Ethics for the Pediatrician: Physician Interaction With the Pharmaceutical Industry

Mark X. Cicero; Michael B. Curi; Mark Mercurio

doi:10.1542/pir.32-1-e1

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Mark X. Cicero, MD*
Michael B. Curi, MD^†
Mark Mercurio, MD^§

^*Assistant Professor of Pediatrics, Yale University School of Medicine, New Haven, CT.
^†Assistant Clinical Professor of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
^§Associate Professor of Pediatrics, Yale University School of Medicine, New Haven, CT.

Author Disclosure
Drs Cicero, Curi, and Mercurio have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Introduction

In the United States, more than 40 billion dollars are spent annually in drug research and development. (1) Wholesale pharmaceutical sales totalled $275 billion in 2008. Pharmaceuticals are both an indispensable tool and a staggering expense in health care. When caring for children, pediatricians consider a medication's efficacy, potential adverse effects, and often whether the child's health-care insurance covers the prescription. A complex relationship has evolved between pharmaceutical companies and pediatricians, with drug manufacturers historically providing gifts, sponsoring continuing medical education (CME), and delivering samples to medical offices. We explore this relationship in light of recommendations of the American Academy of Pediatrics (AAP) and the American Board of Pediatrics (ABP) and the ethical conflicts relevant to this relationship.

Pharmaceutical Industry Gifts

For more than a decade, awareness of the influence that industry gifts have on physician prescribing habits has been increasing. (2) In an oft-cited work, Steinman and associates (3) found most residents (61%) felt they were immune to the influence of pharmaceutical representatives and their gifts, but only 16% believed their peers were similarly above the influence of the drug industry. In truth, industry gifts may influence behavior. Such gifts may cause a conflict of interest with a pediatrician's fiduciary relationship to the patient. By definition, a fiduciary relationship is one based on trust, in which the physician works for the benefit of the patient, holding his or her needs as the highest priority.

Professional organizations and the industry have made attempts to address the potential conflicts of interest. In 2002, the American Medical Association (AMA) and the Pharmaceutical Researchers and Manufacturers of America …