Physician-industry relationship and conflicts of interest: Historical, normative aspects, negative impact and proposals
DOI:
https://doi.org/10.17533/udea.iatreia.16Keywords:
conflict of interest, drug industry, medical, education, ethicsAbstract
This article presents a narrative review of the relationship between physicians and industry (RPI), which includes pharmaceutical, devices and supplements’ industries and the conflicts of interest that arise from this relationship. It introduces the problem through some definitions and a brief history review of how RPI has become a major problem in medical practice and health systems.
The article discusses the different roles within the most common scenarios in which RPIoccurs: biomedical research, clinical practice guidelines, continuing medical education, medical visits, opinion leaders, as well as in direct interaction, indirect exposure, and what we call, an early exposure. Some techniques used by industry to modify prescription habits based on elements of social psychology, are described, as well as the role of gifts and other marketing techniques on prescriptions.
We review literature that shows the impact and effect these techniques have on medical practice. Finally, some initiatives, codes and commendations that have been developed to address the problem and which could contribute to mitigate the negative effects of a very close RPI. The possible actions are: banning any contact between industry and students, inclusion of conflict of interests into the medical curricula, alternative financial support to continuous education, making the disclosure of conflicts of interests mandatory, launching awareness campaings among physicians, and the use of synthesized evidence that have been transparently and independently assessed, among others.
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References
(1.) Field MJ, Lo B, editors. Conflict of interest in medical research, education, and practice. Washington, EE. UU: National Academies Press; 2009; p 414.
(2.) Orlowski JP, Wateska L. The effects of pharmaceutical firm enticements on physician prescribing patterns: there’s no such thing as a free lunch. Chest. 1992;102(1):270-3.
(3.) Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CMAJ. 1993;5(10):1401-7.
(4.) Moynihan R. Who pays for the pizza? Redefining the relationships between doctors and drug companies. 2: Disentanglement. BMJ. 2003 May 31;(7400):1193-6. DOI 10.1136/bmj.326.7400.1193.
(5.) Fugh-Berman A, Ahari S. Following the script: how drug reps make friends and influence doctors. PLoS Medicine. 2007;4(4):e150. DOI 10.1371/journal.pmed.0040150.
(6.) Santa Cruz P. La industria farmacéutica y su influencia en la práctica clínica. Rev GPU. 2011;1:92-102.
(7.) DeAngelis CD. The influence of money on medical science. JAMA. 2006;296(8):996-8. DOI 10.1001/jama.296.8.jed60051.
(8.) Campbell EG. Doctors and drug companies—scrutinizing influential relationships. N Engl J Med. 2007;357(18):1796-7. DOI 10.1056/NEJMp078141.
(9.) Abbasi K, Smith R. No more free lunches: patients will benefit from doctors and drug companies disentangling. BMJ. 2003;326(7400):1155-6. DOI 10.1136/bmj.326.7400.1155.
(10.) Lama A. El médico y los conflictos de intereses. Rev Med Chil. 2003;131(12):1463-8. DOI 10.4067/S0034-98872003001200015.11. Thompson DF. Understanding financial conflicts of interest. N Engl J Med. 1993;329(8):573-6. DOI 10.1056/NEJM199308193290812.
(12.) Stead WW. The Complex and Multifaceted Aspects of Conflicts of Interest. JAMA. 2017;317(17):1765-7. DOI 10.1001/jama.2017.3435.
(13.) Fineberg HV. Conflict of interest: why does it matter? JAMA. 2017;317(17):1717-8. DOI 10.1001/jama.2017.1869.
(14.) Ornstein C. Public Disclosure of Payments to Physicians from Industry. JAMA. 2017;317(17):1749-50. DOI 10.1001/jama.2017.2613.
(15.) Larkin I, Loewenstein G. Business Model–Related Conflict of Interests in Medicine: Problems and Potential Solutions. JAMA. 2017;317(17):1745-6. DOI 10.1001/jama.2017.2275.
(16.) Flier JS. Conflict of Interest Among Medical School Faculty: Achieving a Coherent and Objective Approach. JAMA. 2017;317(17):1731-2. DOI 10.1001/jama.2017.1751.
(17.) Wayne DB, Green M, Neilson EG. Teaching Medical Students About Conflicts of Interest. JAMA. 2017;317(17):1733-4. DOI 10.1001/jama.2017.2079.
(18.) Pizzo PA, Lawley TJ, Rubenstein AH. Role of Leaders in Fostering Meaningful Collaborations Between Academic Medical Centers and Industry While Also Managing Individual and Institutional Conflicts of Interest. JAMA. 2017;317(17):1729-0. DOI 10.1001/jama.2017.2573.
(19.) Rodwin MA. Drug advertising, continuing medical education, and physician prescribing: a historical review and reform proposal. J Law Med Ethics. 2016;38(4):807-15. DOI 10.1111/j.1748-20X.2010.00534.x.
