Are doctors too cozy with drugmakers?

Consumers should be concerned about the relationship between their doctors and pharmaceutical companies, according to Utah medical ethics experts. And doctors should avoid not only conflicts of interest but the appearance of such conflicts in their relationships with drugmakers, they say.

The question is very much in the news these days as medical journal editors, government regulators, health conference planners, journalists, hospital administrators, physicians and the drugmakers themselves try to decipher what's appropriate and what crosses a generally unspoken ethical line in the relationships between the two.

"I think the pharmaceutical industry has strong influence on both conduct and reporting of research and the clinical practice of medicine," says Dr. Jeffrey Botkin, associate vice president for research and a professor of pediatrics and medical ethics at the University of Utah. "I think the general public should be concerned about both those issues."

Doctors and drug manufacturers come together in many ways, some legitimate, some iffy, say Botkin and fellow medical ethics expert Dr. Jay A. Jacobson, chief of the division of medical ethics at LDS Hospital and in the department of medicine at the U. The two men also teach medical ethics classes to advanced medical students at the U. and to those in area residencies.

No one disputes that pharmaceutical companies should bear the cost of developing and testing medications. But their relationship with doctors, who they need to conduct the clinical trials that further testing of a potential or existing treatment, can muddy things up. "Many investigators, leaders in their field, have a relationship and a legitimate interest in helping promote helpful products to the community. If they severed all ties, it probably wouldn't be a good thing. But it's a problem that is only partially solved by disclosure," Botkin said.

"The FDA (Food and Drug Administration) has run up against that problem," he says. They have trouble sometimes finding experts without some kind of financial relationship with the companies that have drugs up before the FDA. "It's a difficult problem to get around."

It's also a problem for reporters who write about new drugs and drug testing, because the doctors often cited as experts on the medication or the condition may also be paid by the pharmaceutical companies as part of their "speakers bureau."

The questions go far beyond that, though.

Because of ethical concerns, for instance, some doctors offices and medical clinics, including some at the U., have stopped accepting free samples of medicine to give patients to try.