with industry representatives ranged from a high of 16 by family docs to a low of 2 among anesthesiologists. Docs in solo or private group practices reported more contacts with industry than docs in hospital or staff-HMO settings.

My fellow family physicians had more contacts with the industry per month than any other specialty but were paid considerably less often than cardiologists. (Maybe we should up our rates.)

One message that I think comes through loud and clear from this survey, despite its various limitations (the response rate, for example, was 52%, which is about par for the course in trying to get harried physicians these days to fill out surveys), is the factoid of 28% being paid as consultants or speakers. Could it really be the case that fully a quarter of all physicians have so much specialized knowledge, and stand out so much from their peers, that they are appropriate recipients of company fees for these services? Or are such fees really a disguised way of giving company cash gifts to physicians who are both high prescribers, and willing to do the company's bidding by trying to persuade their peers to do likewise?

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