Governments and medical associations are cracking down on North American universities that take contracts from industry to do pharmaceutical research.

Industry-sponsored research and academic freedom
On Thursday, the New England Journal of Medicine published a survey suggesting how drug companies can restrict scientists' academic freedom and the public's right to get the full story on the effectiveness of new drugs and medical treatments.

Researchers at the Duke University's medical and law schools found agreements between universities and industry often fail to follow new ethical guidelines that set standards for researchers submitting papers to 500 medical journals.

A committee of medical journal editors issued the revised guidelines in October, 2001. The Duke study surveyed 108 medical schools from November, 2001 to January, 2002 on whether: * authors of reports had access to clinical trial data from all locations * authors or an independent committee controlled editorial and publication decisions* investigators were fully involved in how the trial was designed and conducted They found the agreements seldom met the established standards. On average, one per cent of agreements required researchers conducting multi-centre studies to have independent access to all trial data.

Sponsors typically maintained control over publication decisions, the survey found.

They're concerned that the private funding can influence the outcome of what should be independent trials.

If that happens, consumers could be endangered and scientific objectivity compromised.

In Canada, the crackdown includes changes to guidelines and codes of practice for medical associations.

Drug companies are facing pressure from another side. They go to great lengths to persuade doctors to prescribe their products.

In some cases, their activities are so objectionable that U.S. government officials have warned pharmaceutical companies to steer clear of arrangements that could constitute fraud or abuse.

Drug companies invite doctors to resorts and medical conferences to learn, upgrade their skills and perhaps enjoy some rest and recreation.

The companies pick up the tab for doctors to fly business class, and wine and dine them, getting a captive audience for sales pitches.

"They're out to influence doctors," said Dr. Joel Lexchin, a professor of health policy at York University.

"This is a gift relationship. The doctors are getting something from the drug companies ... and in return, the companies know the majority of doctors will repay that gift in one way or another."

Murray Elston of Canada's brand name pharmaceutical companies, Rx and D, said in some situations, the gifts should not be condoned.

Concerns about how drug companies may influence researchers and doctors prompted Dr. Patricia Baird of the University of British Columbia to say medical studies in North American have begun to resemble advertising copy for drug firms.

The Canadian Medical Association does not condone some of the benefits doctors receive. Its policy said only physicians who make presentations at medical conferences should be allowed to accept free travel and lodging.

The CMA's policy doesn't contain provisions for punishment if doctors break the rules, but Dr. Andre Jacques of Quebec's College of Physicians is rewriting his group's code to include sanctions for doctors who accept unauthorized benefits.

Drug companies are also cracking down on themselves. Rx and D is changing its marketing code to eliminate travel grants for most doctors.

"If it's adhered to, it will make a dramatic improvement in the ethic we've been talking about in this trustworthiness of the physician-patient-pharmaceutical company relationship," said Dr. Richard MacLachlan, chief of family medicine at Dalhousie University.