A new campaign will urge US doctors, academic medical centres, medical societies, and other healthcare organisations to work together to end the conflicts of interests that result from ties to companies that make drugs and medical devices.
The campaign is funded by a two year, $6m (£3.1m; €4.6m) grant from the Pew Charitable Trusts. It will be organised by The Prescription Project, a new group working with Community Catalyst, a Boston healthcare advocacy group, and the Institute on Medicine as a Profession at Columbia University in New York (www.pewtrusts.com).
The campaign was sparked by an article last year in JAMA (2006;295:429-33), in which leading academics said, “More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts.
“We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.”
Robert Restuccia, executive director of The Prescription Project, said, “The prescribing practices of doctors are being influenced by billions of dollars in direct-to-physician marketing. When Americans visit their doctor and get a prescription, they should know he or she is relying only on the best medical information, not the latest marketing campaign.”
The Prescription Project says that US residents received 3.6 billion prescriptions in 2005—about 12.3 a person. National spending on prescription drugs is growing at double the rate of other health services and is approaching $200bn a year. In 2004 consumers paid out of their own pockets for about a quarter of prescribed drugs. Cost effective, evidence based prescribing would benefit many.
The project says it will “document the scope of the problem [industry influence] and its impact on healthcare quality and cost; collaborate with leading academic medical centers, physician organizations, public and private health plans, consumer organizations, and policy makers to promote best practices in prescribing; assist academic medical centers and professional medical societies in adopting policy reforms; and undertake a wide range of policy initiatives in partnership with public and private payers to increase the use of evidence-based systems and reduce conflicts of interest.”
Last year's JAMA article called on academic medical centres, including their medical schools and hospitals, to take the lead. They should prohibit all gifts, free meals, payments for travel or time at a meeting, and payments for participation in online continuing medical education to doctors by drug and device companies, it said.
Gifts of drug samples should also be prohibited. Formulary committees and committees overseeing the purchase of medical devices should exclude health professionals with ties to drug or device makers. Drug manufacturers should not be permitted to support continuing medical education directly or indirectly.
Instead, the article proposed that drug and device manufacturers give vouchers (rather than drug samples) for low income patients, contribute to a central fund to develop continuing medical education, and give grants to a central office to support doctors' travel to meetings and conferences.
Consulting with or accepting support for research from drug and device companies should not be prohibited because they are important for developing new treatments, the article said. Grants should be made to academic medical centres for general support of research, however, rather than to a specific person and should be listed on the institution's website.
The changes would result in decision making becoming more evidence based, greater use of generic drugs, and increased sensitivity of medical students and junior doctors to medical professionalism and scientific integrity, the article concluded.