The American Medical Association finally rolled out its $1 million education campaign last week, mailing out 5,000 packets of information designed to help curtail the growing influence of America's multibillion-dollar drug companies.
But the costly campaign aimed at physicians, the drug industry and the media triggered the same harsh criticism it did months ago, when the AMA acknowledged that most of the funding for the campaign came directly from the drug companies themselves.
"This is being bankrolled by the very industry the AMA says it's trying to police. It's extraordinarily bad judgment on the AMA's part," said Sidney Wolfe, M.D., director of Public Citizen's Health Research Group.
Wolfe, a frequent critic of the AMA's, likened the relationship to the AMA's disastrous 1996 endorsement deal with Sunbeam Corp., which quickly collapsed amid widespread concerns about ethical considerations.
"It's Sunbeam revisited-this year's version of AMA prostitution," Wolfe said.
The Chicago-based AMA accepted $645,000 from eight major drug companies and an industry trade coalition to help underwrite the ambitious education campaign-a connection that was first reported three months ago in Modern Healthcare (June 18, p. 14).
For its part, the AMA contributed about $50,000 in cash and provided about $425,000 worth of in-kind support for an effort it hopes will encourage doctors and drug-company representatives to observe ethical guidelines on gifts.
AMA officials defended the pact with pharmaceutical firms, saying that the educational campaign was a joint effort to highlight a decades-old ethics code that is unfamiliar to many of the hundreds of thousands of young doctors and drug-company salespeople who have started their careers since 1991. The money was provided with no strings attached, said Randolph Smoak Jr., M.D., immediate past president of the AMA.
"This is designed to educate everybody concerned," Smoak said. "The AMA had total control in terms of developing the campaign. If the two groups recognize there's a concern, who else is going to pay for it? Only the cynics would tell you something different."
The AMA's ethics policy generally permits doctors to accept only "modest" meals that are part of an educational program as well as gifts of up to $100, as long as they benefit patients. But drug companies, which spent about $15 billion last year on marketing efforts, have increasingly used lavish gifts, expensive dinners and trips to exotic resorts as a way to help influence doctors' prescribing patterns, critics such as Wolfe contend.
Richard Corlin, M.D., president of the AMA, said some gifts that comply with the ethics code "serve an important and beneficial function for both physicians and patients. But gifts that don't . . . may create the perception of unethical behavior."
"That perception, in turn," Corlin said, "undermines our credibility with patients and the public."
Other observers, including AMA members, questioned the costs and the long-term effect of the campaign, which consists primarily of mailing out brochures with about 20 pages of printed material to 5,000 residency programs, medical schools, state and county doctors' associations, specialty groups, drug companies and members of the media, among other groups. The 18-month effort also includes a Web site.
Richard Roberts, M.D., president of the American Academy of Family Physicians, suggested that the AMA spent an awful lot of money on what essentially is a massive mailing to a select audience.
"I don't know how much of the million dollars went into the materials themselves," he said. "It's fairly simple and straightforward. Is it an issue that merits $1 million? I think so. Does this campaign reflect that the AMA got its money's worth? I don't know. If this is all they're getting for $1 million, it seems like a lot of postage."