The USA’s most influential medical advisory group has issued a report demanding that “voluntary and regulatory measures” are needed urgently to stop conflict of interest between doctors and the pharmaceutical industry.

The Institute of Medicine, part of the USA’s National Academy of Sciences, says that the paper tackles conflicts of interest “across the spectrum of medicine, from biomedical research to clinical care and from the training of new doctors to the continuing education of physicians”. Bernard Lo, chairman of the committee that wrote the study, said “it is time to end a number of long-accepted practices that create unacceptable conflicts of interest, threaten the integrity of the medical profession, and erode public trust while providing no meaningful benefits to patients or society”.

The report says that all entities engaged in health research, education, clinical care, and development of practice guidelines “should establish or strengthen conflict-of-interest policies”. Disclosure “is an essential first step in identifying and managing conflicts of interest and needs to be improved”.

The IoM also suggests that US Congress should require pharmaceutical, biotechnology, and device firms to report through a public website the payments they make. A public record like “this could serve as a deterrent to inappropriate relationships and undue industry influence” and provide medical institutions with a way to verify the accuracy of information disclosed to them.

The report also calls on doctors to “forgo gifts of any amount” from medical companies and “consulting arrangements should be limited to legitimate expert services spelled out in formal contracts and paid for at a fair market rate”. Doctors should “limit their interactions with company sales representatives and use free drug samples only for patients who cannot afford medications”, the IoM adds.

In response to the IoM report, the Pharmaceutical Research and Manufacturers of America’s senior vice president Ken Johnson, said that any conflict of interest policy “should start with the premise that academia, physicians and companies share a responsibility to maintain ethical, professional relationships and exchange information for the benefit of patients”.

He added that “pharmaceutical research companies are careful to ensure that their relationships with both healthcare professionals and students are ethical and appropriate”. He went on to say that “interactions” between sales representatives and healthcare professionals enhance public health and improve patient care.

Mr Johnson concluded by saying that recommendations by IoM and others “can also help advance ethical, professional relationships” but it is important to balance the need to manage potential conflicts of interest against the possibility that overly restrictive policies” – eg prohibitions on use of drug samples – “could have negative consequences for patient care”.