To encourage innovation and advances in patient care while ensuring integrity, the American Rhinologic Society (ARS) recently adopted a conflict of interest policy that permits transparent interactions between medical companies and ARS and its leadership.
The American Rhinologic Society is the world’s largest physician organization whose mission focuses upon the medical and surgical treatment of patients with diseases of the nose and paranasal sinuses. Patient care, research, and education are integral to the ARS mission.
In a press release last week, the ARS noted its decision to not adopt the Council of Medical Specialty Society’s (CMSS) Code for Interaction with Companies because company funding and relationships are not allowed under the code.
ARS leaders “believe such an extreme policy would be harmful to patients.” While there have been “some well-publicized incidents of doctors and companies who have abused the system,” Brent Senior M.D., ARS president and chief of Rhinology, Allergy and Sinus Surgery at the University of North Carolina at Chapel Hill, noted that it would be “a mistake to forbid any interaction with companies” because of these few incidents.
Specifically, Dr. Senior recognized that these “relationships are crucial to innovation and advancements in patient care, and if those lines of communication and opportunities for funding are shut down, patients will suffer.”
The press release also discussed how “ARS leaders recognize that medical innovations require money and resources and, conversely, that companies must rely on doctors who work with patients on a daily basis to determine what issues need solving as well as products, services and drugs that should be developed.”
Moreover, ARS acknowledged that, “government and not-for-profit research money is limited and many studies are funded by companies.”
For example, ARS noted that, “an HIV/AIDS diagnosis is no longer the death sentence it once was, thanks to research performed by physicians who treat patients with the disease and funded by pharmaceutical companies developing drugs that help people manage the disease.”
In addition to treatments, Dr. Senior noted that, “nearly any new surgical procedure or device is by necessity developed through a partnership with physicians and companies.” “Further, medical specialty societies are headed by thought leaders, who are best able to interact with industry in a positive way to help patients.”
ARS Conflict of Interest Policy
Accordingly, “the ARS policy seeks to take a rational approach to relationships with companies. The policy does not set dollar amounts or limit interaction between companies and ARS leaders, or members of its organizational committees, task forces and panels, but it does insist on 100 percent transparency and lists those relationships and specifics on its website.”
The policy also creates ground rules for these relationships to prevent company influence. For instance, a “doctor must disclose a conflict of interest and may sit on a panel and participate in the debate, but not in the drafting of policy or voting.”
Dr. Senior recognized that the “policy of transparency respects the intelligence of patients and doctors by allowing them to make their own decisions based on the nature of the relationship.”
For example, Dr. Senior noted that, “if a patient knows that Dr. Jones received $250,000 from a company, he might understandably have concerns about the doctor and choose to see someone else, but if he knows the doctor was treated to a $45 dinner while he learned about a new innovation, it’s less likely to be a major concern.”
The policy defines conflict of interest as “a condition which occurs when an individual or organization has an interest that might compromise their actions. The presence of a conflict of interest is independent from the execution of impropriety.” The policy also requires the setting up an Ethics or Conflict of Interest Committee
Under the “Transparency” section, the policy specifically defines conflict of interest is defined as “receipt of remuneration, goods, or services in excess of $500. The ARS will publicly disclose Company support (at a minimum Educational Grants, Sponsorships, and Charitable Donations) exceeding $1000. And, the ARS will disclose relationships that Society Officers and members of the Board of Directors have with Companies exceeding $500.
With respect to continuing medical education (CME), the policy establishes that ARS will comply with ACCME Standards for Commercial Support and that the ARS will retain control over the use of Educational Grants, and implement safeguards designed to ensure that educational programs are non-promotional and free from commercial influence and bias.
The ARS will limit support opportunities to general topics (i.e., not product-specific) and will make efforts to achieve a balanced portfolio of support for each CME program. The ARS will not permit Key Society Leaders to participate in Satellite Symposia. In addition, the policy also covers a number of other areas including advertising, exhibits, journals, clinical care, and research.
Discussion
The ARS new policy on conflicts of interest is extremely well balanced in preserving innovation and collaboration in medicine, while also ensuring the proper balance of transparency and integrity in maintaining physician-industry relationships.
As the ARS correctly acknowledges in the beginning of their policy, “for-profit entities that develop, produce, or market drugs, devices, services or therapies used to diagnose, treat, monitor, manage, and alleviate health conditions, also strive to help patients live longer and healthier lives.” Moreover, “companies invest resources to bring new drugs, devices and therapies out of the laboratory and to the patient while maximizing value for shareholders.”
Because numerous medical organizations recognize the same principles and values of physician-industry collaboration that ARS does, other medical societies and professional organizations should reference ARS’s new policy for guidance on how to establish such a well-balanced policy for conflicts of interest. As ARS has done with its new policy, professional associations and societies must place the emphasis on ways to promote, encourage, and protect innovation through proper safeguards, instead of prohibiting such relationships.