Analysis: Docs conflicted over pharma ties

CHCIAGO, Ill., May 25 (UPI) -- Doctors grumbled, joked, argued and complained at the American Society of Hypertension meeting this week over ways of dealing with blood pressure-raising issue of conflict of interest between doctors and drug companies, as well as the attention the relationship has been getting in the news media.

As the physicians discussed how such conflicts should be handled, Thomas Stossel, professor of medicine at Harvard Medical School in Boston, took

up the banner for physicians in the trenches -- those doctors who actually treat patients or work in the laboratories struggling to develop the next drug that will combat some horrific illness.

"Not once has The New York Times or Congress ever produced a drug that helped one person get well," Stossel said, referring to the lawmakers and media outlets who have in recent months shined a critical spotlight on whether physicians' financial ties to drug companies bias the doctors' review of data when conducting a study of a new treatment or affect their drug-prescribing patterns.

Clearly, the 250 to 300 attendees who listened to the debate were on the side of the "guys in the trenches" instead of the "ivory tower types."

David Korn, senior vice president in the division of biomedical and health sciences at the Washington-based Association of American Medical Colleges -- arguably an ivory tower type -- said his organization has put together a task force to create a consensus conflict of interest statement for its member universities.

The task force, made up of representatives from the public sector, industry, pharma, academia and ethicists, will attempt to set out voluntary guidelines for conflicts of interest in a way that preempts government agencies -- reacting to numerous recent articles in the media -- from making their own more onerous rules.

However, the self-policing idea didn't sit well with Jonathan Moss, professor and vice chairman for research, department of anesthesia and critical care, in the Pritzker School of Medicine at the University of Chicago.

Moss said he thought the conflict-of-interest rules at his own institution are so draconian that he, as the inventor of a new class of pain relief medicine, was not permitted to participate in clinical trials of his own product. The school's conflict-of-interest rules also banned the college from participating in phase 3 studies. Moss said that often it is the inventor of a product who can spot glitches during clinical trials that can prevent tragedies or find other uses for the experimental treatment.

His comments led into a disagreement among panelists and the audience about what should be done about device representatives who assist residents and doctors in using new equipment. "Do we really want these pharmaceutical salesmen and device manufacturer salesmen posing as educators in our hospitals?" Korn asked.

Stossel, who admitted to a conflict of interest of a less typical variety --his wife is a sales representative for a neutraceutical company -- said he often assists his wife in distributing company promotional materials at conferences. He said that often the reps are most knowledgeable about how some of the new devices worked.

Stossel noted, however, that other schools have arranged for the sale representatives to deliver lectures outside the general rounds to apprise hospital staff and private doctors how things work.

Stossel was openly critical of the rush to develop a conflict-of-interest statement and to require doctors to provide lengthy lists of present, former and possible conflicts of interest. "We soon will have to produce a book the size of the Manhattan telephone directory in order to comply with conflict-of-interest statements in order to give a speech," he said.

In compliance with ASH policy for serving as a conference panelist, he posted his possible conflicts of interest, also noting he had scooped up many pens and trinkets given away to doctors at conferences, along with a criminal past: "Jailed for brawling, Mackinac I., Michigan, 1964; escaped." Stossel is the brother of TV reporter John Stossel.

Korn said that doctors have to realize that they are under greater scrutiny now with numerous books and magazine and newspaper articles claiming that the close relationship between doctors and industry has created situations in which it appears the doctors are prescribing to make the companies wealthy; particularly a recent New York Times article on overuse of anti-anemia drugs for cancer patients.

He said that governments respond to such allegations in a reactionary way without thinking much about what they are doing.

Stossel asked, if the relationship between medicine and industry is so close and so detrimental to the nation, then why are heart attack and stroke mortality rates plummeting? He also noted that, for more than a decade, industry has spent more money on development of new drugs, compared to government expenditures.

Several doctors attending the conference suggested that, instead of creating conflicts of interest statements -- which creates the impression that doctors have done something wrong -- the medical community should go on the offensive and explain how their work in creating drugs, conducting clinical trials, then prescribing the new medicines helps millions of people overcome diseases.

Sheldon Sheps, senior medical editor for MayoClinic.com in Rochester, Minn., and a moderator of the panel, told United Press International that he finds himself more in the Korn camp.

"We in the medical field have to show that we are acting in the interest of the patient and if we do have conflicts of interest we must be completely transparent about it," he said.

"We may resist it, but there is a perception we are doing improper things. Transparency would correct it."