The ideal patient-physician relationship is one of choice, competence, communication, compassion, and continuity, and is free of any conflict of interest. There is heated controversy about whether the relationship between the pharmaceutical industry and medical professionals betrays this ideal. The heart of this debate lies in the fundamental difference in priorities and goals of the pharmaceutical industry and hospitalists. Hospitalists are trusted with the lives and well-being of patients. A physician is expected to make an unbiased analysis of the treatment options for a given patient and to apply that treatment to the best of his or her abilities. In contrast, the ultimate interest of the pharmaceutical industry lies with the shareholders, and the primary goal is to maximize profit. Many feel that these two goals are mutually exclusive (1,2). Medical educators believe that it is the responsibility of the medical profession, not pharmaceutical companies, to educate physicians. The entanglement of the pharmaceutical industry with physicians calls into question the credibility of information obtained from any pharmaceutical-sponsored event and casts doubt over the medical profession as a whole. Governmental regulation and legislative initiatives such as the Bayh-Dole Act (3) have furthered the commercialization of academic research and realigned academic centers’ approach to clinical research.
The pharmaceutical industry argues that its goals and the goals of the medical profession are complementary (4) and that their involvement optimizes the benefit to the patient. The pharmaceutical industry is quick to point out that pharmaceutical companies are an important source of funding for clinical trials and are the leading sponsors of continuing medical education, and that it is the most research-intensive industry in the United States supported by private funds (5). Corporate contributions to research and development in academia have increased by 900% between 1980 and 2000. The pharmaceutical industry devoted 18% of profits in 2002 to research, development, and testing activities (6). The pharmaceutical industry claims that these are designed to serve the mutual interests of the pharmaceutical industry and the medical community by providing accurate and up-to-date information to maximize patient care. The advances made as a result of commercial development have dramatically altered the landscape of research. Pharmaceutical courtship of hospitalists, who find themselves on the front line in clinical settings as prescribers or researchers, is part of an aggressive marketing campaign that some believe contributes little to the common good.
Hospitalists have increased their financial incentives with stock options, fees for consultation, speaking arrangements, and memberships on advisory boards for pharmaceutical companies. Disclosure of financial conflicts is becoming an empty ritual providing a false sense of security. Pharmaceutical research is increasingly organized by Contract Research Organizations, written up with the help of ghostwriters, and published under the name of established investigators (7,8). Not all industry-funded studies are necessarily fl awed and without scientific merit, but the fact that negative consequences can be devastating to the financial health of a corporation has to be considered.
A leading catalyst for continued pharmaceutical industry/hospitalist interaction is continuing medical education (CME). In 2003, the pharmaceutical industry provided 900 million of the one billion dollars spent on CME in the United States. Currently, the pharmaceutical industry funds approximately 60% of all CME activities in the United States (9). Information provided to physicians by a pharmaceutical representative has an inaccuracy rating of 13% (10). Not surprisingly, many of these inaccuracies favor the product being presented and casts an unfavorable light on competing drugs (10,11). This has led some to believe that this pharmaceutical representative/physician interaction is having a negative impact on patients (12) through the dissemination of inaccurate information. In addition, misleading advertisements have been found to overstate the effectiveness and minimize the risks of a given drug (11). Another form of bias is the selective publication of research studies by the pharmaceutical industry (13).