"Let he who is without conflict-of-interest cast the first stone."
On Thursday, we ran a letter from Mike Wei, M.D., a FierceHealthcare reader who criticized Stanford University Medical Center's new policy prohibiting its physicians from receiving pharmaceutical and medical device industry gifts. I asked whether completely limiting industry involvement might be too drastic a policy, and I'm pleased to say that many of you responded passionately, intelligently and at length on the pros and cons of such a measure. As expected, responses fell into two groups: Some maintained that the policy was on point and that it prevents doctors from being unduly influenced by industry gifts. However, a majority felt that Stanford's policy is well-intentioned but ultimately damaging to physicians. Several readers also made this observation: While most doctors are immune to industry influence, as with every profession, there are always those who take advantage of the system. People's opinions of this policy are based on how they feel we should deal with this small minority of unethical doctors.
Two things became apparent in the course of reading your emails. First, this is a sensitive issue for everyone involved and how you answer the question has a lot to do with your role in the healthcare industry. Second, and perhaps more importantly, there are no easy answers when it comes to determining what level of involvement the pharma and device industries should have with doctors. If more organizations follow in Stanford's footsteps, I expect we'll see debate on this issue explode.
Arguments in favor of the policy
"With no gifts to influence access to doctors, doctors themselves can select the products, devices and techniques as well as the detail personnel who they wish to invite in to advise them of new developments," - Anonymous
"I strongly endorse the move to limit gifts to physicians. In the short term it will limit marketing costs for the companies and eliminate the biasing of physician opinion by flashy marketing campaigns…It will also eliminate the incentive for companies to invest precious R&D dollars on marginally incremental innovations that cannot be supported on the basis of scientific evidence." - Swami Subramaniam, M.D., Ph.D
"As with a lot of MD's, [Dr. Wei] is expecting freebies for his personal life. Dinner meetings with non-industry guests are social events, not professional development. Part of the due diligence he owes himself is…making sure he stays on top of developments in his field. If he can only make meetings during family time and must bring his wife, it is a very simple matter to pay for her dinner on his own." - Anonymous
Arguments against the policy
"I feel that limiting industry gifts is a misguided, though well-intended, notion. I agree that pharmaceutical reps have significant influence on physician prescribing patterns, but, honestly, many physicians learn about new drugs only through these means. Busy providers of primary care…do not have time to read all the studies, and spend time away from their practices at CME conferences." - Susan Thomas, MHSA
"Most non-medical businesses thrive on the gifts, dinners, golf games, outings and other perks given to decision-makers by sales, marketing and lobbying people in their industry. I think we are held to a double standard. Let he who is without conflict-of-interest cast the first stone. Get real America. Doctors cannot do their best work in the current climate, let alone with Medicare and the other carriers offering cuts of 4 to 5 percent each year. Do a free dinner and a canned talk about a medication make me a slave?" - Anonymous
"If the pharmaceutical industry wants to announce a new drug or product, what is wrong with it? In this process, if a doctor has to stand by and listen to 5-20 minutes of infomercial, why not reimburse that doctor in some way. Doctors are humans and potentially corruptible. Fortunately, most of us do not see...a trinket…that is left in our office as an inducement to prescribe a drug!...This is more than just an ethical issue. For doctors practicing in the trenches, generous medication samples mailed in by drug companies or left behind by reps help a lot of poor patients." - Narayanachar S. Murali, MD, FACP, FACG
This is just a small sample of the feedback I received. To read all of the letters, check out our Web site. And thank you, Dr. Wei, for kicking off this debate. - Maureen