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Industry-health relations topic of
Pitts
by Mary
Helen Yarborough
Public
Relations
The Fourteenth Annual Thomas A. Pitts Memorial Lectureship in Medical
Ethics will focus on whether industry and health professionals should
enjoy a relationship or become estranged.
“Dangerous Liaisons? Industry Relations with Health Professionals,”
will be held Sept. 7-8 at the Charleston Riverview Hotel, and will
feature the nation’s foremost authorities, critics and proponents of
the industry/health relations controversy.
Visit http://www.values.musc.edu/.
The topic was the subject of media and congressional debate by the U.S.
Senate’s Special Committee on Aging June 27 (see http://aging.senate.gov/hearing_detail.cfm?id=277848&),
when lawmakers were considering whether doctors and health care centers
should, among other things, provide a record of drug makers’ gifts.
Some teaching hospitals; including Yale, Stanford and University of
Pennsylvania; have banned access by representatives of pharmaceutical,
medical equipment and device-making industries. MUSC is
con-sidering a similar ban.
The ongoing debate is whether industry’s influence on health care
professionals in education, research, and patient care is
positive or negative, said Robert Sade, M.D., the lectureship series
director since 2000. Direct-to-consumer advertising, for
instance, has faced constant opposition by the general medical
community and members of Congress because of perceived undue influence
to patients.
“Most of the medical community is opposed to direct-to-consumer
advertising because physicians believe they should be the ones to
decide on prescription drugs,” said Sade, who also is the former chair
of the American Medical Association’s ethics panel. Sade also testified
before the U.S. Senate on the issue as a representative of the AMA.
The AMA had called for a moratorium on direct-to-consumer advertising
of new products, but it failed to materialize, Sade said.
“I believe a moratorium is not a good idea,” Sade said. “A doctor
should have enough spine to prescribe a more appropriate product in
spite of what a patient thinks he wants.”
Sade said that advertising may be having a positive impact by prompting
patients to ask their doctors questions. But the doctor should assert a
professional opinion based on science.
Physicians also should not make medical decisions based on their own
financial interests, Sade said in testimony before the Senate panel. He
said that the AMA has clear guidelines on the behavior of doctors, and
that a ban on the industry-doctor relationship is unnecessary.
“…Physicians must not place their own financial interests above the
welfare of their patients, and their medical recommendations must not
be inappropriately influenced by financial considerations,” Sade said.
“Accordingly, it is unethical for a physician to unnecessarily
prescribe a drug for financial benefit; rather, prescriptions must be
based on the best medical interests of patients. This requires that a
physician's prescribing be consistent with the latest scientific
information and consistent with the physician’s best medical judgment.”
Sade said that prescribing decisions are heavily dependent on the
quality of the scientific information available, provided to them, in
part, by industry and federal regulators.
“There is a clear need for interactions between physicians and the
pharmaceutical industry to ensure the free flow of valid scientific
information,” he said. “When the information is accurate and complete,
physicians have the necessary tools to make the right prescribing
decisions. If infor-mation is not properly provided by an industry, or
if physicians never receive such information, necessary and appropriate
medical care can be jeopardized.”
The AMA has developed ethical standards to guide physicians in their
interactions with industry, particularly in relation to the direct
interaction of pharmaceutical representatives with physicians, Sade
said.
Whether doctors should receive gifts from industry depends on the
nature and size of the gift. “Gifts accepted by physicians should
primarily entail a benefit to patients or be related to the physician’s
work and should not be of substantial value,” Sade said. The AMA code
explicitly prohibits gifts to physicians with strings attached, such as
a gift in exchange for a promise to prescribe a certain drug to
patients.
All gifts are not inappropriate, however, as long as they benefit the
patient. For example, drug samples that are provided free to patients
who need them and would otherwise not have access to these drugs
benefit patients.
Meanwhile, the AMA is developing a series of educational programs for
medical students and physicians to promote the importance of sound
prescribing. Partly funded by the state Attorneys General of the United
States, these programs build on previous AMA efforts to educate
physicians about their ethical responsibilities in making
cost-effective prescribing decisions and how they can minimize and even
eliminate undue influence by industry marketing and promotional
practices, Sade said.
“Special attention is given to the next generation of
physicians—medical students and resident physicians—in addressing this
important issue, especially because interactions with industry often
start very early in a physician’s professional career,” he said.
The
lectureship
Set up as a series of four debates, noted experts on both sides of
controversial issues will focus on the alleged conflicts of interest
that have existed between health professionals and industry. Featured
subjects will include regulations and biomedical research, gifts from
industry to health care professionals, direct-to-consumer advertising,
and industry support for medical education.
Speakers include:
Majorie Powell
Powell is the senior assistant general counsel for the Pharmaceutical
Research and Manufacturers of America (PhRMA), a trade association
representing pharmaceutical and biotech companies. Powell contends that
the pharmaceutical industry has self-imposed a code of ethics that she
said has reined in inappropriate gifts to physicians and severely
limited what is allowable. In previous debates, she has argued in favor
of Medicare drug benefits to address the prescription drug crisis.
