Financial Conflicts of Interest in Physicians' Relationships with the Pharmaceutical Industry – Self-Regulation in the Shadow of Federal Prosecution

ArticleinNew England Journal of Medicine 351(18):1891-900 · November 2004with23 Reads
DOI: 10.1056/NEJMlim042229 · Source: PubMed
    • "Despite the fact that in some developed countries a number of restrictions have been introduced to reduce the influence of pharmaceutical companies in academic and public institutions, the influence is still evident. Such influences may not appear to be on a direct personal level, but are exerted indirectly, for example by donations or grants to academic institutions and societies137138139140141 . In general, the marketing approach is different for each pharmaceutical company, for each country and each " customer " and depends mainly on the local conditions and the potential market scale. "
    [Show abstract] [Hide abstract] ABSTRACT: According to global annual estimates hunger/malnutrition is the major cause of death (36 of 62 million). Cardiovascular diseases and cancer (5.44 of 13.43 million) are the major causes of death in developed countries, while lower respiratory tract infections, human immunodeficiency virus infection/acquired immunodeficiency syndrome, diarrhoeal disease, malaria and tuberculosis (10.88 of 27.12 million) are the major causes of death in developing countries with more than 70% of deaths occurring in children. The majority of approximately 800 million people with other rare diseases, including 100000 children born with thalassaemia annually receive no treatment. There are major ethical dilemmas in dealing with global health issues such as poverty and the treatment of orphan and rare diseases. Of approximately 50000 drugs about 10% are orphan drugs, with annual sales of the latter approaching 100 billion USD. In comparison, the annual revenue in 2009 from the top 12 pharmaceutical companies in Western countries was 445 billion USD and the top drug, atorvastatin, reached 100 billion USD. In the same year, the total government expenditure for health in the developing countries was 410 billion USD with only 6%-7% having been received as aid from developed countries. Drugs cost the National Health Service in the United Kingdom more than 20 billion USD or 10% of the annual health budget. Uncontrollable drug prices and marketing policies affect global health budgets, clinical practice, patient safety and survival. Fines of 5.3 billion USD were imposed on two pharmaceutical companies in the United States, the regulatory authority in France was replaced and clinicians were charged with bribery in order to overcome recent illegal practises affecting patient care. High expenditure for drug development is mainly related to marketing costs. However, only 2 million USD was spent developing the drug deferiprone (L1) for thalassaemia up to the stage of multicentre clinical trials. The criteria for drug development, price levels and use needs to be readdressed to improve drug safety and minimise costs. New global health policies based on cheaper drugs can help the treatment of many categories of orphan and rare diseases and millions of orphan patients in developing and developed countries.
    Article · Sep 2014
    • "There is little systematic research on the impact of financial support for continuing education for physicians, although there are some reports of potential bias in favor of the pharmaceutical industry131415 Remedies to control conflict of interest range from individual discretion to collective regulations including legal action [16,17]. In the past decade, guidelines and recommendations were developed by an expert panel, professional societies, accrediting bodies, the pharmaceutical industry associations and the government in the United States1819202122. In Japan, physicians working for public hospitals are prohibited from accepting kickbacks [23]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. Methods and Findings A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. Conclusions Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.
    Full-text · Article · Sep 2014
    • "Additionally the result of this study (Table 4) showed that there is a larger number (59%) of physicians who agreed in that drug promotion is beneficial to the patient, yet it didn't achieve a statistically significant value. But most importantly there is a significant difference between the number of patients and physicians who didn't get a benefit by drug promotion, this fact can be explained in that biased promotional information may not beneficial and even harmful to the patient, besides that other causes like gift acceptance may be one of the benefit to the physician that lead to conflict of interest that may negatively influence prescribing behaviors of the physician232425 and thus may lessen patient welfare and benefit [26]. This study (Table 5) also showed that more than 59% of the participated physicians trust promotional information, yet, there is a non significant difference among physicians who directly trust the information from drug companies and MRs from those who don't trust unless check the data by themselves using suitable reference books or journals, this finding in contrast to the finding in USA at which the majority of physicians said that they relied mainly on academic source of information rather than the promotional source [27]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Evaluating the quality of promotional information that given by medical representatives (MRs) to physicians in Iraq. Methods: A survey in questionnaire format for 22 specialist physician was done in Baghdad governorate during March – October 2013. The questionnaire involve questions about the age, gender, occupation of the physician besides 4 different questions regarding reliability, accuracy, and benefit from promotional information to the Iraqi physician. Results: Medical representatives provide physicians with good information about drug indication and weak information about drug contraindications and side effects. On the other hand, academic physicians have a significantly more negative opinion than physicians who work in hospitals regarding the reliability of promotional information. Furthermore only hospital physicians found that MRs Information are useful for them. There is a non significant difference among physicians who directly trust the information from drug companies and MRs from those who don't trust unless check the data by themselves using suitable reference books or journals. Conclusion: MRs provide Iraqi physicians with biased information, yet non academic physicians found that information is beneficial for their clinical practice.
    Full-text · Article · Jan 2014
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