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JAMA article attacks pharma influence

Teaching hospitals urged to do more to stop gifts and inducements to doctors

Academic medical institutions and teaching hospitals should take the initiative in guiding doctors about the conflict of interest posed by their accepting gifts from the pharmaceutical and medical devices industries, according to a recent article in the Journal of the American Medical Association (JAMA).

The article's authors said voluntary methods aimed at limiting corporate influence in drug prescription have generally failed, since inducements influence doctors to over-prescribe some drugs and turn a blind eye towards side effects.

ìMy mother told me never to accepts gifts from strangers. If a stranger wants to give you a gift, it's very likely they want something in return,î said Jordan Cohen, co-author of the article. ìWe've become overly dependent on these kinds of blandishments to support our core activities, and that is jeopardising public trust and scientific integrity.î

The article comes at a time when a whistleblower court case in Memphis, Tennessee exposed huge payments to some spine surgeons from medical devices firm Medtronic for undertaking limited amounts of work. In the case, Jacqueline Poteet, a former senior manager of the firm alleges that the doctors were given lucrative contracts in exchange for using and promoting Medtronic products.

ìThere is solid evidence it isn't the size of the gift, it's the gifting itself that creates a sense of loyalty and indebtedness,î said Sharon Levine, associate executive director of Kaiser Permanente's Northern California group practice, told the Washington Post.

The JAMA article recommends the banning of all gifts, including free meals and pens, saying that even inexpensive gifts can distort doctors' behaviour. Instead it suggests pharma companies could provide funds for seminars and travel by depositing money at a central office where it could be utilised widely.

The co-authors also said that doctors should be prohibited from accepting free samples and that those doctors with financial ties to pharma companies should be excluded from serving on panels that decide drug formularies.

ìWe as a profession have not been sufficiently clear and demanding of individual physicians to put in place processes and procedures that safeguard the public against the biased information that may be delivered in this fashion,î said Cohen.

The article estimated that pharma companies in the US spent $13,000 (£7,360) per doctor per year on marketing activities. Total marketing spend reached over $20bn a year, about 90 per cent of which was directed at doctors, the article said.

30th September 2008

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