COMMENTARY

Response to AMA's Council on Ethical and Judicial Affairs Draft Report on "Ethical Guidance for Physicians and the Profession With Respect to Industry Support for Professional Education in Medicine"

Thomas P. Stossel, MD

Disclosures

June 12, 2008

Origin and Resistance to Commerce in Medicine

The growth in size and scope of the American healthcare enterprise since the middle of the last century challenged the control that physicians exercised over their activities and income. Although predictions that corporations would completely dominate medical practice[3] did not materialize,[4] healthcare providers today struggle "to be competent to help and to help with the patient's best interests in mind[5]" and sustain their "privilege of autonomy...self-regulation, public esteem, and a rewarding and well-compensated career[6]" (both statements cited in The Report[1]). These challenges occur amidst the competing interests of government healthcare budgeters, private insurers, a demanding and litigious public, and the business community. All of these groups are complicit in and resentful of rising healthcare costs, but it is corporate producers of medical products that have become the major scapegoats for the resentments.

Industrial investment in biomedical research began to increase steadily in the 1970s, rose faster thereafter, surpassed public research funding in the late 1980s, and now exceeds it by nearly 2-fold.[7] As the number of products available to more specialized providers in progressively diverse work settings grew, product marketing, especially by pharmaceutical companies, also became much more prevalent. Such marketing through promotion to physicians (detailing) or to the public (direct-to-consumer advertising) is US Food and Drug Administration (FDA)-regulated. As noted in The Report, private companies now provide half of the total costs of continuing medical education (CME) activities.[1] Although codes of ethics promulgated by medical product manufacturers and accreditation requirements for CME limit companies' control of educational content, The Report concluded that these safeguards are insufficient to legitimize industry support of this activity.

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