Wednesday, August 23, 2006

More on Physicians' Conflicts of Interest Down Under

The Internal Medicine Journal (from Australia) just published an article that adds to our knowledge about conflicts of interests affecting physicians. (McNeill PM, Kerridge IH, Henry DA et al. Giving and receiving of gifts between pharmaceutical companies and medical specialists in Australia. Intern Med J 2006; 36: 571-578.)

The article is based on a survey of a one-half random sample of Australian specialists, excluding surgeons and anesthetists. Results from this survey have been reported before. The response rate, conservatively estimated, was 39%.

This article focused on the proportions of physicians who had been offered and who accepted various items of value from pharmaceutical companies. The survey also enquired whether physicians had requested such items.

Over 90 percent were offered food or items for the office, and of those, 90 percent accepted. About half were offered items for personal use, or journal or texts, and of those a little more than half accepted. Almost two-fifths were offered funding for travel or various payments, and of those more than two-thirds accepted.

Funding for travel was offered for symposia, educational or CME meetings, and occasionally for product launches. Most of those offered travel support were not speaking at these meetings. Travel support was estimated to be the most expensive of offers made to physicians, with a median value of Aus $ 3000. (Other items were valued mostly in the tens to hundreds of dollars.) A relatively small number of physicians admitted to requesting various things, notably travel support.

The investigators also found that "medical specialists who had conducted industry-supported research within the previous 12 months ... were more likely to be offered gifts and activities and the gift items and activities were probably of a higher value than those offered to other specialists." Furthermore, "clinicians who were active (within the previous 12 months) as consultants to the industry ... or as members of industry advisory panels ... were more likely to be offered items and activities of a higher value than others" and "to accept such items." In addition, "active industry-supported researchers were also much more likely to seek funding for activities other than research, were clinicians who are active as consultants to the industry or as members of an industry advisory panel."

The authors suggested that codes of ethics should be tightened regarding gifts and travel support.

I would note that this article suggests that relatively low-level potential conflicts of interest affecting physicians are very common. The sorts of financial interactions described in this article may affect physicians' decision making. Although I would guess that relatively small financial interactions have relatively small effects on average on individuals' decisions, the cumulative effect of such very common interactions may be substantial. Thus, I would support much more stringent restrictions on interactions like these among physicians and pharmaceutical companies.

Parenthetically, note that many of the financial interactions among leaders of medical organizations, especially academic medical organizations, and other organizations that we have discussed on Health Care Renewal (for example, here and here) involve substantially larger amounts of money, and may also involve other forms of commitment. For example, being a member of a board of directors of a US public, for-profit health care company may involve total yearly reimbursement over US $100,000, plus a fiduciary obligation to the company and its stock-holders. Presumably, such major interactions are likely to have much more profound effects on decision making than $100 worth of food, or even $2500 worth of travel support.

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