A recent article in the Journal of Health Care Contracting tried identifying problems with conflict of interest regarding speaking and consulting for industry, by focusing on two specific questions: first “how susceptible are physicians to being influenced to purchase products or equipment, or prescribe certain drugs, based on their relationship with a vendor and the freebies or consulting/speakers’ fees they receive? And second, do physicians, in fact, make purchasing or prescribing decisions based on relationships rather than on the merit of the product or drug?”
In response to the first question, the article provided that physicians are not influenced because most drug and device makers such as the Advanced Medical Technology Association (AdvaMed) and Pharmaceutical Research and Manufacturers of America (PhRMA), already have “spelled out model codes of conduct for their members, proscribing certain practices, placing limits on gifts, etc.” Additionally, “many professional societies and associations, including the American Medical Association, also have codes of conduct or ethics in place,” which make it highly unlikely that any relationships influence purchasing or prescribing decisions.
This kind of evidence was also emphasized by the Association of Clinical Researchers and Educators, or ACRE, who held its charter meeting in Boston last July. The article cites that “ACRE (www.acreonline.org) is an organization of medical professionals who recognize that appropriate physician-industry collaborations and relationships benefit patients and advance science."
Accordingly, the article noted comments from ACRE steering committee member Carey Kimmelstiel, M.D., director of cardiac catheterization laboratory and interventional cardiology, and director of clinical cardiology at Tufts Medical Center in Boston. He is also an associate professor of medicine at the Tufts University School of Medicine.
As Dr. Kimmelstiel asserted, today’s efforts to eliminate conflicts of interest have gone too far because the practices about which people are concerned – such as gift-giving, nice trips, etc. – have pretty much been eliminated. He also noted that rules reimbursing physician practices for talks are tight as well, probably too tight.
For example, when Dr. Kimmelstiel tried giving a presentation on a drug recently, he wanted to add some slides to his presentation to share his clinical experience with others but, he was unable to since the presentation had already been reviewed by the FDA and no changes could be made.
Essentially, the point Dr. Kimmelstiel was trying to make is that “most physicians are savvy enough to be able to ferret out those who are giving a talk of value vs. those who are prostituting themselves.” Moreover, the idea that a physician is going to change their practice patterns or be influenced by what they prescribe by Post-It notes or pens they use is problematic.
As a result, Dr. Kimmelstiel acknowledged that these “overly strict conflict-of-interest policies can stand in the way of the education of students, physician trainees and practicing physicians.” He noted that “groups of fellows and physicians gather on a regular basis to listen to cases and share knowledge on particular medical topics at local restaurants which are often subsidized by industry.” Since new guidelines will prevent this, he wondered "Who will fund them, since hospitals and state government will not.”
Dr. Kimmelstiel also indicated that stricter conflict of interest policies could “potentially spell an end to clinical research being carried out at hospitals.” He even cited how some companies are leaving states like Massachusetts for other states, where they do not have to spend time worrying about compliance and exposure.
In the end, Dr. Kimmelstiel asserted that since “physicians need ongoing education on new technologies and pharmaceuticals, the best people to provide that training are other physicians.” Consequently, physicians who provide such training are not ‘promotional speakers’ because the only thing they are promoting are their patient’s health. What Dr. Kimmelstiel calls it is ‘industry-funded speaking.’ The only way to give physicians the training about new technologies, clinical guidelines and clinical trials is to conduct educational sessions, which physicians should be paid for. Why would a physician take the time to do it for free? Why would any profession?
What Kimmelstiel and ACRE want regarding conflict of interest policies are "to begin to level the playing field, to begin to have a discussion so we don’t stop doing clinical research, so we don’t stop educating our peers and others." In order to carry out this discussion, "there are no way physicians and CME can survive without industry."
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