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Appendix A: American College of Physicians Physician–Industry Relations
POSITION PAPER
Physician–Industry Relations. Part 1: Individual Physicians
Susan L. Coyle, PhD, for the Ethics and Human Rights Committee, American College of Physicians–American Society of Internal Medicine*
5 March 2002 | Volume 136 Issue 5 | Pages 396-402
This is part 1 of a 2-part paper on ethics and physician-industryrelationships. Part 1 offers advice to individual physicians;gives recommendations to medical education providers and medical professional societies.
Physicians and industry have a shared interest in advancingmedical knowledge. Nonetheless, the primary ethic of the physicianis to promote the patient’s best interests, while theprimary ethic of industry is to promote profitability. Althoughpartnerships between physicians and industry can result in impressivemedical advances, they also create opportunities for bias andcan result in unfavorable public perceptions.
Many physicians and physicians-in-training think they are imperviousto commercial influence. However, recent studies show that acceptingindustry hospitality and gifts, even drug samples, can compromisejudgment about medical information and subsequent decisionsabout patient care. It is up to the physician to judge whethera gift is acceptable. A very general guideline is that it isethical to accept modest gifts that advance medical practice.It is clearly unethical to accept gifts or services that obligatethe physician to reciprocate.
Conflicts of interest can arise from other financial ties betweenphysicians and industry, whether to outside companies or self-ownedbusinesses. Such ties include honorariums for speaking or writingabout a company’s product, payment for participating inclinic-based research, and referrals to medical resources. Allof these relationships have the potential to influence a
physician’sattitudes and practices. This paper explores the ethical quandariesinvolved and offers guidelines for ethical business relationships.
In 1990, the American College of Physicians published a positionstatement titled "Physicians and the Pharmaceutical Industry"to address ethical issues in relationships between industryand the medical profession (1). The statement, which was promptedin large part by evidence of the drug industry’s influenceon physician behavior and concern for professional integrityand patient care, examined potential conflicts of interest inrelationships with industry and provided ethical advice in certainareas. Since the statement was originally released, evidenceof industry’s influence on medical practice, research,and education has continued to emerge, and physician-industry relationships have multiplied. Once again, the American Collegeof Physicians–American Society of Internal Medicine remindsphysicians and industry to be vigilant about potential conflictsand ethical problems. The College recognizes that while thereare no easy answers to many ethical questions, guidance in certainareas can be useful.
This is part 1 of a 2-part paper on ethics and physician-industryrelationships. In part 1, the College offers recommendationsto individual physicians, mainly clinicians and clinician- researchers,regarding acceptance of gifts and other financial relationshipswith industry.
addresses medical education providers and medicalprofessional societies that accept corporate funding for organizationalprojects or membership events, such as meetings and symposiums. Despite the introduction in the early 1990s of ethical standardsfor physicians regarding physician-industry relationships, concernspersist and evidence accumulates that commercial rewards canunduly affect clinical judgment (2-9). Industry allocates substantialresources to promote its products to physicians. In 1999, thepharmaceutical industry spent nearly $8.0 billion (U.S.) tosend sales representatives to physician offices and to exhibitproducts at medical conferences and events (10). Such costlycorporate overtures raise questions about undue influence andcould undermine genuine educational efforts.
In addition to the pharmaceutical industry, physicians are increasinglycourted by newly emerging industries (biotechnology, pharmacogenetics,e-commerce), and potential conflicts of interest, whether realor perceived, are pervasive. Physicians meet industry representativesat the office and at professional meetings, collaborate in community-basedresearch, and develop or invest in health-related industries.In all of these spheres, partnered activities often offer important