Guarding against medical conflicts of interest

In an effort to limit financial conflicts of interest between academic medicine – hospitals, universities and doctors - and industry – drug makers and medical device companies – the Association of American Medical Colleges issued a report today establishing new guidelines to limit the impact on patient care.

The 46-page report “In the interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decisions Making” was written by a 20-member panel of national medical leaders chaired by P.J. Brennan, chief medical officer of the University of Pennsylvania Health System.

“We believe these recommendations will provide guidance for how to implement policies that will meet the needs of both patients and the institutions them,” Brennan said.

Penn has among the nation’s most stringent conflict of interest policy that includes posting of the financial ties between its medical faculty and outside companies and other organization on its website. The health system and medical school, known collectively as Penn Medicine, also limit access to medical students and facilities by drug company sales representatives.

A key recommendation of the task-force report is that salaries and other compensation for medical faculty be aligned with the best interests of patients. “Medical centers have the responsibility to develop compensation plans that are based on incentives that are consistent with the values of medical professionalism and reflect the primacy of the patient’s best interests,” the report stated.

Moreover the report stated that academic medical centers must “address their physicians’ financial relationships with industry in the context of the clinical care they deliver.”

That includes:

  • All academic medical centers should establish mechanisms to identify physician-industry financial relationships and evaluate their potential for biasing the clinical practice of physicians and to eliminate, limit, or manage those that appear to represent a risk of bias.
  • The identification of these financial relationships should include the receipt of, or rights to receive, royalties by physicians, consulting or other services for industry by physicians, and physicians’ ownership interest in related companies.
  • The institutions should set thresholds for physician reporting to their institutions and for institutional evaluation mechanisms to assess the reported interests.
  • Each medical center should also determine under what circumstances an individual physician’s financial interest relating to particular drugs being prescribed or devices being used on a particular patient are such that they should be disclosed to the patient as well as the means for disclosure to the patient.
  • Clinical conflicts of interest policies should include provisions for consequences for failures to adhere to them.

The report is the third by the AAMC addressing issues of financial conflict of interest in academic medicine. The first two reports focused on such issued in medical research and education. Those reports are availablehere.

“Because patients and the health of the public are top- priorities for the nation’s medical schools and teaching hospitals, we must uphold the highest standards of professionalism, while maintaining principled relationships with industry to improve patient care,” said Joanne M. Conroy, chief health care officer of the association.

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