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A Critical Diagnosis

A Critical DiagnosisNoted Tufts School of Medicine professor Jerome Kassirer believes that money from drug companies is creating harmful conflicts of interests among physicians, affecting patients and risking the public’s trust in medicine.

Boston [08.01.05] Increasingly, doctors and the drug industry are becoming mutually reliant upon one another, with physicians reaping substantial “educational grants” and perks while drug companies gain exposure via paid speakers and heavy presence at medical events. According to one Tufts expert on medical ethics, the two entities need to distance themselves from one another.

“Medicine must begin to extract itself from the open arms of the drug industry.” Dr. Jerome Kassirer wrote in an op-ed published in The Boston Globe. “In turn, the pharmaceutical companies, by engaging so many physicians and organizations in its marketing ventures, is doing a disservice to the very profession that it relies on to analyze, recommend, and prescribe its products.”

Kassirer is a Distinguished Professor and senior assistant to the dean at Tufts University School of Medicine. He served as editor-in-chief of the New England Journal of Medicine in the 1990s and is the author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.

“Extracting medicine from industry's educational ventures will be painful, but probably less painful than inappropriate and more costly medical care or the opprobrium of a disenchanted public,” he wrote in the op-ed.

That extraction may be expedited by the government. Kassirer praised the US Senate Finance Committee’s recent investigation into the billions of dollars in “educational” grants that many major drug companies provide to doctors annually. The inquiry comes ahead of the addition of a prescription drug benefit to Medicare.

“The companies swear that in supporting physicians' meals, meetings, and events, all they care about is educating doctors, but the US Senate is now asking how much of the content of these programs is education and how much is product marketing,” wrote Kassirer.

The key, the Tufts professor said, is determining what, if any, returnthe drug companies are receiving for the funds they provide to physicians, and then establishing greater oversight over this practice.

“Congress has finally opened the Pandora's box of industry sponsorship of continuing medical education, and once it discovers where the money is going, it seems likely that they will come calling, not just on the grantors, but also on the recipients,” he wrote.

According to Kassirer, the problem lies in the fact that “industry pays for well over half of the expense of doctors' continuing medical education.” Professional medical societies also draw large sums from drug companies, usually by offering up portions of large annual meetings for corporate sponsorship. In addition, the pharmaceutical industry also pays doctors to speak at functions and conferences.

“The concern is hidden bias,” wrote Kassirer. “Do directors of educational programs intentionally choose company-sponsored physicians to give the talks? Do they allow conflicted speakers to hawk drugs for purposes not approved by the FDA?”

Kassirer criticized medical societies for formulating treatment recommendations based on information provided by doctors paid by certain drug companies.

“How can we expect company-paid speakers to be objective when their talks are regularly observed by company representatives?” he asked.

Physicians being compensated by drug companies, contends Kassirer, have no business formulating treatment guidelines.

“Practicing doctors need to trust the recommendations of academic physicians and their professional societies, and people need to be able to trust their doctors.”
























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