Reforms Proposed to Limit Conflicts of Interest

“I think banning food and gifts makes things a lot easier, frankly,” he said. “It's so nice to walk into a conference and not have to have that awkward conversation with a drug rep, and not have to feel squeamish about possible conflicts of interest.”

He acknowledged that the proposed reform central to most physicians in private practice—banning free samples and other gifts from detail people—is not likely to be adopted any time soon. At Yale, “we considered banning free samples for patients, because it clearly encourages the use of more expensive medications. Even worse, it is a poorly regulated process, so these drugs can end up in the hands of patients who are not followed adequately. But it was finally decided that free samples could not be prohibited until some other system for delivering free samples to needy patients is in place.”

Yale did ban the use of free samples by physicians and their families, a measure that has had an unexpectedly large effect. “There has been some grumbling,” but the response to the strict guidelines from Yale physicians as well as outsiders has been overwhelmingly positive, Dr. Coleman said.

Another dissenting note was sounded by Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, Washington, who noted that sales representatives are technically well trained and provide crucial information to doctors about the way drugs work and their side effects. Most detailers already follow PhRMA's voluntary guidelines and focus on ensuring that medicines are used correctly, he said.

Most physicians interviewed agreed heartily with one proposed reform: ghostwriting. This should be controlled or eliminated, because some companies do influence the wording in research manuscripts, and busy investigators may go along with it, Dr. Deedwania said.