The recent Institute of Medicine (IOM) report on the relationship between physicians and the drug industry shows how far we've come in the last few years, and how far we still have to go. In 2006, ten leading academicians and the head of the Association of American Medical Colleges (AAMC) criticized the conflicts of interest that many physicians and clinical researchers had because of their financial relationships with pharmaceutical companies. They called for "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."
Of course, most academic medical centers were (and still are) recipients of drug company largesse. So at the time, few institutions would even comment on the article, let alone act on its advice. (Courageous exceptions included Stanford, Yale, and the University of Pennsylvania.) Now, in the wake of scandals that have motivated health care systems, medical societies, Congress, and even the drug industry to reduce the conflicts of interest, the IOM has weighed in with a report that essentially endorses all of the recommendations that the academic thought leaders made three years ago. The question is, do they go far enough?
Take the IOM's recommendation that physicians accept drug samples only to help patients who can't afford the medications. That sounds good in theory, but how is anyone to know why a doctor accepts drug samples? Samples have become institutionalized in American medicine and are frequently handed out to reinforce patient loyalty. Certainly, no drug rep who has been admitted to a physician's inner sanctum is going to tell anyone that the physician is giving out samples to patients who can afford to pay. And once they start on a drug, they're likely to stay on it.
Here's another example: The IOM says that "the current system for financing accredited continuing medical education relies too heavily on industry support and needs to be overhauled to be free of industry influence and provide high-quality education." One member of the IOM panel that wrote the report, Dr. Neil R. Powe of San Francisco General Hospital, suggested that the drug industry could contribute to "pools of unrestricted funding that don't drive the particular content of that education."
That's a good idea, and the Accreditation Council for Continuing Medical Education (ACCME) is reportedly looking into it. The ACCME is also seeking new ways to ensure that CME is free of commercial influence and that only individuals who have no ties to the industry conduct medical seminars. But it's hard to find academic experts who have received no money from drug companies, and the ACCME "Standards for Commercial Support" of CME already spell out how to maintain an arm's-length relationship between medical education and those who sponsor it. None of this, so far, has had the slightest effect on the ability of pharmaceutical companies to influence physicians. Just go to any major clinical conference and look at the traffic winding through the myriad booths of drug manufacturers. Or attend a symposium or dinner meeting sponsored by Big Pharma.
The fact is, the medical societies and other organizations that put on CME conferences need drug industry support to make their events economically viable. If physicians were willing to pay higher dues to professional societies, or to get most of their CME online, pharmaceutical companies might be prevented from persuading them to prescribe their latest and greatest products. But neither of those possibilities is likely to occur, and the odds of drug companies making unrestricted grants are not great. So the IOM and other parties will continue to bash away at conflicts of interest, but they will probably always be with us.