By Bernard Carroll MD
[posted with his permission]
Discussion of Pharma influence at medical society meetings often overlooks the real but unused power of physicians to make changes happen.
No one would argue with the need for increased attention to our corporate relationships and to transparency. Few would argue, either, for a radically new relationship that involved severing ties between professional medical societies and industry.
Nevertheless, we are viewed unfavorably for our increasingly publicized reliance on corporations, not because these relationships are intrinsically unethical but because the profession has no record of taking action against corporations that are found to be crooked. For example, the drug industry has been censured for reneging on pledges to list clinical trials in a federal database, with Merck, GlaxoSmithKline and Pfizer being singled out as recalcitrant corporations. A New York Times editorial concluded, "the best hammer would be federal legislation.. with stiff penalties for noncompliance."
Physicians and professional medical societies have an alternative "hammer" that they have never used: disengagement from corporations that flout their commitments and abuse public trust. Corporations that receive adverse court rulings with financial penalties, regulatory fines, cease-and-desist orders for false advertising, and that pay millions of dollars in plea bargained settlements have so far been immune from the consequences of these ethical failures. They continue to have unimpeded access to professional medical groups. The professional societies maintain a double standard, indulging crooked corporations in ways that do not apply to individual members. The by-laws of professional medical associations provide for the censure and expulsion of individual members who fail to act in accordance with ethical codes. Sufficient cause for such adverse action can include clinical or scientific fraud, as well as criminal conduct that need not be related to a member's clinical practice or professional work. Any felony conviction, for example, will result in termination of membership in most professional medical societies. The corporations that enjoy access to our professional organizations are immune from similar treatment.
In some medical societies, companies pay for the status of Supporting Corporations. These corporations and their designated liaison employees are prominently listed, along with company descriptions (infomercials), in membership directories. Supporting corporations typically send several employees to the annual meetings, where many deals are struck for clinical trials, research projects, educational programs, and professional consulting, accompanied by much wining and dining. In giving their support, the corporations are not motivated by altruism. They are buying access.
Likewise, many professional medical societies sponsor huge exhibit halls at their annual conventions, with lavish, high-tech displays operated by pharmaceutical corporations. These events are unparalleled opportunities for the corporations to influence practitioners and "thought leaders." The corporations also support continuing medical education symposia at the conventions through "unrestricted educational grants", while having every confidence that featured speakers are "on message."
Our medical societies have every right and, I believe, the duty to terminate or suspend their association with corporations that receive criminal judgments or adverse regulatory rulings or that agree to judicial settlements for negligence, violations of good manufacturing practice, fraud, misrepresentation, and suppression of scientific data in the interest of marketing. That would send a powerful message from us to back up any legislative hammer. A 5-year suspension-of-access period per incident would get the attention of the corporations more than the penalties typically negotiated by Pharma with regulators. Likewise, individual academic physicians could send a powerful message by resigning from the advisory boards and speaker panels of corporations that receive judicial and regulatory penalties.
When academic physicians and professional medical societies simply shrug off these corporate behaviors, they collude in the cynicism of the corporations, for whom the monetary penalties, that may run to hundreds of millions of dollars, are viewed as just part of the cost of doing business.
The fundamental issue in this evolving scandal is the distinction between professional and commercial ethics. As the sociologist Jane Jacobs observed, the most rudimentary civic morality is the line between these two. Physicians have to understand that when they work in the service of the public or as advocates for patients, they cannot also be in service to clients who seek to influence legislation or regulatory decisions or who simply want to maximize profits.
Many professional medical organizations have tried to straddle this line, using predictable rationalizations such as money for operations, expanded educational programs, and strategic inclusiveness. The straddle has become increasingly uncomfortable, however, and the professional societies would do well to reassert their independence by treating corporations as they would treat any individual member who violates ethical and criminal codes. There is no reason for the professional medical societies to give multi-billion dollar corporations a pass on ethics. As the saying goes, when you sup with the devil, use a long spoon.
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