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Pills without shills (MS)

FINANCIAL links between the drug industry and the medical profession threaten to undercut patients’ faith in their care every time their doctors reach for their prescription pads. An antidote to such distrust is the new set of conflict-of-interest policies unveiled last week by Partners Healthcare, parent of Massachusetts General and Brigham and Women’s hospitals. While not perfect, the new rules are an effort to draw clear ethical lines between drug-industry support of worthwhile medical education and research, and the industry’s use of doctors as paid shills.

With healthcare consuming more than 16 percent of the economy, cozy relationships that lead to the overuse of expensive drugs hurt the patients and employers who pay for treatment. All too often, the drug and medical device industries use gifts – ranging from lunches to handsome speaking fees – to persuade doctors to promote their newest, costliest products, when older and cheaper ones often serve as well or better.

With more bite than the state’s new law restricting industry gifts to doctors, the Partners rules would prohibit its doctors from joining industry speakers bureaus. Free drug samples provided by companies would go to hospital pharmacies or other repositories and not to doctors directly.

Other institutions have gone further than Partners in restricting the funding of continuing medical education courses by drug companies. But under the new rules at Partners, such courses would need at least two company sponsors – to minimize undue influence by any one drugmaker – and would have to pass muster with a new Educational Review Board.

The effectiveness of the policies will depend in part on the details that flesh them out. Massachusetts General Hospital President Peter Slavin, who served on the commission that formed them and will chair a task force for implementing them, said a first step will be to educate staff in all the Partners facilities about the new rules. Partners should also make sure it goes beyond the state’s new law in requiring full and public disclosure by researchers of payments from companies for clinical research.

The goal is not to build a wall between industry and teaching hospitals, which would slow research advances, but to ensure that connections are transparent and do not turn doctors into "hired guns," in Slavin’s phrase. "Unless the relationship is healthy," he said in an interview this week, "our ability to bring ideas to the marketplace would be compromised." Partners has taken a first step at making the relationship an arm’s-length one – a good way to limit infection and keep the relationship healthy.