Letters to the Editor
To the Editor:
The calls for medicine to reassert its professionalism and protect against weakening of its ideals from relationships with industry have been increasing in recent years. A recent Association of American Medical Colleges (AAMC) document, Industry Funding of Medical Education: Report of an AAMC Task Force,1 is a great step forward in showing academic medicine the road it should follow toward ensuring professionalism. Still, I am concerned about a couple of features of the report, which are generally similar to those in other policies previously published.
First, some of the recommendations represent a more paternalistic, possibly reactionary, approach to ensuring professionalism than is perhaps wise. While we have not yet done a good job of teaching or modeling appropriate academic–industry relationships, that does not mean such modeling is not the best approach to teaching students and residents appropriate behavior. There is a wide gulf between “you shouldn't” and “you can't,” and some of the recommendations in the report essentially forbid some behaviors. I think that modifying these recommendations to allow the potential for small gifts or meals or other interactions (that are in the “gray zone” of acceptable versus unacceptable) but at the same time still teaching physicians and students ways to appropriately decline them, would be a stronger message for professionalism than simply forbidding those behaviors. Prohibition, rather than modeling and teaching, is not the path to professionalism.
Second, the primary data2,3 regarding changes in physicians' behavior or decision making as a result of samples, industry influence, etc., are very sparse and increasingly old, and the recommendations in the report often rely on significant extrapolations from data that are at best suggestive. Would we base medical care decisions on data of this quality? We need current, appropriate studies that actually measure the influence of industry relations on physicians' behavior, focusing on the common, “equipoise” behaviors rather than more egregious faults. It is surely the responsibility of academic medicine to not only model appropriate interactions and make appropriate policy recommendations but also to continue to study the problem and supply current, reliable, informative data.
Charles Kodner, MD
Associate professor, Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky; (firstname.lastname@example.org)
2 Haayer F. Rational prescribing and sources of information. Soc Sci Med. 1982;16:2017–2023.
3 Peay MY. The role of commercial sources in the adoption of a new drug. Soc Sci Med. 1988;26:1183–1189.