Keeping up with the growing trend of publications on Physician-Industry relations, an endocrinologist from the University of Minnesota Medical School published a refreshing perspective.
In an article published in the Journal Endocrine Practice “The Physician-Industry Relationship: Lessons From the Minnesota Experience,” Dr. J. Michael Gonzalez-Campoy outlines some of his positive dealings between academia and industry. He asserts that excellent patient care requires “…a healthy working relationship between physicians…biotechnology companies, and pharmaceutical companies.”
He also acknowledges that doctors have a duality of interest, which includes protecting the patient-physician relationship, and pursing other scientific endeavors for public health and regulatory activities in order to advance science.
Seemingly, while the report describes some laws on physician-industry tie, none of these laws challenge whether physicians should be paid for work they do outside the patient-physician relationship. The report also declares that federal and state laws significantly delay the dissemination of pharmaceutical and device product information to physicians, causing harm to patients.
Consequently, these laws have created a lack of access to the marketing side of pharmaceutical and biotechnology companies. This prevents physicians and medical school programs the ability to learn about new and emerging treatments. There are also unintended consequences from the changes in the physician-industry relationship such as patient harm:
– Caused by the delay of implementing newer, better treatments.
– Caused by the implication that pharmacotherapy is hurtful, which leads patients to withdraw from treatment.
– Caused by forcing patients to choose older, cheaper medications when newer alternatives are better.
– Caused by damaging the education of medical students and physicians in training when academic institutions deprive them of any given source of information, including marketing information.
– Caused by the negative media portrayal of physicians and industry.
– Caused by marketing shifts to direct-to-consumer messages.
Furthermore, “there is no conflict in physicians learning about new products.” Moreover there is no conflict of interest for new indications from the Food and Drug Administration or new warnings once safety data are released.
In addition, the overwhelming majority of physicians have access to a well-rounded knowledge base of all products and representatives in a drug category. This allows for the multiplicity of interest (not conflict of interest) to exist and leads to patient benefit. Similarly, physicians do not just choose pharmaceuticals based on a sales pitch. Doctors make decisions on the basis of science, patient choice and budgets, and because it appears that the benefits outweigh the risks.
Similarly, gifts do not influence prescribing habits to favor a product in a drug category because physicians accept these items from all companies. In fact, when a change in prescribing habits is seen, it’s usually “highly desirable and directly leads to patient benefit,” as seen in the new generation of insulin products. Likewise, the highest amounts of earnings reported frequently correspond to physicians whose institutions are awarded research grants.
PAYMENT TO PHYSICIANS FOR WORK DONE
The report also acknowledges that the work done with pharmaceutical and biotechnology companies, which benefits patients, cannot be exempted from the work product of physicians because:
– There must be physicians involved in every stage of drug and biotechnology development.
– Researchers who are primarily involved in research and development are ideally poised to educate their peers.
In fact, the research from industry and physicians have advanced science, led directly to improved patient care, led to better quality and quantity of life for our patients. Specifically, almost every medication and technology we use today is a result of these relationships, and “there is no way that we would be this far advanced in American medicine if it were not for that working relationship.”
As a result, physician income from industry or technology companies represents one revenue stream, and it should not be distinguished from other sources of income such as federal grants, endowments, etc. Even the AMA asserted that “the elimination of commercial support from certified CME activities would not guarantee the elimination of commercial bias from these activities.”
Additionally, industry grants have helped academic medical centers develop medical education, and the cost of medical publications that keep physicians updated has been traditionally defrayed by sales of ads from industry.
On the other hand, managed care and health maintenance organizations (HMOs) and their formularies represent a true conflict of interest for physicians. These groups are restricted to choices when they know that treatment alternatives are better for the individual patient, depriving them of personalized care.
Ultimately, the unintended consequence of propagating that professional relationships with industry are wrong, and will create an attitude for future generations of physicians that will shy away from clinical research and education. Dr. Gonzalez has hit the nail dead on its head: industry and physician relations are not only necessary, they are essential to providing better patient care outcomes, advances in medicine, and better medical education.