Powell has fought against government-imposed price controls, because
she said that the majority of new drugs are developed in the free
market of the United States, which also fuels research and development.
Powell has testified before Congress and has been featured in the
national media on the subject of industry-health care relations.
Howard Brody, M.D., Ph.D.
Brody is the director of the Institute for the Medical Humanities and
Professor of Family Medicine, and holds the John P. McGovern Centennial
Chair at the University of Texas Medical Branch, Galveston since May
2006. Previously, he was University Distinguished Professor of Family
Practice, Philosophy, and the Center for Ethics and Humanities in the
Life Sciences at Michigan State University. He has written numerous
articles and books, the most recent of which is Hooked: How Medicine’s
Dependence on the Pharmaceutical Industry Undermines Professional
Ethics.
Sigrid Fry-Revere, J.D.,
Ph.D.
Fry-Revere is the Cato Institute’s director of bioethics studies. She
focuses on legal and policy issues in the life sciences, and has been
published in the popular press, such as the Los Angeles Times, the New
York Times, and the Wall Street Journal, and in scholarly journals,
such as the Cambridge Quarterly of Healthcare Ethics, The Journal of
Clinical Ethics and the American Journal of Bioethics. She has taught
at the University of Virginia and George Mason University, and has
practiced health law.
Patrick J. Brennan, M.D.
Brennan is a professor of medicine at the University of Pennsylvania
School of Medicine and chief of Healthcare Quality and Patient Safety
at Penn Health System. A critic of industry-health care relationships,
he initiated restrictions on industry and their relationship with
health care providers at Penn. He also helped draft administrative
policies for Penn Health that forbid gift-giving by commercial
companies at any of the health system’s clinics and hospitals. The new
rules also require drug reps to register with the appropriate offices
and see doctors by appointment only. Freebies of any kind are not
permitted. He has argued that the practice of doctors giving out free
drugs is marketing, and not solely for patient benefits.
Peter Lurie, M.D., MPH
Lurie is deputy director of Public Citizen’s Health Research Group in
Washington, D.C., where he conducts advocacy in pharmaceutical policy.
He has held faculty positions at the University of California, San
Francisco and the University of Michigan. He has published papers on
such subjects as needle exchange programs, ethical aspects of
mother-to-infant HIV transmission, and HIV vaccine trials, in the
Lancet, New England Journal of Medicine, and JAMA. At Public Citizen,
his interests have included pharmaceutical policy, mental health,
occupational health, and international tobacco policies.
Bruce W. Lytle, M.D.
Lytle is chairman of Thoracic and Cardiovascular Surgery at the
Cleveland Clinic Heart Center. He has authored or co-authored numerous
articles and papers in leading scientific journals and book chapters in
textbooks on cardiovascular disease covering a wide range of topics in
cardiac surgery, and is an internationally recognized expert in cardiac
and thoracic re-operations and aortic surgeries. He currently serves as
President of the American Association for Thoracic Surgery, the
nation’s prestigious academic society for thoracic surgeons.
Paul H. Rubin, Ph.D.
Rubin is the Samuel Candler Dobbs Professor of Economics in the
Economics Department of Emory University and a Professor of Law and
Economics at the School of Law. He serves as editor-in-chief of
Managerial and Decision Economics. He served as Senior Economist at the
Council of Economic Advisers under President Reagan, chief economist at
the U.S. Consumer Product Safety Commission, and director of
Advertising Economics at the Federal Trade Commission. He has written
or edited several books, and has published over one hundred articles
and chapters on economics, law, and regulation. His most recent book is
Darwinian Politics: The Evolutionary Origin of Freedom.
Lance K. Stell, Ph.D.
Stell is the Charles A. Dana Professor and director of Medical
Humanities at Davidson College where he teaches ethics, philosophy of
law and clinical ethics. He holds a faculty appointment in the
Department of Internal Medicine at Carolinas Medical Center in
Charlotte. N.C. He publishes papers in ethics, medical ethics, and the
philosophy of law, and serves as a consultant to hospitals and
professional medical associations, on the Committee on Ethical and
Judicial Affairs of the North Carolina Medical Society, and on the
Grievance Committee of the 26th Judicial District of North Carolina.
Matthew K. Wynia, M.D., MPH
Wynia is the director of the Institute for Ethics at the American
Medical Association and serves as the executive director of the Ethical
Force Program. His research has focused on physicians’ responses to
market pressures in medicine, comparing the codes of ethics of medical
professional associations, exploring physician professionalism and the
role of professionals in society, and creating performance measures for
health care ethics. He is assistant professor of Medicine in the
Section of Infectious Diseases at the University of Chicago, and is a
recent president of the American Association for Bioethics and the
Humanities.
Friday, Aug. 31, 2007
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updated
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