Doctor Training Aided by Drug Industry Cash
http://www.nytimes.com/2010/02/23/business/23docs.html?partner=rss&emc=rss
By DUFF WILSON
Published: February 22, 2010
More than half of the nation’s medical residency programs to train doctors in
internal medicine accepted financial support from the drug industry, even though
three-fourths of the programs’ directors said accepting the aid was “not
desirable,” a survey found.
At issue are potential conflicts of interest as the residency programs accept
drug company support to help train tens of thousands of new doctors at a point
in their careers when they are beginning to prescribe drugs, according to the
survey report.
The article was published Monday in the Web version of The
Archives
of Internal Medicine. “Program directors are aware of the problem, but right
now they don’t have the funds to be free,” Dr. Joanne M. Conroy, chief health
care officer of the Association of American Medical Colleges, who was not
involved in the survey, but had seen the report.
The survey, conducted in 2006 and 2007, found that drug companies paid for
educational materials like pocket guides in 83 percent of the programs that
accepted support, meals in 90 percent, office supplies in 68 percent and drug
samples in 57 percent.
Medical residency programs in the southern United States were much more likely
to accept the industry largess than those in the Northeast 72 percent to 47
percent. The overall rate of accepting drug industry financing was 55 percent,
but that was down from the 88 percent level reported in a 1990 survey.
The Association of Program Directors in Internal Medicine conducted the survey.
Responses were returned by 236 of the nation’s 381 internal medicine program
directors, who together train more than 22,000 doctors.
Of special note in the survey results, the authors wrote, programs where fewer
graduates passed tests from the American Board of Internal Medicine “one
indicator of program quality” were also more likely to accept the assistance.
Dr. Furman S. McDonald, a co-author of the survey report and director of
internal medicine residency at the
Mayo Clinic, said it was unclear whether the lower test scores indicated a
lack of overall support for the residency programs that took industry money, or
a negative effect from the information being imparted by the pharmaceutical
industry.
“As the pass rates went down,” he said of the new doctors’ test scores, “the
odds of accepting pharmaceutical support went up.” Dr. McDonald called for more
research in that area.
Residency programs in internal medicine typically last three years after medical
school, “a particularly formative time for physicians,” the study said.
Other surveys have indicated that medical residents do not think that their own
actions are influenced by industry gifts, but that they do think that their
colleagues are influenced. Surveys have also shown that gifts as small as a pen
or food can influence prescribing patterns.
Meals are often provided for busy residents during educational presentations.
Dr. Martin J. Blaser, chairman of the department of medicine at
New York University, said his organization’s internal medicine residency
program decided about five years ago to stop accepting food or financial support
from industry.
“I spend a fair amount of my budget feeding my residents,” Dr. Blaser said, “but
then they can learn in a way that is not unduly influenced by who is feeding
them.”
“Our lunches are not quite as opulent as the lunches they used to have, but they
have sufficient
nutrition,” said Dr. Blaser, who was not involved in conducting the survey.
While 72 percent of the survey respondents said drug industry financing was not
desirable, many of those skeptics still took the money, the survey showed. The
reason, for two-thirds of the directors who reported taking industry money, was
inadequate financing from other sources.
They also cited the popularity of drug industry perks among residents in 40
percent of the programs, and encouragement from the administration in 19
percent.
The Accreditation Council for Graduate Medical Education is the one place that
could possibly ban such pharmaceutical financing in all medical residency
programs, Dr. McDonald said. The survey did not call for a blanket ban, but for
more research.
The accreditation council declined comment on Monday.