(20.) May CD. Selling drugs by ”educating” physicians. J Med Educ. 1961;36(1):1-23.
(21.) Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283(3),373-80. DOI 10.1001/jama.283.3.373.
(22.) Neumann PJ, Sandberg EA, Bell CM, Stone PW, Chapman RH. Are pharmaceuticals cost effective? A review of the evidence. Health Aff (Millwood). 2000;19(2):92-109. DOI 10.1377/hlthaff.19.2.92.
(23.) Grande D, Frosch DL, Perkins AW, Kahn BE. Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences. Arch Intern Med. 2009;169(9):887-93. DOI 10.1001/archinternmed.2009.64.
(24.) DeJong C, Aguilar T, Tseng C-W, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA. 2016;176(8):1114-22. DOI 10.1001/jamainternmed.2016.2765.
(25.) Ornstein C. Public Disclosure of Payments to Physicians From Industry. JAMA. 2017;317(17):1749-50. DOI 10.1001/jama.2017.2613.
(26.) Lo B, Grady D. Payments to Physicians. JAMA. 2017;317(17):1719-20. DOI 10.1001/jama.2017.1872.
(27.) Jones CW, Handler L, Crowell KE, Keil LG, Weaver MA, Platts-Mills TF. Non-publication of large randomized clinical trials: cross sectional analysis. BMJ. 2013;347:f6104. DOI 10.1136/bmj.f6104.
(28.) Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic
eview. BMJ. 2003;326(7400):1167-70. DOI 10.1136/bmj.326.7400.1167.
(29.) Bekelman JE, Li Y, Gross CP. Scope and Impact of Financial Conflicts of Interest in Biomedical Research. JAMA. 2003;289(4):454-65. DOI 10.1001/jama.289.4.454.
(30.) Krimsky S, Rothenberg LS, Stott P, Kyle G. Scientific Journals and Their Authors’ Financial Interests: A Pilot Study. Psychother Psychosom. 1998;67(4-5):194-201. DOI 10.1159/000012281.
(31.) Bhandari M, Busse JW, Jackowski D, Montori VM, Schünemann H, Sprague S, et al. Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials. CMAJ. 2004;170(4):477-80.
(32.) Goldacre B. Bad pharma: how drug companies mislead doctors and harm patients. London, Fourth Estate; 2012.
(33.) Blech J. Inventing disease and pushing pills: Pharmaceutical companies and the medicalisation of normal life. London: Routledge; 2006.
(34.) Ioannidis JPA. Are Medical Conferences Useful? And for Whom?. JAMA. 2012;307(12):1257-8. DOI 10.1001/jama.2012.360.
(35.) Neuman J, Korenstein D, Ross JS, Keyhani S. Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and United States: cross sectional study. BMJ. 2011;343:d5621. DOI 10.1136/bmj.d5621.
(36.) Flórez Gómez ID, Montoya DC. Las guías de práctica clínica y el instrumento AGREE II. Rev Colomb Psiquiatr. 2011;40(3):563-76. DOI 10.1016/S0034-7450(14)60147-5.
(37.) Moynihan R. Who pays for the pizza? Redefining the relationship between doctors and drug companies. Entanglement. BMJ. 2003;326:1189-92. DOI 10.1136/bmj.326.7400.1189.
(38.) Oldani MJ. Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices. Med Anthropol Q. 2004;18(3):325-56. DOI 10.1525/maq.2004.18.3.325.
(39.) Relman AS. Separating Continuing Medical Education From Pharmaceutical Marketing. JAMA. 2001;285(15):2009-12. DOI 10.1001/jama.285.15.2009.
(40.) National Institute Health and Care Excellence N. Policy on declaring and managing interests for NICE advisory committees [internet]. London: NICE; 2018 [accessed on March 8th, 2019]: Available from: https://bit.ly/2SPnYxf
(41.) Larkin I, Ang D, Steinhart J, Chao M, Patterson M, Sah S, et al. Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing. JAMA. 2017;317(17):1785-95. DOI 10.1001/jama.2017.4039.
(42.) Palmisano P, Edelstein J. Teaching drug promotion abuses to health profession students. J Med Educ. 1980;55(5):453-5.
(43.) Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med. 2001;110(7):551-7. DOI 10.1016/S0002-9343(01)00660-X.
(44.) Hodges B. Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks. CMAJ. 1995;153(5):553-9.
(45.) Dana J, Loewenstein G. A Social Science Perspective on Gifts to Physicians From Industry. JAMA. 2003;290(2):252-5. DOI 10.1001/jama.290.2.252.
(46.) Steinbrook R. Physician-industry relations, Will fewer gifts make a difference? N Engl J Med. 2009;360(6):557-9. DOI 10.1056/NEJMp0900143.
(47.) Waud DR. Pharmaceutical promotions-a free lunch? N Engl J Med. 1992;327(5):351-3. DOI 10.1056/NEJM199207303270511.
