During the past 10 to 20 years, there has been a growing intrusion of pharmaceutical companies and medical device makers into the day-to-day practice of medicine. Industry gifts—pads, pens, logo bags, and the like—have grown commonplace. In many doctors’ offices, hospitals, and medical centers, the free lunch, courtesy of industry sponsors, has turned into an accepted way of life. And these gifts can also include dinners at expensive restaurants (to hear a lecture by a physician also being compensated by industry) or free travel to meetings at fancy resorts (to participate in a medical education event sponsored by industry).
That is not to say I don’t value our relationships with the pharmaceutical industry. Indeed, we depend on our industry partners to carry the fruits of our research to market. At the same time, data increasingly show that even small gifts influence the drugs physicians prescribe. On a larger scale, physicians who serve as paid consultants to industry are more likely to recommend the approval of a drug or device to the FDA than those not receiving consulting fees.
In 2005, I appointed a faculty task force to develop a policy on how Stanford should ensure that our relationships with industry are ethical and appropriate. In October, 2006, we enacted a policy across the Stanford University Medical Center campus, prohibiting our faculty members from accepting gifts of any kind, however small, anywhere on the medical campus or at off-site facilities where they may practice.
It also bars industry sales and marketing representatives from wandering the hallways of our two hospitals and our laboratories, and prevents companies from directly paying for meals in connection with educational programs—once a fairly common practice. It requires that those involved in the decision to buy formulary drugs or clinical equipment disclose any related financial interests.
We are also developing guidelines for physician participation in “speakers bureaus,” which offer generous honoraria from companies for taking part in presentations related to company products.
Since our policy went into effect, many other academic medical centers have followed suit. As we train the next generation of physicians under these new standards, we will sow the seed for what could be a wholesale cultural change in the U.S. medical profession.
U.S. physicians are committed to quality health care. It’s part of the oath they take. So, despite what critics say, it’s insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary. What’s more, there are regulations and a comprehensive industry ethics code to help make sure information about new treatments provided by America’s pharmaceutical research companies is accurate and well-substantiated.
Existing federal law is very clear: Pharmaceutical research companies and their technically trained representatives, including some health-care professionals, must not give physicians anything of value in exchange for the doctors writing prescriptions for their medicines. The companies must also ensure that information they convey to physicians is consistent with pharmaceutical product labeling approved by the Food & Drug Administration. The fact is, federal and state authorities, including the FDA, the Justice Dept., and state Attorneys General are closely monitoring for improper activities.
For its part, the Pharmaceutical Research & Manufacturers of America (PhRMA) sponsors ethical guidelines to keep communications between its member companies and physicians focused on proper use of medicines and the needs of patients. The PhRMA ethics code says all forms of entertainment are inappropriate and only modest meals—such as sandwiches—should be provided when doctors meet with pharmaceutical research companies. Additionally, our code says items given to physicians should not exceed $100 in value and should be things, including stethoscopes and medical dictionaries, that benefit patients or support a medical practice.
In the end, it’s clear pharmaceutical research companies have the most extensive information about new medicines. After all, they devote 10 to 15 years and spend nearly $1 billion to develop just one new medicine in a process that generates thousands of pages of scientific data.
To us, the evidence is compelling: Physicians meeting with well-trained company representatives gain crucial knowledge about side-effect profiles and proper use of medicines. And when doctors are given free pharmaceutical samples, they receive valuable firsthand experience that helps them decide which medications to prescribe. The simple fact is company representatives help physicians provide effective patient care. And that often saves lives.Opinions and conclusions expressed in the BusinessWeek.com Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.
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