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To the Editor: The Special Communication by Dr Brennan and colleagues¹ appropriately positioned AMCs to take the lead in changing current accepted relationships between medicine and industry. The authors summarize important literature illustrating the problematic influence of industry on physician behavior and the limited benefits of disclosure. There are, however, several potential barriers to the implementation of the authors' policy proposals that were not discussed.

First, there is a significant culture of entitlement to even the smallest of gifts (lunches, modest meals, pens) that may make their elimination difficult in some health centers.² Second, the authors suggest separating industry funding from trainees in an era of dwindling financial support for GME when some institutions are seeking innovative funding sources, such as industry itself, for residency positions.³ Third, the ambitious goal of excluding faculty involvement in speaker's bureaus could prove difficult, given a recent study that found that physicians who participated . . . [Full Text of this Article]

Peter Y. Watson, MD
pwatson1@hfhs.org
Department of Internal Medicine

Joseph L. Musial, PhD
Department of Surgery

Akshay K. Khandewal, MD; John D. Buckley, MD, MPH
Department of Internal Medicine
Henry Ford Hospital
Detroit, Mich

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