A paper in the Archives of Ophthalmology published yesterday suggests that something has to change about the way the profession interacts with the pharmaceutical industry. Since a symposium on physician–industry relations in May 2008, a group of authors from the American Ophthalmological Society have taken a long, hard look at their interactions with industry and how those can interfere with their obligations as practitioners and teachers.
Moving through the five roles that ophthalmologists play in medicine — practitioner, researcher, academic physician, teacher, and member of a professional organization – the authors discuss the dynamics and problem of bias in all the major areas of industry influence: drug reps, samples and gifts; speakers’ bureaus, continuing medical education support (CME), medical advisory boards, and research relationships.
“To preserve our professionalism, it is clear that changes must be made in ophthalmologist-industry relationships,” the authors write. Sensibly, the authors acknowledge the advantages of working with the pharmaceutical industry – namely innovation for better patient care – rule out full divestiture from industry relations as a practical way to eliminate bias.
“[W]e do not live in an idealist’s vacuum. There are clearly advantages to maintaining communication and collaboration with industry that result in improved patient care. However, relationships that cede to industry the research and continuing medical education (CME) agendas should be averted. In short, we must modify our dealings to enable ophthalmologists to regain and retain the public trust.”
But they reaffirm that in daily therapeutic decisions, “[t]he ophthalmologist’s duty is to the patient when making those choices.”
The authors conclude with a statement of principles, and we think they get it right (bolding ours).
1. Ophthalmologists are professionals. We are given a place of value in society, with society’s trust. Our first consideration must be the patient’s welfare, and we must consider the needs of society. The same is true of our professional organizations.
2. Taking gifts and other items of value from pharmaceutical companies can change a physician’s perspective and behavior. Although we often believe that we are immune, studies have clearly shown that our prescribing practices and other aspects of our behavior are influenced by receiving these gifts.
3. We are not entitled. Nothing we did during medical school, internship, or training entitles us to such gifts as free meals, reduced registration fees, and paid travel.
4. We accept additional professional responsibilities when we teach or perform research. Both are founded on seeking of scientific truth to care for our patients.
5. We and our organizations should not be marketers for the company. This compromises our professionalism.
6. The fundamental mission of for-profit pharmaceutical companies and device manufacturers is not charity. When they give away money, rarely is it for the welfare of humanity but to influence behavior to improve their profitability. This is their duty to their stockholders and owners.
7. If we do not behave as professionals, government bodies and society will impose on us regulations that will be onerous. We stand to lose our valued place in society.
Oh, and we liked reading this, too: The American Ophthalmological Society does not now and has never taken any monies from industry to support its annual meeting or for its publication, Transactions of the American Ophthalmological Society.
The Archives paper signals growing momentum among professional medical associations (PMAs) to re-examine and redefine their relationship with the pharmaceutical and medical device industry. In JAMA in April of this year, current and former specialty society leaders laid out ten recommendations to move PMAs toward a zero-dollar reliance on industry, including an immediate interim cap on using industry funding for no more than 25 percent of a society’s operating budget, banning all industry satellite symposia and branded promotional items from conferences and annual meetings, establishing a central fund into which all industry research and education funds would go to be distributed by a conflict-free committee, and requiring that members of committees that write guidelines have zero-dollar financial interest in any company whose sales might be affected by the guidelines.
-Kate Petersen, Postscript blogger