Reforms proposed to limit conflicts of interest: existing guidelines 'are not sufficiently stringent' and let professionalism and patient care be undermined.(Practice Trends)

The relationship between physicians and the makers of pharmaceuticals and medical devices now is so fraught with conflicts of interest that broad reforms regulating their interactions are essential, according to a group of medical ethics experts.

Industry-sponsored events, the dispensing of free samples and other "gifts" by detail people and drug reps, and lucrative "consultation" agreements are unmistakable ploys by drug and device makers to promote the use of their products. These practices have intensified in recent years to the point that they pose a "serious threat" to both physician integrity and patient welfare, Dr. Troyen A. Brennan of Harvard Medical School, Boston, and his 10 coauthors noted.

Existing guidelines of such groups as the American Medical Association, the American College of Physicians, and the Accreditation Council for Continuing Medical Education "are not sufficiently stringent" and allow both professionalism and patient care to be undermined. "The profession itself must exert much tighter control over the relationships between manufacturers and physicians," Dr. Brennan and his associates said (JAMA 2006;295:429-33).

The group, whose work was sponsored by the American Board of Internal Medicine Foundation and the Institute on Medicine as a Profession, called for academic medical centers to take the lead in:

* Prohibiting all gifts to physicians including free samples, meals, payment for travel, and payment for time spent at meetings.

* Strictly regulating industry support of continuing medical education and prohibiting direct funding of CME meetings.

* Strictly regulating industry support of research.