Financial Conflicts of Interest in Physicians’ Relationships with
the Pharmaceutical Industry
Self-Regulation in the Shadow of Federal Prosecution
Legal Issues in Medicine
The New England Journal of Medicine, October 28, 2004, pp. 1891-1900
David M. Studdert, LL.B., Sc.D., M.P.H., Michelle M. Mello, J.D., Ph.D., M.Phil.,
and Troyen A. Brennan, M.D., J.D., M.P.H.
THESE AUTHORS NOTE:
“The past two years have witnessed extraordinary regulatory ferment in the area of
conflicts of interest involving physicians, especially conflicts arising in relationships
with the pharmaceutical industry.”
“Professional regulatory bodies, the pharmaceutical industry, and the government
have all decided that physicians and drug manufacturers need stronger advice
about appropriate relationships.”
“There is a growing realization, inside and outside medical circles, of the troubling
influence that pharmaceutical marketing can have on patient care.”
Also, since Medicare has adopted a prescription-drug benefit, there is widespread
concern about the costs of this program.
Therefore, a body of federal law dealing with “fraud and abuse” is being used “by
prosecutors to punish pharmaceutical companies and physicians involved in
marketing practices that were once fairly common.”
“Apprehension over conflicts of interest in medicine is rooted in a concern that
professional judgments about the welfare of patients may be inappropriately
influenced by a secondary interest — in this case, the personal gain derived from
relationships with pharmaceutical companies.”
“A drug company’s primary interest is to maximize sales of its product. Physicians
do not (or should not) share this goal, but they are the chief conduit for sales.
Consequently, physicians have been the central target of marketing strategies, and
they remain so even after the rise of direct-to-consumer marketing.”
“The pharmaceutical industry spends approximately $12 billion annually on gifts
and payments to physicians.” [WOW!]
70% of funding for drug clinical trials is paid by drug companies.
Drug companies absorb over half of the costs of for continuing medical education.
‘educational’ gifts such as pens and memo pads and lunch for the office staff.
Essentially all physician practicing today have been the beneficiary of
virtual fixtures in medical practice.”
Over-the-top marketing practices (often bordering or outright illegal, “are
doctor to the drug company, which can lead to inappropriate drug prescribing.
Even small gifts from drug companies create a sense of indebtedness by the
COMMENT BY DAN MURPHY
Some of these practices may apply to some of the marketing of products within the