Reports of undisclosed financial ties between researchers and drugmakers have eroded public confidence, and restoring it will require an end to some "free" perks, health policy experts said on Tuesday.

Doctors may have to give up not just pens and prescription pads, but cozy seminars put on by drug companies in the guise of education, while the companies may need to give up direct-to-consumer ads, the experts wrote in a series of commentaries in the British Medical Journal.

Concern over research integrity in the United States has become more pronounced following accusations last year by Iowa Republican Sen. Charles Grassley that prominent Harvard University psychiatrist Dr. Joseph Biederman and others failed to fully disclose payments from drug companies.

"We've seen a lot of transgressions -- people who have taken advantage of the system for their own self-aggrandizement or profit. It's got to stop," said Dr. Harlan Krumholz of Yale University in New Haven, Connecticut.

One solution, offered by Dr. Marcia Angell of Harvard Medical School in Boston, is for doctors to keep industry at arms length. "I believe there should be no relationship between the drug industry and either prescribers or patients," wrote Angell, former editor of the New England Journal of Medicine.

She argues that doctors should pay for their own continuing medical education instead of turning to drug companies for updates on prescription drugs. And she said professional organizations should pay for their own meetings and publications, instead of going "hat in hand to industry."

The meetings would be "less opulent," Angell said in a telephone interview.

GOLF IN HAWAII

"You might have to go down the local high school instead of playing golf in Hawaii, but the education would be better because it would be impartial," she said.

Gordon Coutts, a vice president and general manager of Schering Plough UK, argued that healthcare professionals should have access to drug industry information on medicines. "It is paradoxical that some do not consider doctors capable of separating good information from bad," Coutts wrote.

But Krumholz agreed that pens, lunches and even drug samples can have a subtle influence on a doctor.

"I would often grab samples off the shelf because I thought I was doing patients a favor," Krumholz said in a telephone interview. "I was naive. I didn't realize this was a very effective marketing technique."

Krumholz argues that direct-to-consumer advertising influences patients to ask for costly treatments over cheaper options. "I think it has overshadowed the science," he said.

Scott Gottlieb, a health policy analyst in Washington who consults for pharmaceutical companies said drugmakers need to establish transparent guidelines governing their interactions with doctors and patients, and focus more on advancing science rather than marketing. "Relationships should be predicated on genuine scientific work," he wrote.

Earlier this year, many drugmakers said they would stop giving out small gifts such as pens and flash drives as part of new voluntary guidelines from Pharmaceutical Research and Manufacturers of America, an industry group in Washington.

The group's 2002 code already bans more costly gifts like trips to resorts, and calls for companies that pay for medical education at conferences to leave the content to outside experts.  //02.08.09 mInA