I always imagined that doctors chose devices and prescriptions based on their benefits to a patient’s health. After all, “I will prescribe regimens for the good of my patients according to my ability and my judgment,” is in the Hippocratic Oath. However, drug companies muddle this process by tempting doctors with vacations, free lunches, and huge salaries for their work as “consultants”. If a doctor is that deep in bed with a manufacturer, how are they to maintain an unbiased opinion on all of the drugs and devices available?

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This presents an obvious conflict of interest, but how can we excise these conflicts from the current system? I recently asked a cardiologist what he thought about a Medtronic representative. The doctor told me, “It’s just business. This is just a business, and everyone is trying to get their piece of the pie.” However, he claimed that the drug and device reps had no affect on his ability to make unbiased decisions. “I don’t pick the devices we use, anyway,” he joked.

He might pick the devices one day, though, and that’s precisely what the drug and device companies are banking on. With all the money these companies spend on direct marketing, they obviously are seeing some sort of return on their investment to justify all of their spending.

Here another take on the issue from the New York Times article, “Crackdown On Doctors Who Take Kickbacks“:

A common problem in illegal drug and device marketing cases is doctors’ willingness to delude themselves into thinking that cash, lucrative trips and other kickbacks do not affect them, said Mr. Morris, the chief counsel.

“Somehow physicians think they’re different from the rest of us,” Mr. Morris said. “But money works on them just like everybody else.”

“I have been shocked at what appears to be willful blindness by folks in the physician community to the criminal conduct that corrupts the patient-physician relationship,” he said

But where do we draw the line? Should gifts in excess of $50,000 be prohibited? How about anything more than a $50 lunch meeting? Either way, any relationship with the drug and device companies presents the possibility for a conflict of interest. From medical student to resident to full fledged physician, doctors are bombarded by the wooing of drug and device companies. The habit of accepting their offerings almost seems too ingrained into the medical culture to simply draw a line in the sand, but medical practitioners need take a few steps back and reconnect with more patient centered approaches.

March 5, 2009: Another take on the issue: Why are some Harvard Medicine professors making more money from drug and device companies than from their regular payroll?

New York Times — Harvard Medical School in Ethics Quandary