Physicians and the salespeople bearing gifts to them are targets of an upcoming refresher course on AMA ethics guidelines.
Alan Nelson, M.D., who was president of the AMA when its Council on Ethical and Judicial Affairs cranked out a set of guidelines on industry gifts in 1990, now heads an AMA-sanctioned panel taking a second look at those standards. The Working Group for Communication of Ethical Guidelines on Gifts to Physicians from Industry has met three times since August 2000 and will make its work public July 11.
Ethical issues are little changed a decade after those first guidelines were drafted, Nelson says. The working group found them "still relevant and appropriate," he says. "If everyone would adhere to them, the problem would go away."
The working group concluded it would adopt the existing AMA guidelines, then focus more attention on publicizing the advisories, Nelson says.
Bert Spilker, M.D., senior vice president of scientific and regulatory affairs at the Pharmaceutical Research and Manufacturers of America, the Washington-based trade group, says a PhRMA-financed study found only 50% of physicians even know the 1990 CEJA guidelines exist. Spilker is one of two PhRMA representatives on the 31-member working group, which also includes leaders of several medical societies, drugmakers and manufacturers of medical equipment.
The first phase of the ethics awareness campaign will include the launch of a Web site augmented by representatives discussing issues at trade shows and other professional meetings, Spilker says. A second phase, proposed to start several months later, will focus on training, including question-and-answer reports and the development of case studies.
Eight drug companies and a drug industry consortium paid $645,000 to fund the campaign, according to an AMA report.
The AMA has contributed $50,000 toward the campaign and $425,000 worth of in-kind services such as staffing and administration work.
For the drug industry, the hope is that with renewed emphasis on ethics, "the companies would feel that they're all acting in an equal and ethical manner and are all following the CEJA guidelines," Spilker says.
The group revisited the guidelines, which are advisory and carry no penalty for violations, because of "a sense of unease by many physicians about marketing practices," Nelson says.
That's putting it mildly. Drug industry sales techniques such as "dine and dash" and "gas and go" have gained notoriety from national media reports.
Physicians in several states await sentencing after pleading guilty to federal conspiracy charges in a grand jury probe of illegal marketing of physician-administered drugs. Several drugmakers have reported to stockholders that their marketing practices are being targeted by state and federal investigators.
A recent government study of fraudulent marketing schemes involving just 24 physician-administered drugs found that Medicare and Medicaid, and ultimately taxpayers and patients, are being bilked out of $1.6 billion a year.
The meeting of the AMA House of Delegates, held in Chicago last month, was a hotbed of resolutions on relations between physicians and the drug industry.
"I think a lot of physicians are concerned by the erosion of professionalism, and this is just one part of it," Nelson says.
"The confidence and trust of patients has been shaken over the years, whether it's managed care or the misinformation over the Net. We have to do everything we can to restore confidence."
When the guidelines were rolled out a decade ago, there was what Nelson described as "solid adherence," but that allegiance has waned in the years since.
"It's the nature of human beings," Nelson says. "That's why we need to continually remind ourselves."
The bottom line in the old guidelines is to put patients first. Nelson says physicians should still keep that in mind when confronted with ethical questions today.
"The litmus test is whether I'd want to go out and announce to my patients what this is about," he says.