A change of heart at Stanford Medical School allowed it to accept $3 million from Pfizer for CME after having publicly denounced the inappropriate financial influence of industry on CME. The draconian ACCME decision regarding AHA (American Heart Association) meeting restrictions on industry presentations could have had serious financial implications for AHA if they had not defended their peer review screening process and the desire to have industry scientists on their programs. Although there was considerable support for the research information sharing value of industry participation, I also suspect a considerable amount of industry financial support could have been at risk including major sponsorship commitments, exhibit space sales, and other marketing opportunity fees. And now the state of Massachusetts is having second thoughts about restrictions they have placed on pharmaceutical sales representative activities (e.g., pens, sticky pads, and free lunches) because of the negative financial impact the restrictions are having on local businesses.
Are we getting to a point where the level of ethical and conflict of interest concerns about pharmaceutical industry influence will be moderated more by the level of financial impact than the convictions of those imposing the restrictions?
Here is one way to keep people honest about their ethical and conflict of interest considerations when restricting pharmaceutical industry activities.
It is the right of these groups and organizations to regulate and even ban pharmaceutical industry activities. But, if industry influence on prescribing and concerns for conflict of interest are seen to be detrimental to patients and are the basis for these decisions to preclude the industry from participation, then the restrictions and the need to avoid these influences should apply in principle to all members of that group or organization as well. There are now a sufficient number of cases which demonstrate physicians and scientists are not immune to breaches of integrity and have been equally responsible for creating these concerns for biasing information about prescription drugs and participating in the creation of conflicts of interest. Therefore the restrictions should apply to both sides of the activities of concern. Here are some examples of how they should apply to Massachusetts or for any other organization with pharmaceutical industry restrictions:
- No physicians in the state of Massachusetts (faculty member of Stanford or AHA member, for example) should be allowed to accept any fees from industry, even for legitimate advisory, consulting services, or Board of Directors participation. These individuals are selected for their expertise and they could be influenced by these payments (more so than a free lunch or pen). More importantly, these individuals, because of their expertise and influence, have the capacity to influence (pass along biased information) far more physicians in private conversations and even in non-industry sponsored programs.
- Massachusetts licensed physicians and other healthcare providers (or from other restricting groups) should not be allowed to participate in any industry sponsored meetings or conferences. This includes any national society meetings or conferences or scientific meetings sponsored by industry. A pharmaceutical company merely being seen as a sponsor could favorably influence a physician about their views of the company and their products. Not to mention the exhibit area influences they would be subjected to.
- No medical meetings or events sponsored by the pharmaceutical industry should be allowed to be held in Massachusetts as this would be encouraging the very behavior (inappropriately influencing physician prescribing) and activities they are trying to curtail with their restrictions.
- Clinical studies are powerful ways to influence prescribing, especially for new products. Therefore, clinical studies should not be done in Massachusetts (or other restricting institutions). If they are done they should be done for no fees with only nominal, non-compensation related administrative expenses being reimbursed.
- Research grants and funding have the potential to favorably influence prescribing practice, especially if the data are published under the reputable name of the institution. Therefore, no industry sponsored research should be conducted at or in institutions other than drug, life science, or biotech companies within Massachusetts. No industry sponsored research should be allowed at any state facilities or their affiliates.
While these may have significant negative financial implications for individuals, businesses, and organizations, this mutual implementation of restrictions would preserve the integrity of decisions made to avoid conflicts of interest and limit the perks and financial influence of the pharmaceutical industry on prescribing practices. In fact, these restrictions would have a far greater impact on assuring the elimination of industry influence than taking away pens, pads, and free lunches.
I suspect the negative financial impact will probably be far too great to allow ethics and decision making integrity to prevail in most situations . As long as it makes financial sense for Massachusetts or other organizations, the restrictions and expectations for compliance will be one way (only the industry must be controlled and comply) and will not really be driven by the ethical and integrity convictions of those imposing the restrictions.