The ties that cure?
Nearly all US doctors have links with drug companies
By Jean Louis Santini, Agence France-Presse
WASHINGTON
With the US health-care industry under increasing scrutiny over dangerous conflicts of interest, a new study concludes that almost all doctors have some relationship with drug makers.
US and Australian researchers said in the study that 25 percent of doctors surveyed said they had received direct payments from pharmaceutical producers. In addition, fully 94 percent of practicing doctors "have at least one type of relationship with the drug industry," though this most often means receiving food in the workplace or sample prescription drugs.
"Relationships with industry are a fundamental part of the way medicine is practiced today. The real questions relate to how much is too much and how far is too far," said a summary of the study.
The study, published in the April 26 issue of the New England Journal of Medicine, comes in the wake of several scandals in the health and research industries over conflicts of interest.
Last year, for instance, Dr. Trey Sunderland of the US National Institutes of Health was shown to have received US$285,000 from Pfizer, the world's largest drug company, for cooperating with them without having informed his superiors at the government health-research agency.
The study found that drug and medical-device manufacturers single out doctors in certain areas and doctors with influence over others to develop close relationships, offering things like payments for consulting and honorariums for speaking engagements.
Cardiologists are a key target of the industry's consulting and other payments, in part because they can influence what drugs and devices other doctors choose, said lead researcher Eric Campbell of the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School.
"Cardiology is a highly influential specialty within the medical profession. If the drug and device industry can influence cardiologists, they can likely influence the prescribing practices of other doctors," said Campbell. "It appears that these relationships benefit physicians and industry, but the important policy question is to what extent do these relationships benefit patients in the terms of the care they receive," he said.
The researchers note that more payments go to doctors who develop clinical guidelines and mentor other doctors in training than to other types of doctors.
"I know it's cliché, but if it didn't work, drug companies wouldn't do it," said David Blumenthal, director of the Institute for Health Policy.
"It appears pretty clear that industry forms tighter relationships with doctors who are really the thought leaders, the ones who are likely to affect the behavior of other doctors," he added.
According to the summary, the authors of the study said their findings should "raise alarms" to do more to prevent health manufacturers from having too much influence over doctors.
The study was conducted by researchers at Massachusetts General Hospital-Partners Health Care System, Yale University, and the University of Melbourne and Royal Melbourne Hospital in Australia.
They surveyed 1,662 physicians in anesthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics over their financial ties with industry, and the reasons behind those ties.
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END OF SELF-RULE?
British government wants to strip British physicians of the right to police themselves
LONDON
British doctors will lose the right to act as their own watchdog under plans the government presented in Britain's biggest overhaul of medical regulations in decades. The changes are part of the government's response to the inquiry into how doctors failed to notice or raise red flags in the case of Harold Shipman, the unassuming family physician who became Britain's worst serial killer.
The General Medical Council (GMC) will lose the right to issue a final ruling in malpractice cases, although it will still investigate the complaints against doctors. Final decisions will likely pass to an independent tribunal.
Founded in 1858 under an act of parliament, the GMC is responsible for licensing doctors in Britain and bringing disciplinary proceedings against those suspected of malpractice and wrongdoing.
Panels overseeing fitness-to-practice cases will no longer use the current criminal standard of proof of "beyond reasonable doubt" and will instead use the civil standard of proof on a sliding scale. The civil standard looks at the "balance of probability."
Doctors will face checks every five years to ensure they are competent to continue working under the plans, while those who practice in a specialist area will also face inspections, overseen by the royal colleges. Under the plans, death certificates will be subject to independent scrutiny or signed by a medical examiner.
The moves are part of the government's response to the Shipman Inquiry, which lambasted the GMC.
In December 2004, the long-running Shipman inquiry said the GMC was too focused on "looking after their own," and doubted its ability to protect patients from "dysfunctional or underperforming doctors."
Shipman is believed to have killed at least 215 patients over 23 years with lethal injections of morphine at his practice in Manchester, northern England. The most prolific serial killer ever to be convicted in Britain, he was jailed for life in January 2000 on 15 counts of murder. He always denied his crimes but at the age of 57 hanged himself in his prison cell in January 2004.
Shipman had been allowed to carry on practicing by the GMC despite being convicted of drug offenses in 1976 after becoming addicted to pethidine as a young doctor. Despite a very high death rate among patients at his one-man suburban practice, other doctors failed to raise concerns.
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French doctors call for legal euthanasia
PARIS
Some 2,000 French doctors and nurses have issued a joint call for euthanasia to be legalized in France, arguing that mercy killings are already widely practiced by the French medical profession.
In a manifesto that appeared in the Nouvel Observateur weekly, all the doctors claimed to have helped patients to "die with dignity" in the past, using drugs to alleviate their suffering and precipitate death.
"Because, without a doubt, illness was defeating therapy, because despite suitable care, physical and psychological suffering were making the patient's life unbearable, because the patient wanted to end his life, we carers, in full conscience, have medically helped patients to die with dignity," they wrote.
"The majority of those who care regularly for patients up until death, use-in the circumstances cited above-chemical substances to precipitate an end that has become too cruel, in full knowledge they are breaking the law."
French legislation adopted in 2005 made it possible not to artificially prolong the life of a terminally ill patient who asks to stop treatment, as well as administer pain-relief drugs that may accelerate the patient's death.
The law was adopted in response to the high-profile trial of a Frenchwoman who helped her quadriplegic son-left blind, mute, and paralyzed by a car crash-to die in 2003. Both she and her doctor were acquitted in the case..
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