The American Medical Association has accepted about $645,000 from major pharmaceutical companies to help pay for an educational campaign designed to curb the growing financial influence of pharmaceutical companies, Modern Healthcare has learned.
The apt name of the AMA's new initiative: "Gifts to Physicians Campaign."
"The irony is rich," said Art Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "It's somewhere between amusing and sad. I would think the effort would be more plausible if it wasn't funded by the various companies whose temptations and allures (doctors) are supposed to be resisting."
Modern Healthcare first reported in April that drug giant Eli Lilly & Co. had agreed to provide an undetermined sum for the campaign. AMA documents now reveal that eight major pharmaceutical firms and an industry trade coalition contributed a total of $645,000 in unrestricted grants in the past year. Five of the 10 biggest drug companies in the world are among the contributors.
The AMA's educational campaign has been described as an attempt to alert doctors to a voluntary code of ethics, largely ignored in recent years, that strictly limits gifts physicians may accept from drug companies.
Alan Nelson, M.D., a former AMA president who leads a committee that developed the educational plan, said the Chicago-based doctors' group has become increasingly concerned about the "perception of undue influence" by drug companies, which amassed an army of about 83,000 sales representatives last year and spent about $15 billion on marketing.
At the same time, Nelson said, he doesn't see any problems of perception or otherwise in the AMA's decision to accept money from the very companies whose financial influence it hopes to limit or curtail.
"I don't see this as a conflict," he said. "It'd be pretty hard to launch any kind of an educational program on a shoestring. I don't see this as a large amount of money for any kind of a sustained educational program. These are unrestricted grants, ranging from $50,000 to $100,000-that's the salary for a couple of drug-company representatives. How is that going to buy the AMA?"
Last year, an AMA-sponsored survey indicated that as many as half of the physicians in America were unfamiliar with a decade-old code of ethics that permits only "modest" meals that are part of an educational event and gifts of up to $100, such as textbooks, as long as they benefit patients. Many doctors routinely ignore the ethics code, accepting expensive dinners, lavish gifts and expense-paid trips.
Nelson said the goal of the educational campaign, which is tentatively scheduled to begin in July, is to "ratchet down the intensity of gifts (from drug-company representatives) involved in marketing."
For his part, Caplan said the AMA is all but inviting conflict-of-interest charges by appearing to rely so heavily on funding from the industry that triggered the educational effort in the first place.
"Is it unethical for (pharmaceutical companies) to support an educational campaign? Absolutely not," Caplan said. "Does it make better sense to have someone independent do it? Yes."
The list of contributors reads like a who's who of major U.S. drug manufacturers. Besides Eli Lilly, there are Bayer Corp., Glaxo Wellcome, Johnson & Johnson, Merck & Co., Pfizer and Procter & Gamble. The unrestricted grants range from $50,000 to $100,000 and include $50,000 from a coalition of drugmakers called the "Industry Round Table."
"I think it's the responsibility of the industry to put its money where its mouth is," said Frederic Wilson, director of continuing medical education for Procter & Gamble. "The industry agrees with the AMA (and its code of ethics). We therefore need to work together to try to avoid any appearance of impropriety."
For its part, the AMA-which said it solicited the grants after several drug companies indicated support for the program-has contributed $50,000 and estimates that it has provided about $425,000 worth of in-kind support, including staffing. An official said the contribution shows that the effort is not exclusively sponsored by the drug industry.
The industry's trade group-the Pharmaceutical Research and Manufacturers of America-has not contributed money to the campaign but has strongly supported the initiative, assigning two employees to work closely with Nelson's committee, said spokesman Jeff Trewhitt. He said it is "absolutely appropriate" for the industry to join an effort to educate both doctors and sales representatives.
The controversial topic is certain to generate lively debate at the AMA's annual meeting, which began Sunday in Chicago. Among the resolutions up for discussion is a proposal by the Minnesota delegation that the 290,000-member AMA develop far more specific policies limiting the kinds of gifts doctors can receive from drug representatives.
"It's become quite apparent that some pharmaceutical firms have become very creative in circumventing the current rules," said Paul Sanders, M.D., chief executive officer of the Minnesota Medical Association. "The current guidelines are far too general. We need to develop specific policies so there's no ambiguity at all."