“Professional Medical Associations (PMAs) should work toward a complete ban on pharmaceutical and medical device industry funding ($0), except for income from journal advertising and exhibit hall fees.”
This is the bottom line of The Journal of the American Medical Association’s (JAMA) Special Communication entitled: Professional Medical Associations and Their Relationships with Industry a Proposal for Controlling Conflicts of Interest.
The Special Communication is authored by ardent anti-industry critics, David Rothman, Ph.D., the Director of the Institute of Medicine as a Profession (IMAP) at Columbia, Katherine DeAngelis, M.D., Editor of JAMA, one current and several former medical society officers including Steve Nissen, M.D., former President of the American College of Cardiology, and James Scully Jr., M.D., CEO of the American Psychiatric Association.
The “Special Communication” covers several major operations that they believe the medical societies should discontinue seeking funding for including: general budget support, national conferences, regional meetings, research, fellowship and training programs, practice guideline distribution, outcome measures, certain publications, and product endorsements. In addition, they call for the elimination of all ties to industry, including funded research by presidents and officers of medical societies.
The paper funded by the Pew Charitable Trust but not disclosed through the Prescription Project to IMAP, follows the pattern of a similar paper entitled Health Industry Practices that Create a Conflict of Interest: a Policy Proposal for Academic Medical Centers that was orchestrated by the same groups (but not disclosed) and published in JAMA in 2006 that has lead to the Association of American Medical Colleges and major universities to revise their conflicts of interest guidelines.
The goal of this paper is stated plainly in the conclusion:
· PMAs should work toward a goal of $0 contributions from industry;
· PMAs leaders and executive staff should be free of conflict of interest; and
· In time, the entirety of the board and members of the practice guidelines committees should be free from conflict ($0 dollars).
Conferences
Industry Sponsorship of Conference Programs
Establish Continuing Medical Education (CME) Committees that are free of conflicts of interest who could freely distribute the (I thought they wanted this banned) unrestricted educational grants from industry. And, PMAs should seek funding from foundations and/or the National Institutes of Health (NIH) for specific courses or endowed chairs.
Funding, if sought, should go through a PMAs central repository or committee.
Conflicts of Interest Standards for Program Committee Members
At a minimum, members of the program committee should disclose any financial ties with industry to the committee chairman and legal counsel.
Gifting of Promotional Items
A ban on all gifts and food.
Satellite Symposium
PMAs should not endorse, facilitate, or accept funding for satellite symposia.
Research by PMAs and “Members”
Industry should not be allowed to provide a grant for a project of its choosing or be associated with a specific project.
The research awards should be peer reviewed without any involvement from industry.
Funds should go to a central repository or committee.
Fellowships and Training Programs
Fellowships should not be named after the pharmaceutical company or device manufacturer.
Fellows should not know which company funds underwrote their fellowships.
Small societies should consider avoiding all such support.
Committees that Formulate Practice Guidelines and Outcome Measures
The establishment of guidelines and registries must be independent of all industry influence, actual or perceived.
Disclosure of industry relationships by committee members is not sufficient protection.
PMAs must excluded from guidelines committee persons with any conflicts of interest ($0 threshold) involving research support or additional income from a company whose products could be effected by the guidelines.
Publications (Journals)
Creation and distribution of guidelines and other advisory materials should be independent of industry funding.
Should not accept industry funding of journal supplements.
Companies are free to purchase the materials (journal articles), and distribute and refer to them in their promotional materials but without a logo or branding.
Advertising can be acceptable when it is clearly identified as such.
Companies should be permitted to purchase reprints of articles published in journals.
Product Endorsements
Never solicit or accept any offer that would attach its name or logo to a commercial product, service, or activity.
Affiliated Foundations
Affiliated foundations must be held to the same standards on conflicts of interest as the parent PMA.
Presidents, Officers, and Board Members
At a minimum the president, president-elect, immediate past president, vice president, secretary, and treasurer of a PMA should be conflict free ($0 threshold) during their tenure. This includes no personal income, and no research support should be derived from industry.
Guidance for PMA Members
As PMAs strengthen their conflicts of interest policies, they should use the policies to influence and lead their members to adopt similar standards. The PMA should make it explicit that the principles underlying the organization’s behavior apply to the physician behavior.
Physicians should avoid marketing industry products.
Summary
They present no evidence of a problem, and they offer no viable solutions to solve the problem for which they show no evidence.
The papers views only represent a very small but vocal minority of medical society members.
This is an opt-ed editorial with no balance or opposite opinion disguised as a “special communication.”
In reading the “Special Communication,” there is no mention of peer review. Also, Katherine DeAngelis states she has no influence in its publication, sure…
This is the typical rhetoric of anti-industry purists who seek to scare the public into believing that all medical professionals who collaborate with industry are somehow tainted and that there is no good reason to collaborate with industry even in research.
Nowhere does it focus on the best interest of patients. It just assumes that conflicts of interest are bad, but does not speak to the value of collaboration. While the United States government is developing a system to solve the nation's financial crisis through government/industry collaborations, this group seeks to end pharma and device industry collaboration with medical researchers and clinicians. How can that be good for patients, and increasing access to medical care?
Certainly, it is a good idea for any organization or group of organizations to engage in self-reflection and self-regulation. Indeed, the pharma and device industries have self-regulatory codes, and almost all associations have internal and external guidelines for dealing with conflicts of interest. Most have revised their conflicts of interest policies in the last four years, and this “Special Communication” gives no credit to the changes.
Though the paper praises disclosure regimes, it says they do not go far enough. What is their basis for that? I believe we praise openness, transparency, disclosure efforts, and support programs that expand their reach and effectiveness.
The exclusion of journal advertising and supplements is self-serving to say the least, if this group is serious about a complete separation, they may want to start at home (Journals), as opposed to inflicting their self-righteous moral stance on everyone else.
This also explains the stance that the American Psychiatric Association took last week on sponsored food and education for their meeting, they were fully aware of this week’s publication.
They go out of their way to relate PMAs to university medical centers and push for even further restrictions (i.e., ban on industry funded research). The major difference is that PMAs are not universities and the barrier to create a new medical association is quite small (this is America), and disgruntled members can easily form a less intrusive organization. Um… The American Society of Clinical Psychiatrists….
One note sent to me by Bruce Ballande former Executive Director of the Alliance for Continuing Medical Education made a good point that the special communication recommends that “The American Association of Medical Colleges have recently adopted conflict of interest policies for faculty that can serve as useful models”.
This is an interesting suggestion which contradicts the recommendations of the AAMC paper.
Essentially the AAMC strongly recommends that faculty, students, residents and fellows participate in and attend only ACCME Certified education and not promotional education.
Moreover the AAMC strongly endorses the continuation of commercial support for education and research unlike the recommendations of the article.