No More Free Lunches

Elyas Bakhtiari, for HealthLeaders Media , December 18, 2008

Let's conduct a quick, unscientific survey. Pick a day this week to take note of every time you come across a drug or device company's branding at your practice or hospital. On your pen, maybe? On the coffee mug you're drinking from right now? On the stationary in the briefcase carried by the pharmaceutical representative who's waiting in your lobby?

Physicians' relationships with industry, pharmaceutical companies in particular, have gotten a lot of attention and scrutiny this year. State and federal government officials, as well as industry representatives, are increasingly clamping down on improper financial exchanges.

And to be fair, both parties have made some significant strides toward improving transparency and setting up some basic ground rules.

The Pharmaceutical Research and Manufacturers Association, which represents the country's top pharmaceutical research and biotech companies, adopted a voluntary code that goes into effect next week which lays out what reps should not do—give non-educational items as gifts, take doctors out for meals, and so on. On the flip side, the AMA has ethical guidelines for physicians (also voluntary) outlining what types of gifts physicians should refuse.

On the transparency front, the Cleveland Clinic recently announced that it would begin publicly posting all of its physicians' financial relationships. And several states, including most recently Massachusetts, are either investigating or are in the process of passing laws that will require public disclosure of doctor-industry ties.

But these steps are only a start. There are relationships far more nefarious than gift exchanges that still need to be addressed, including payments for articles in medical journals that endorse a particular therapy or drug. Just last week Sen. Charles Grassley, R-IA, sent letters to pharmaceutical company Wyeth as part of an investigation into the company's involvement in medical ghost writing.

These issues are a ticking public relations time-bomb for physicians. In an era of growing transparency and consumerism, each revelation about a handful of physicians profiting from industry ties erodes the public's trust in all physicians.

There are two ways this can play out. Physician organizations can take the initiative to clean up the problem themselves—and we're already seeing some of that from Cleveland Clinic and the AMA. Or, they can ignore the festering problem until the government brings down the hammer. We'll probably see more state governments move in this direction in 2009, and Grassley and others want to address it on a federal level at some point.

I recognize that there are valid reasons for doctor-industry relationships and that not all ties are inappropriate. But the public's tolerance for the interactions that do cross the line is dropping, and we're headed toward more disclosure and regulation of these relationships one way or another.

Physicians will be better off in the long run if they take the lead in making that happen.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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