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February 24, 2011

Physicians and Industry: Fix the Relationships But Keep Them Going

The practice of medicine involves establishing and maintaining interpersonal relationships with a number of individuals in the healthcare community. Important physician relationships include those with “family, patients, doctor colleagues, nurses, physician assistants, hospital administrators, office staff, trainees, students, lawyers, media folks, and accountants.”

Many of these relationships bring advantages or benefits to individuals or society without financial gain for any of the parties, such as talking with a fellow colleague in private practice, at an academic medical center or in a hospital.

On the other hand, some of these relationships may be related to financial gains, such medical doctors conducting clinical trials or research with drug and device makers. In these cases, physicians may have relationships with individuals representing corporations that produce medical devices, supplies, and pharmaceuticals.

As a recent article from Medscape explained, “having good relationships with others in a practice setting can help a physician or surgeon recruit patients, provide better coverage and consultation, and facilitate better patient care in many other ways.” Some of the most crucial relationships physicians have are with the pharmaceutical and medical device industry because these entities provide the ongoing education, research, information and clinical data on new breakthroughs and treatments that physicians can give to their patients.

However, in a recent Medscape article entitled “Physicians and Industry: Fix the Relationships, but Keep Them Going,” Frank J. Veith, MD noted that “a recent initiative to completely sever the relationship between industry and doctors has gained traction because of some flagrant abuses and excessive hidden financial rewards to physicians.”

Dr. Veith pointed out that “this initiative has been supported by several states, including Massachusetts and Vermont, and universities, such as Harvard, Stanford, the University of Massachusetts, and the University of Michigan, which have enacted draconian laws or policies designed to separate doctors and industry and to interrupt any relationship between them.” He also noted that the Senate Finance Committee and other states and universities are considering taking similar steps.

In addition, Dr. Vieth recognized that “many individual physicians have sanctimoniously jumped on the bandwagon and written articles or opinion pieces attacking the evils of any relationship between industry and doctors, suggesting the severance of any such relationships.” What is problematic about these authors—besides their lack of evidence that industry-physician relationships causes patients harm—is that “most professional and specialty societies have bowed to these attacks and have remained surprisingly mute in defense of the many benefits of such relationships.” Some groups, such as neurologists, electrophysiologists, surgeons, endocrinologists, and experts in multiple myeloma, have made strong statements supporting the value of physician-industry relationships and collaboration.  Nevertheless, Dr. Vieth explains that “the initiative to separate industry from physicians and surgeons has taken on the trappings of a witch hunt.”

In response to these actions, Dr. Veith correctly asserts that “congressmen, state legislators, and others who are so eager to prevent even the appearance of financial conflict of interest between doctors and industry should first apply the same standards to their own relationships with their financial supporters.”

Consequently, while there have been abuses in these relationships in the past and bad things have happened, “does that mean that all such relationships are intrinsically bad and should be interrupted?” Dr. Veith argues that it does not. Over 50,000 people die each year from car accidents. Does that mean we should stop people from driving? No. Instead, we have enacted rules and measures to minimize accidents and try to make our highways safer.

Accordingly, Dr. Veith states that we should do the same with relationships between physicians and industry. He recognizes the need to “establish rules to prevent or minimize the abuses, but we should not totally interrupt all doctor-industry relationships.” Dr. Veith asserts that “to do so is wrong-headed and would eliminate the many beneficial effects that accrue to medical care and society from these relationships. It would be throwing the baby out with the bathwater.”

Benefits from Physician-Industry Collaboration

Dr. Veith explains that “relationships between medical doctors and industry foster innovation and development and that nowhere is this more apparent than in medical device development.” He describes how “physicians have the original ideas to improve the treatment of patients, and industry has the engineering expertise and money to develop these ideas into usable devices, which must, in turn, be evaluated by other doctors.”

Second, Dr. Veith points out that “physicians also have the expertise to assist in the development and evaluation of effective drugs and assays. This advantage is exemplified by a recent front page lead article in The New York Times headlined "Rare Sharing of Data Leads to Results on Alzheimer's Disease: Collaboration Between Science and Industry Seen as Model for Parkinson's Studies."

Third, “industry-sponsored medical education helps to keep physicians informed about new developments, new devices and pharmaceuticals, and how they should be employed most safely and effectively.” While “there is opportunity for the introduction of bias,” Dr. Veith correctly acknowledges that this bias “can be minimized by appropriate safeguards, such as those provided by the guidelines of the Accreditation Council for Continuing Medical Education (ACCME). Moreover, “without industry support, meetings and many other forms of continuing medical education (CME) would be largely eliminated, and physicians would be forced to get most of their continuing education from textbooks and journal articles, which are notoriously out of date and, in some cases, heavily biased.”

Fourth, Dr. Veith recognizes that “without industry representatives to enlighten specialists in the use and pitfalls of individual medical devices, our learning process would be more difficult and dangerous to patients.” Additionally, “some of these industry representatives who are in attendance at device insertions on a daily basis have far more familiarity with their devices than doctors who are using them initially or sporadically. The result is that patients are cared for better and more safely.”

Fifth, “industry-sponsored courses on these devices help medical doctors learn to use them better and more safely, and industry-sponsored support of training for residents almost always has positive effects for both patients and trainees.”


Ultimately, to preserve the benefits of doctor-industry relationships while eliminating their abuses, Dr. Vieth recommends mandating “more transparency, particularly in the financial aspects of these relationships.” He states that universities and medical centers “can set up blue-ribbon committees that are composed of nonphysician representatives of society to oversee all doctor-industry relationships to prevent unethical or even questionable behavior.”

Such recommendations are “far better solutions than completely eliminating all industry-doctor relationships with their many patient and societal benefits.” Moreover, “such safeguards will be better than the present trend for institutions and governments to enact strict measures to separate physicians from industry.”

Institutions that continue to enact and consider such draconian measures “will be blighted and suffer competitive disadvantages.” Accordingly, “their leaders should recognize this and resist the temptation to join the separation witch hunt and instead preserve the positive aspects of these relationships.”

In the end, Dr. Vieth asks all medical societies, while supporting the elimination of abuses, to “speak up and take official positions strongly in support of preserving the positive aspects of the natural relationships between medical doctors and industry.” Such action is necessary among medical societies, professional organizations, and individual clinicians and healthcare practitioners before it is too late.

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