When the American Medical Association unveils its new educational campaign to help curb the growing influence of drug companies over physician prescribing practices, the initiative will be financed in part by one of the world's largest drug companies.
Eli Lilly and Co., the Indianapolis-based drug giant, will provide an undisclosed amount of financial support and technical assistance when the AMA rolls out what is described as an ambitious effort to educate physicians about a code of ethics that has been largely ignored or misunderstood by the medical community.
The alliance, similar to collaborations in the past, has generated some criticism from medical ethicists who wonder if the AMA is creating at least the appearance of a conflict of interest.
"I'm incredulous," said Art Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "It makes no sense-(the AMA) is going to get pounded on it even if the company and the AMA have nothing but the highest motives. It's a decision that's asking to be misunderstood."
Ed Sagebiel, a spokesman for Eli Lilly, acknowledged that the drug company is "supporting some of that (AMA educational) campaign financially and through technical details."
Asked about the level of financial support by Eli Lilly, which posted net sales last year of $10.8 billion, Sagebiel declined to cite specifics, saying only that his firm had "invested" in the AMA's campaign.
He dismissed the notion that financial support from a drug company would create a conflict with the AMA's effort to police unethical behavior of drug company sales representatives. In fact, he and other industry observers have noted, the drug companies worked with the AMA in the early 1990s to create the ethics code that the medical group now wants to reinforce among doctors.
"We share the same concerns that the AMA has in making sure that the guidelines are followed and that there is an education effort involving both physicians and drug company representatives," Sagebiel said.
Officials with the Chicago-based AMA, the nation's largest doctors' group with about 290,000 members, declined to discuss the educational campaign or Eli Lilly's financial involvement, saying only that details would be announced when the effort is launched and not before.
AMA officials won't say when the program might debut or whether drug companies other than Eli Lilly have committed to financial support.
Though the guidelines are voluntary, a national effort to reinforce a strict ethics code runs the risk of alienating at least a small number of AMA members, which have declined in recent years (April 2, p. 4).
"There are a lot of players involved," one AMA spokesman said. "It's a good program, and we'll be very public about it once all the pieces are in place. But we're not going to do it in a piecemeal fashion."
Herbert Rakatansky, M.D., a Rhode Island gastroenterologist and chairman of the AMA's Council on Ethical and Judicial Affairs, said he wasn't aware of Eli Lilly's financial support but said the code of ethics allows such "unrestricted grants." Rakatansky has no role in the educational campaign.
"Any money given in an unrestricted grant in which there is no control (or pre-established conditions) is acceptable," Rakatansky said. "And it doesn't make much difference if it's to discuss an educational campaign or molecular biology or ethics."
David Blumenthal, M.D., professor of health policy at Harvard Medical School, Cambridge, Mass., said Eli Lilly should receive some credit if it is "willing to pay to have the medical community create barriers against advertising" by drug companies. Still, he said, the association "creates an appearance of a conflict, which is undesirable."
"All I can say is it would be far better to get support from a disinterested third party," Blumenthal added.
The AMA formed a task force about a year ago to address concerns that many doctors do not follow a strict ethics code that generally prohibits anything but "modest" or "token" gifts from drug-company sales representatives. The task force discovered that anywhere from 40% to 50% of doctors-especially younger ones-were unaware of those guidelines.
Officials with the drug industry's trade group, the Pharmaceutical Research and Manufacturers of America, would not reveal whether they have provided support for the AMA's educational campaign or plan to do so in the future.