No free lunch
Doc groups set rules to check conflicts of interest
The Council of Medical Specialty Societies has developed a voluntary code for interactions with companies in the for-profit health sector, stating that it did so to help maintain the “actual and perceived independence” of its member organizations and the 650,000 physicians those organizations are said to represent.
The code has been signed by only 13 of the council’s 32 member groups, but additional societies are expected to sign on to the code once the leadership of those groups review and approve it. “Members and patients count on Societies to be authoritative, independent voices in the world of science and medicine,” the Code’s preamble states. “Public confidence in our objectivity is critical to carrying out our mission. We know the public relies on us to minimize actual and perceived conflicts of interest.”
The code gives guidance on disclosing and managing conflicts of interests, publicly disclosing sources of financial support, developing independent education programs and advocacy positions, and prohibiting society leadership from having direct financial relationships with for-profit healthcare companies.
American Psychiatric Association Medical Director and CEO James Scully Jr., who also serves as president of the council, said the organization was motivated by the Institute of Medicine’s report from last April, Conflicts of Interest in Medical Research, Education, and Practice, which recommended that medical societies develop codes on this subject.
They were also motivated by congressional inquiries from Sen. Chuck Grassley (R-Iowa) and others seeking information about medical colleges’ policies on faculty conflict of interest, Scully said, adding the council was also pushed into action by medical students who complained about the pernicious and ubiquitous presence of drug company logos and sponsorship of social and educational events.
“They led the way,” Scully said. “It was the students who said: ‘Hey, what are you guys doing?’ I still hear from my (APA) members who just don’t believe they can be influenced by drug-company marketing, but studies show you are influenced—even if you’re not aware of it.”
Scully added, however, that members of medical societies in particular and healthcare professionals in general were aware of what the public perception was, and he cited a 2008 New Yorker magazine cartoon as particularly damning. “It showed a doctor all decked out like a NASCAR racecar driver with drug company logos all over his white lab coat,” Scully said. “That was telling.”
He also said that the medical societies had more or less begun moving in this direction independently—particularly the American College of Physicians, American Academy of Family Physicians, and the Society of Thoracic Surgeons—but it was decided that the council should develop a standard code that all medical societies could adopt. “Everybody’s been working on it,” Scully said.
The thoracic surgeons and Scully’s own group, the American Psychiatric Association, haven’t adopted the code yet, but most of the member organizations are expected to do so by the end of the year, Scully said, noting that the APA board is expected to vote on the code at a September meeting.
He added that, even without formal adoption of the code, people attending the APA’s annual meeting being held May 22-26 in New Orleans will notice a difference from years past. “If you come to our meeting in New Orleans, you’ll see a much lower drug company presence,” Scully said, explaining that there will be no more banners with drug company logos on them, program presenter’s Power Point slides are checked for evidence of bias toward a particular company or product, and they will notice that industrysponsored education programs during the meeting are being phased out. “We’re down to two,” he said. “We used to have 30 or 40.”
The new code includes a section on society meetings and, while corporate support is still allowed, the code states that societies will not solicit corporate supporters’ suggestions on program topics, speakers or content. It prohibits company-controlled presentation materials and the use of company logos on slides. It also states that “societies will not seek support for product-specific topics,” and that groups must “make reasonable efforts to achieve a balanced portfolio of support.”
The council task force was formed in the spring of last year and went through “many, many drafts” of the code before having the council’s board approve it on April 17, Scully said. “The process was intense and there were good, polite debates and, in the end, we worked toward consensus,” he said. “The code wasn’t handed down from the mount.”
Medical societies are not the only ones rolling out new conflict-of-interest policies. The U.S. Food and Drug Administration also released a “draft guidance” on April 21 that it said would “expand transparency and disclosure” of when FDA advisory panel members’ receive conflictof-interest waivers.
In the draft, the FDA is proposing to expand the information disclosed, and post on the Internet the type of conflict involved and the financial interest of any company or institution associated with that conflict.
An FDA news release noted that, at times, it is appropriate for the agency to seek advice from experts who may be biased, and the news release addresses this issue by quoting from a letter from FDA Commissioner Margaret Hamburg sent to senior agency officials.
“In my view, it is clearly better for the agency in fulfilling its public health mission when advisers have no conflicts of interest,” Hamburg stated in the letter. “FDA staff should search far and wide for experts who have the requisite knowledge without conflicts of interest. At the same time, however, I recognize the fact that many of the top authorities in specific areas may have conflicts of interest.”
New rules proposed by physicians’ groups will help minimize conflicts of interest such as free dinners given by drug companies.