(48.) DeAngelis CD. Conflicts of interest in medical practice
and their costs to the nation’s health and health care system. Milbank Q. 2014;92(2):195-8. DOI 10.1111/1468-0009.12052.
(49.) Sah S, Fugh-Berman A. Physicians under the Influence: Social Psychology and Industry Marketing Strategies. J Law Med Ethics. 2013;41(3):665-72. DOI 10.1111/jlme.12076.
(50.) Cialdini RB. Influence: The new psychology of modem persuasion. New York: Quill; 1984.
(51.) Sah S. Conflicts of Interest and Your Physician: Psychological
Processes That Cause Unexpected Changes in Behavior. J Law Med Ethics. 2012;40(3):482-7. DOI 10.1111/j.1748-720X.2012.00680.x.
(52.) Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med. 1982;73(1):4-8.
(53.) Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas SC, Cohen JJ, et al. Health Industry Practices That Create Conflicts of Interest. JAMA. 2006;295(4):429-33. DOI 10.1001/jama.295.4.429.
(54.) Marcia A. The truth about the drug companies: how they deceive us and what to do about it. New York: Random House; 2004.
(55.) Pronin E, Lin DY, Ross L. The Bias Blind Spot: Perceptions of Bias in Self Versus Others. Psychol Rev. 2004;111(3):781-99. DOI 10.1037/0033-295X.111.3.781.
(56.) Festinger L. A theory of cognitive dissonance. Stanford: university press; 1962.
(57.) Chimonas S, Brennan TA, Rothman DJ. Physicians and Drug Representatives: Exploring the Dynamics of the Relationship. J Gen Intern Med. 2007;22(2):184-90. DOI 10.1007/s11606-006-0041-z.
(58.) Department of Health and Human Services, Office of Inspector General. Prescriptión drug advertisements in medical Journals [inernet]. [Accessed on 2019 March 8th]. Available at: https://bit.ly/2VO9DDj
(59.) Department of Health and Human Services. Office of Inspector General. Prescription Drug Promotion Involving Payments and Gifts.[internet]. [Accessed on March 8th, 2019] available at: https://bit.ly/2u18cFB
(60.) PhRMA [internet]. Washington: PhRMA; c2008. [Accessed on March 8th, 2019]. Available at: https://onphr.ma/2zwnl5T
(61.) Agrawal S, Brennan N, Budetti P. The Sunshine Act - Effects on Physicians. N Engl J Med. 2013;368(22):2054-7. DOI 10.1056/NEJMp1303523.
(62.) Lenzer J. Two years of sunshine: has openness about payments reduced industry influence in healthcare? BMJ. 2016,354:i4608. DOI 10.1136/bmj.i4608.
(63.) Benkimoun P. French “sunshine act” sheds little light on drug industry’s payments to doctors, say critics. BMJ. 2013;346:f3762-f. DOI 10.1136/bmj.f3762.
(64.) Adlington K, Godlee F. Disclosure UK: transparency should no longer be an optional extra. BMJ. 2016;354:i3730. DOI 10.1136/bmj.i3730.
(65.) Consejo General de Colegios Médicos de España. Ética de la relación profesional del médico con la industria farmacéutica y las empresas sanitarias [Internet]. [accessed on March 8th, 2019]. Available from: https://bit.ly/2u5voTrf
(66.) Rojo-Abril M, Fragoso de Castro J, Balmy S, Cabo-Dominguez L, Diaz-Trujillo L, Escudero-Galan N, et al. Primera Guía de Buenas Practicas de Información Médica en la Industria Farmacéutica: experiencia de trabajo. España: APDIS; 2016.
(67.) Lifshitz A, Halabe J, Jasso L, Frati A, Alva C, Arrieta Ó, Burgos R, et al. Comité de Ética y Transparencia en la Relación Médico-ndustria (CETREMI); Recomendaciones para los médicos en su relación con la industria farmacéutica. Gac Med Mex. 2016;152:295.
(68.) Colombia. Ministerio de Salud y Protección Social. Resolución 2881 Transparencia en el sector farmacéutico y de tecnologías en salud [internet]. [Consultado mar 17 2019]. Disponible en: http://cort.as/-LQR5
(69.) Steinbrook R. Physicians, Industry Payments for Food and Beverages, and Drug Prescribing. JAMA. 2017;317(17):1753-54. DOI 10.1001/jama.2017.2477.
(70.) McCormick BB, Tomlinson G, Brill-Edwards P, Detsky AS. Effect of Restricting Contact Between Pharmaceutical Company Representatives and Internal Medicine Residents on Posttraining Attitudes and Behavior. JAMA. 2001;286(16):1994-9.
(71.) Gómez-Córdoba AI, Latorre-Santos C, Carreño JN. Dilemas éticos en las relaciones entre la industria farmacéutica y los profesionales de la salud. Pers Bioet. 2007;11(1).
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