COMMENTARY

Physicians and Industry: Fix the Relationships, but Keep Them Going

Frank J. Veith, MD

Disclosures

February 22, 2011

Interpersonal relationships are a major part of the behavior of all humans, including physicians. Almost everything we as physicians do involves these relationships, to better meet the needs of the involved individuals and society. Many involve bringing advantages or benefits to individuals or society without financial gain for any of the parties. Some, however, may be related to financial gains. A few examples of such relationships are those involving producers with merchants, lawyers with their clients and with judges, pilots with aircraft makers, congressmen and their staffs with lobbyists, and medical doctors with drug and device makers.

Important physician relationships include those with family, patients, doctor colleagues, nurses, physician assistants, hospital administrators, office staff, trainees, students, lawyers, media folks, and accountants. Physician relationships also include those with individuals representing corporations that produce medical devices, supplies, and pharmaceuticals. In a practice setting, having good relationships with others can help a physician or surgeon recruit patients, provide better coverage and consultation, and facilitate better patient care in many other ways. In an academic service or medical group setting, good relationships are even more important to achieving success. Sharing rewards and meeting each other's needs are crucial. "We" trumps "I" almost every time.

Because of some flagrant abuses and excessive hidden financial rewards to physicians, a recent initiative to completely sever the relationship between industry and doctors has gained traction. This initiative has been supported by several states, including Massachusetts and Vermont, and universities, such as Harvard, Stanford, the University of Massachusetts, and the University of Michigan, which have enacted draconian laws or policies designed to separate doctors and industry and to interrupt any relationship between them. The Senate Finance Committee and other states and universities are considering taking similar steps. Perhaps congressmen, state legislators, and others who are so eager to prevent even the appearance of financial conflict of interest between doctors and industry should first apply the same standards to their own relationships with their financial supporters. Even many individual physicians have sanctimoniously jumped on the bandwagon and written articles or opinion pieces attacking the evils of any relationship between industry and doctors, suggesting the severance of any such relationships. Of note, most professional and specialty societies have bowed to these attacks and have remained surprisingly mute in defense of the many benefits of such relationships. The initiative to separate industry from physicians and surgeons has taken on the trappings of a witch hunt.

Let's examine this initiative more closely. Yes, there have been abuses in these relationships and bad things have happened. However, does that mean that all such relationships are intrinsically bad and should be interrupted? I submit that it does not. Some husbands abuse their wives, but does that mean we should prevent relationships between men and women or outlaw marriage? Similarly, we have numerous road accidents, many of them fatal. That does not mean we should outlaw cars and trucks or driving. What we have appropriately done is to enact rules and measures to minimize spousal abuse and accidents and try to make our highways safer: so, too, with relationships between physicians and industry. We should establish rules to prevent or minimize the abuses, but we should not totally interrupt all doctor-industry relationships. To do so is wrong-headed and would eliminate the many beneficial effects that accrue to medical care and society from these relationships. It would be throwing the baby out with the bathwater.

What are some of these benefits? First, relationships between medical doctors and industry foster innovation and development. Nowhere is this more apparent than in medical device development. Physicians have the original ideas to improve the treatment of patients, and industry has the engineering expertise and money to develop these ideas into usable devices, which must, in turn, be evaluated by other doctors. Second, physicians also have the expertise to assist in the development and evaluation of effective drugs and assays. This advantage is exemplified by a recent front page lead article in The New York Times headlined "Rare Sharing of Data Leads to Results on Alzheimer's Disease: Collaboration Between Science and Industry Seen as Model for Parkinson's Studies.[1]"

Third, industry-sponsored medical education helps to keep physicians informed about new developments, new devices and pharmaceuticals, and how they should be employed most safely and effectively. Certainly, there is opportunity for the introduction of bias, but this can be minimized by appropriate safeguards, such as those provided by the guidelines of the Accreditation Council for Continuing Medical Education.[2] Without industry support, meetings and many other forms of continuing medical education would be largely eliminated, and physicians would be forced to get most of their continuing education from textbooks and journal articles, which are notoriously out of date and, in some cases, heavily biased.

Fourth, without industry representatives to enlighten specialists in the use and pitfalls of individual medical devices, our learning process would be more difficult and dangerous to patients. Some of these industry representatives who are in attendance at device insertions on a daily basis have far more familiarity with their devices than doctors who are using them initially or sporadically. The result is that patients are cared for better and more safely. Fifth, industry-sponsored courses on these devices help medical doctors learn to use them better and more safely, and industry-sponsored support of training for residents almost always has positive effects for both patients and trainees.

How can we preserve the benefits of doctor-industry relationships while eliminating their abuses? We can mandate more transparency, particularly in the financial aspects of these relationships. In universities and medical centers, we can set up blue-ribbon committees that are composed of nonphysician representatives of society to oversee all doctor-industry relationships to prevent unethical or even questionable behavior.

These will be far better solutions than completely eliminating all industry-doctor relationships with their many patient and societal benefits. Such safeguards will be better than the present trend for institutions and governments to enact strict measures to separate physicians from industry. Those institutions that choose such inquisitional approaches will be blighted and suffer competitive disadvantages. Their leaders should recognize this and resist the temptation to join the separation witch hunt and instead preserve the positive aspects of these relationships. Of note, all our medical societies, while supporting the elimination of abuses, should speak up and take official positions strongly in support of preserving the positive aspects of the natural relationships between medical doctors and industry. They should take the lead in doing this before it is too late.

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