Imagine the outrage of basketball fans if they learned that the referees in the championship game were being paid by one of the teams. People would be equally upset if they discovered that a judge had a financial interest in a case before the bench.
We expect umpires and judges to be impartial. They must make their decisions based on the evidence and they must completely avoid any conflict of interest. Were they to get caught accepting money, they would be fired or prosecuted.
Physicians are also expected to avoid conflicts of interest. A patient’s treatment should be selected on the basis of objective evidence. Too often, however, influential doctors take money from drug companies.
Until recently, such payments have been secret. But several states have enacted legislation requiring drug companies to disclose payments to doctors.
A new study in the Journal of the American Medical Association (March 21, 2007) examined these records in two states. The researchers found that in Minnesota, more than 7,000 payments were reported over three years (2002 through 2004).
More than $30 million was designated for speaking, research, consulting and education. Nearly half the funds, however, were for unspecified purposes. In Vermont, more than half such payments were not disclosed, on the grounds that they were “trade secrets.”
According to an investigative report in the New York Times, nearly one out of every five licensed doctors in Minnesota received a payment between 1997 and 2005. The median amount was $1,000. More than 100 people took in over $100,000.
The American Medical Association recommends that drug companies limit their gifts to doctors to no more than $100. But there are no limits on payments for speaking or consulting. Many physicians, especially opinion leaders, are paid hundreds of thousands of dollars by the pharmaceutical industry.
Such influential physicians are often the very ones who write guidelines on how to treat serious conditions such as heart disease, diabetes or kidney disease. They frequently tell their colleagues which are the best medications to prescribe.
Many of these same respected clinicians and researchers sit on advisory panels for the FDA. They influence which drugs get approved for sale and which do not.
Most doctors who take money from drug companies maintain that these gifts or payments do not affect their treatment decisions. But the JAMA study noted that research has shown prescribing patterns are influenced by financial relationships with drug companies. Pharmaceutical marketers do not throw away money. They realize that when doctors are sent to beautiful resorts and paid to speak or consult, they are more likely to prescribe the company’s products.
Do patients know about these cozy relationships? Most doctors in Minnesota didn’t feel it was necessary to reveal their drug company ties. But a New York Times/CBS News poll found that 85 percent of the public believes this kind of payment is inappropriate. They also think it would influence doctors’ prescribing.
It is unacceptable for judges, umpires or other professionals to take money that could influence their decisions. Shouldn’t we hold physicians to the same standards?
