Proposals facing the American Medical Association include a measure seeking to make all drug study results public, even unpublished research funded by pharmaceutical companies that might reflect poorly on their products.
The measure stems partly from concern over unpublished data linking some antidepressants with suicidal behavior in children. Government officials are investigating the potential link.
Another measure would strengthen a policy the AMA adopted last year on "shadowing," the practice of drug company representatives sitting in on patients' visits with their doctors.
Critics say the practice is an attempt to influence what medicines are prescribed. Drug companies say the practice is educational, but they sometimes pay hundreds of dollars a day to the doctors for these visiting rights — money the new measure says doctors should refuse.
The more than 250 proposals prepared for the meeting, which began Saturday, also ask the AMA to take a stand on issues that include the obesity epidemic, the execution of juvenile criminals and the harvesting of organs from patients who haven't explicitly given consent.
The generally cautious AMA frequently avoids taking bold stands on controversial issues, and many proposals at the five-day meeting will be rejected or revised before being sent to the group's delegates, who begin voting Tuesday on policies to adopt.
A new financial report touts the group's fiscal health, showing a $20.1 million operating profit in 2003 — the fourth consecutive year of operating in the black. The increase from $11.7 million in 2002 was attributed partly to revenues from publishing and sources other than AMA dues, which have been declining along with membership.
The AMA had 250,830 members in 2003, down from 260,455 in 2002, representing about a third of the nation's doctors and medical students.
Still, any AMA support could lend credence to the meeting's proposals, including the move to make all drug study results public.
As drafted, the measure would ask the U.S. Department of Health and Human Services (news - web sites) to consider forming a national registry of all drug studies, possibly available over the Internet.
Alan Goldhammer of the industry group Pharmaceutical Research and Manufacturers of America said a public research registry could lead to misinterpretation.
"Those are the kinds of things that we'd have to look at and discuss before endorsing or rejecting any proposal," Goldhammer said.
Calls for publicizing all drug studies also have come from the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry and bioethicists concerned about industry influence on doctors.
"It would be good to see the AMA get on board," said Merrill Goozner of the Center for Science in the Public Interest. "Medical professionals who are after all the prescribers and the primary users of these tools ... should be the guys in the forefront" of the issue, Goozner said.
It is critical for doctors to have all information on tested drugs so they can make informed prescribing decisions, said Dr. David Fassler, a Vermont psychiatrist.
Drug companies aren't required to publish study results, and medical journal editors "are at the mercy of what is sent in the mail," said Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association (news - web sites).
Drug company-funded submissions more often than not have positive results, a phenomenon called publication bias.
DeAngelis voiced support for the push for a national registry, as did Dr. Jeffrey Drazen, editor of the New England Journal of Medicine (news - web sites).
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