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How Does Pharma Influence Affect Professionalism?

In the January issue of the GME e-Letter, we referenced an editorial by Arnold S. Relman, MD in the Dec. 12 JAMA that decries the decline of medical professionalism resulting from the growing commercialization of US health care, including the influence of the pharmaceutical industry:

This industry now uses its enormous financial resources to help shape the postgraduate and continuing medical education of physicians in ways that serve its marketing purposes. Physicians and medical educational institutions aid and abet this influence by accepting, sometimes even soliciting, financial help and other favors from the industry, thus relinquishing what should be their professional responsibility for self-education. A medical profession that is being educated by an industry that sells the drugs physicians prescribe and other tools physicians use is abdicating its ethical commitment to serve as the independent fiduciary for its patients.

In response, we received the following feedback from readers (identifying information removed, with the exception of the author of the editorial).


In the past, I have spoken at meetings on industry-ACCME collaboration, where I delivered the same message about the dangers of pharmaceutical industry influence that I described in the JAMA article. I met with considerable resistance from the representatives of the industry, however, who seemed to dominate the meetings. Those few representatives of the medical profession who were present seemed to be resigned to the situation, saying that without pharmaceutical money CME would have to be drastically curtailed. I don't agree, of course, and have said so in two articles I have published in JAMA ("Separating Continuing Medical Education From Pharmaceutical Marketing," April 18, 2001; "Defending Professional Independence," May 14, 2003).

In any case, if there is no good reason to justify pharmaceutical support for CME, there is certainly even less reason for industrial involvement in GME. So I am very pleased to see that you have distributed my recent comments about this issue to the GME community.

As the professional values of our profession continue to erode, and as commercialism in medicine continues to expand its influence, I think it is imperative that the leadership of the profession take a stronger stand. I have expanded on this theme in my recent little book (A Second Opinion. Rescuing America's Health Care. Public Affairs, NY, 2007).

- Arnold S. Relman, MD

Dr. Relman is absolutely correct: The influence of the pharmaceutical industry cannot be understated. Fixing this will require a major shift in how our society views medicine. We must divorce ourselves from the idea that medicine is akin to any other business: Capitalism is not a good paradigm for health care.

This is a typical example of trying to solve a problem (I assume you are!) that is merely a symptom. It is useless to try to resolve a symptom. You have to cure the disease.

The underlying cause is declining reimbursements across the board to physicians. Solve that problem first. And remember, always keep in mind that we are the ones with the knowledge, the skills, and the expertise, and those who are bullying us and trying to boss us around have nothing like it. We have to stand up.

When you understand that you have asked the wrong question, you will be one step further.

The problems with medicine today also extend to state boards pressuring MDs to recertify, declining Medicare reimbursements, insurance companies, malpractice lawyers, etc etc . . . .

We as doctors let this happen to ourselves—do not blame others. We are a powerful force in this country. Think of the avalanche of problems that would occur if we were to take a few days off from practicing. Maybe then we could start to regain our voice, and our strength as a profession.