The pharmaceutical industry spent $14.2 billion on clinical trials and sponsored 57% of biomedical research in 2003 and funded over 60% of continuing medical education (CME) in 2001. Two recent books, The Truth about Drug Companies and On the Take, each written by a former editor of The New England Journal of Medicine, raise serious concerns about the physician-pharmaceutical industry (PI) relationship. We wanted to understand how our internal medicine faculty regarded this relationship. From November 2004 through February 2005, we conducted three group discussions focused on power and influence within health care with internists at our medical school. We recorded in-depth, 1-hour interviews with seven distinguished researchers and educators on our faculty that emphasized relationships with PI. We analyzed each transcript for comments about personal involvement with PI, clinical research, CME, and clinical practice. All had substantial involvement with PI in clinical research, medical education, or both. They regarded PI-funded clinical research as prevalent and useful for generating information and money for themselves and their divisions. They stated that such research, while not as highly regarded as investigator-initiated and peer-reviewed projects, was acceptable and valued. They did not report personal experience with suppression or manipulation of results. They all attended and/or taught at PI-sponsored CME programs. They felt that PI funding was “the way to get things done” in clinical research and CME. They also felt that CME “would not survive without it.” Most reported no PI control or influence on the content of their CME presentations. One reported that support for independently chosen speakers was becoming more difficult and the content of talks more controlled. He attributed these changes to new regulations. All acknowledged strong PI influence on clinical research, medical education, and clinical practice but did not feel compromised or inappropriately influenced themselves. None reported being counseled or criticized by their leaders about their relations with the PI. They did not include information or advice about these relationships in the formal curriculum for their trainees. Interviews with a small number of highly regarded medical faculty suggest that they have accepted an increasingly powerful role of PI in clinical research and education and that they do not advocate additional regulation or envision alternative ways to support these activities. Therefore, if change occurs in these relationships, it will likely come from sources outside of medical schools.
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