NEWS - Medical societies, individual docs question impact of pharma industry funding

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Medical societies, individual docs question impact of pharma industry

funding

Apr 4, 2005

Rheumawire

Janis

San Francisco, CA - The speech of outgoing American College of Rheumatology

(ACR) president Dr Wofsy (University of California, San Francisco and

VA Medical Center, San Francisco) at the 2004 ACR annual meeting departed

dramatically from the usual bland fare of association remarks and attacked

head on one of the most contentious areas in medicine: the role of

pharmaceutical-company money. That speech was published in the February 2005

Arthritis & Rheumatism and joined a widening chorus of critics from many

branches of medicine [1].

" The pharmaceutical industry spends over $21 billion in the US each year to

influence what we think, what we teach, and what we do. That is more than

they spend on research and development, more than is spent in this country

on medical school and training combined . . . and over $25 000 per

physician, " Wofsy said.

Wofsy questions effect of ACR dependence on pharma money

" 't is not my intent to critique the pharmaceutical industry

. . . Rather, I want to focus on what it means for a society of health

professionals to depend so heavily upon their largesse, " said Wofsy.

His remarks centered on pharma funding of ACR programs and services but also

included concerns about potential conflicts of interest for ACR leaders;

funding of rheumatology residents' salaries, research, and travel; and the

continuing upward leap of prescription-drug costs.

The massive funding is possible because pharmaceutical companies have

developed new arthritis drugs that are both more effective and more

expensive than previous agents. Wofsy noted that as recently as 1998 the

" unchallenged standard of care " for rheumatoid arthritis (RA) was

methotrexate, with annual sales of $141 million, and the highest-selling

prescription nonsteroidal anti-inflammatory drug (NSAID), naproxen, had

sales of $490 million.

" Since then, there have emerged 5 billion-dollar drugs in rheumatology that

have been the focus of the most aggressive advertising campaigns this side

of Cialis, " Wofsy writes.

What's for sale?

A certain portion of that cash deluge has become a funding stream for the

ACR and other medical associations. According to Wofsy, the 5 main sources

of income for the ACR are pharmaceutical support (34%, including journal ads

and exhibit hall fees), meetings (31%), journals (12%), investments (13%),

and dues (10%). " With this much money on the table, we have an obligation to

be clear about what is for sale and what is not for sale, " Wofsy says.

With that in mind, the ACR board recently approved a policy that will limit

the amount the ACR accepts from pharmaceutical and medical-device companies

to no more than 49% of the ACR's overall income. The board also adopted a

policy designed to prevent the ACR from becoming overly dependent on support

from any single company.

The ACR is not alone in capping the amount of drug company money it will

accept. In 2002 the Society of General Internal Medicine adopted even an

even more restrictive policy, limiting combined pharmaceutical funding to

not more than 10% of the association's operating budget. Subsequently,

sponsorship of the group's annual meeting by drug companies fell by almost

70% [2].

Wofsy's list of things " not for sale " at the ACR includes " our leadership,

our young, our political principles . . . [and] our silence. " He notes that

potential ACR leaders have long been the subject of interest from industry,

and the ACR recently adopted a formal conflict-of-interest policy for the

president and president-elect that is more restrictive than the ethics

guidelines for members. An ACR task force has also recommended that the

association not enter into sole-supporter agreements with drug companies for

programs designed for rheumatology trainees but instead solicit support from

multiple companies to contribute to a new " ACR Fellows Education Fund. "

To a large degree, current concern over the impact of pharma-industry

largesse tracks back to a meta-analysis Dr Wazana (McGill University,

Montreal, QC) published in the Journal of the American Medical Association

in 2000 [3]. Wazana found that, although physicians remained steadfastly

convinced that their judgment and practices were unaffected by interactions

with industry, this was not quite the case. According to Wazana, after

meeting with a pharma representative, resident physicians were more likely

to ask that the company's drug be added to the hospital formulary and to

favor the company's drug over better (and generic) alternatives. Physicians

who attended drug-company-sponsored CME programs or accepted funding for

travel to other educational symposia were likely to increase their rate of

prescribing the sponsor's drugs. " Attending presentations given by

pharmaceutical-representative speakers was also associated with nonrational

prescribing, " Wazana reported.

Physicians increasingly questioning drug-company gifts

Beginning in January of 2004, pursuant to an agreement between the National

Health Service and the pharmaceutical industry, doctors in Scotland are

required to report to an official, publicly available registry any links to

pharma companies, including shareholdings, lecture fees, payments to attend

meetings, and research grants [4]. This move is the first government

regulatory initiative related to a fast-growing grassroots movement among

physicians themselves questioning the effects of industry money on the

practice of medicine.

The most strident of these critics urge complete refusal of nearly all such

funding. The highest-profile physician group behind the " divestment " move is

No Free Lunch, which began in the US and Canada and now has extensions or

sibling organizations in the UK, Italy, France, and Australia. The group

urges physicians to take a pledge to be " free of company money and influence

in clinical practice, teaching, and research " and sponsors a " pen amnesty

program " through which doctors hand in drug-company pens and receive a " No

Free Lunch " pen in exchange.

The American Medical Students Association has launched a spin-off group,

encouraging fellow students to sign a " PharmFree " pledge and holding

periodic PharmFree days calling for an end to pharma-company gifts, lunches,

sponsored education, and paid speaking engagements. The students have also

produced a " model oath for the new physician " that includes the vow, " I will

make medical decisions . . . free from the influence of advertising or

promotion. I will not accept money, gifts, or hospitality that will create a

conflict of interest in my education, practice, teaching, or research. "

Sources

Wofsy D. Living in a different world. Arthritis Rheum

2005; 52:395-401.

Moynihan R. Who pays for the pizza? Redefining the

relationships between doctors and drug companies. 2: Disentanglement. BMJ

2003; 326:1193-1196.

Wazana A. Physicians and the pharmaceutical industry. Is a

gift ever just a gift? JAMA 2000; 283:373-380.

NHSScotland. A common understanding: Guidance on joint

working between NHSScotland and the pharmaceutical industry. ish

Executive: Edinburgh, Scotland, 2003. Available at:

http://www.scotland.gov.uk/library5/health/gojw-00.asp

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org