Does industry funding jeopardize objectivity?

New Orleans - Recent research shows that the pharmacy and medical equipment industries influence a physician's practice, education and research, according to Jeffrey J. Meffert, M.D., program director of the dermatology program of the San Antonio Uniformed Services Health Education Consortium.

"There is a body of literature out there now looking at these issues," he says. "For instance, a lot of (physicians)believe their patients don't care if they have logo pins and cups; however, there are surveys that show that patients do care, and have become suspicious that things like pins and coffee cups are influencing the physician's choice of what they are prescribing. They say they actually disapprove of a number of physicians' practices."

For example, 50 percent of patients disapprove of pharmacy companies taking physicians out to dinner - a common practice.

He points out that a number of studies have shown that prescribing habits change in direct proportion to the amount of time and the number of contacts a physician has with industry representatives. There are even more dramatic changes when physicians receive bigger gifts, such as dinners, trips and textbooks.

Practices widespreadIndustry funding and gift-giving is a large part of the U.S. medical industry.

"A lot of organizations, including the American Academy of Dermatology (AAD), would not know how to function well without it," Dr. Meffert says. "For instance, the cost of the annual academy meeting would be much more if we kept pharmacy money at arms' length."

Industry research is also affected. "The same industry influence, through subtle and non-subtle methods, is having a bearing on what gets published and what gets researched and what gets talked about at our CME activities," he says.

What to doDr. Meffert advises physicians to become more aware of industry influence and to make their own decisions as to whether to accept samples, pens, sports bags or textbooks, or to eat free dinners "on the pharmacy industry's dime."

Physicians also should look at pharmacy advertisements very critically, he says, because they contain a lot of misinformation and misleading data.

Dr. Meffert does not advocate immediately going "cold turkey" to eliminate all industry funding.

"American medicine would find it very difficult, if not impossible, to function if the faucet was suddenly turned off," he says. "The stage we are at now is to make individuals aware so that we can start to plan to wean our society off of this expected money, whether it is for research or for running our continuing medical education. First, the individual physician can stop taking freebies from drug companies," he says.

MarketingDr. Meffert says, "I do appreciate what the pharmacy industry puts out. I like having a choice of drugs to treat patients with," but adds that high costs can be better contained.

"Often we accept high drug prices as the price we pay for innovative research. However, there is growing literature and several books that have been written lately that show that the industry research is not that innovative," he says. "Often industry is letting the NIH and private institutions do most of the work and then swinging in for the patents and licensures for medications. If you add up marketing and administration, they are usually twice what they spend on R&D. Any company of any size spends far more on marketing than they do on R&D, which, along with high profit margins, is one of the reasons, in the U.S., we pay one of the highest medication prices in the world."

DisclosureDr. Meffert also emphasizes the need for a better full disclosure system in which physicians reveal their salaries and retainers from specific companies.