Our relationship with industry.(Guest Editorial)

Over the past few years there has been increased scrutiny of the relationship between physicians and the health care industry. Voluntary guidelines from numerous organizations promote self-regulation, but if interactions do not remain appropriate and disclosed, the Federal government could impose mandatory regulations.

The industry provides us with money for educational activities, clinical trials, and physician research. We need each other--we just have to make sure our interactions are transparent and not up to second-guessing. The industry provides more money for research than the National Institutes of Health; it gives each medical society an average of $80,000 per year and each medical school an average of $1.3 million per year.

The first guidelines for physician-industry interactions came out in 1992: the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. Before this, there really were very few guidelines as to what was permitted. Industry had a substantial role in how activities were promoted, and companies frequently paid physicians and spouses for meeting travel.

Different guidelines from different organizations can be confusing. In addition to" the ACCME, the Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association, and the Department of Health and Human Services Office of Inspector General have devised guidelines that address physician-industry interactions.

The ACCME's Standards for Commercial Support do not allow commercial promotion in the same room as scientific presentations. For example, pens distributed during scientific sessions can feature the name of a company but not a product. PhRMA guidelines indicate that companies can give physicians pens or pads but not gifts of substantial value, such as a radio, television, or set of golf clubs. All significant financial interests with industry should be disclosed.

The basis of physician-industry interaction is to enhance physician relationships and to ultimately benefit patients, according to the voluntary guidelines. Interactions should focus on informing health care professionals about products, providing scientific and educational information, and supporting medical research and education. Almost all U.S. pharmaceutical companies have signed on to the PhRMA guidelines. The guidelines also state that reasonable honoraria and reimbursement of expenses for physician speakers are acceptable and that no gifts should be accepted if there are ...