The Council of Medical Specialty Societies (CMSS) which represents 32 leading medical professional societies, with a collective membership of more than 650,000 U.S. physicians released the CMSS Code for Interactions with Companies.
The code provides detailed guidance to medical specialty societies on appropriate interactions with for-profit companies in the health care sector. The voluntary code is designed to ensure that societies’ interactions with companies are independent and transparent, and advance medical care for the benefit of patients and populations. CMSS represents
“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation and transparency,” said Dr. James Scully, CMSS President and CEO of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”
“The private sector plays a central role in developing new treatments and medical advances, and medical societies collaborate with industry in many ways that benefit medical practice. We developed this code to ensure that those relationships are appropriate, and to ensure public confidence in our objectivity and commitment to high-quality care,” Dr. Norman Kahn, Executive Vice President, and CEO of CMSS.
The CMSS code was developed by a 30-member task force consisting of the leaders of member societies. At the time of adoption, 13 medical societies have already formally adopted the code and committed to fully implementing it.
Others plan to adopt it over the coming months, and many members already have rigorous policies in place that meet or exceed some of the principles in the code. The full code, and the list of original signers who have adopted it thus far, are available on the CMSS website at www.cmss.org/codeforinteractions.aspx.
The code includes seven core principles and detailed guidance on implementation. The principles cover the following key areas:
· Conflicts of Interest: Develop and publicly post policies and procedures to disclose and manage conflicts of interest among those who participate in society activities (e.g., medical meetings, clinical practice guidelines, scientific journals).
· Financial Disclosure: Publicly disclose donations and support received from for-profit companies in the health sector, and disclose Board members’ financial and uncompensated relationships with companies.
· Independent Program Development: Develop and make publicly available policies and procedures that ensure that educational programs, advocacy positions, and research grants are developed independent of industry supporters.
· Independent Leadership: Prohibit society leaders (presidents, CEOs, and editors-in-chief of society journals) from having direct financial relationships with relevant for-profit companies in the health care sector.
Specifics
CME
For CME the code follows closely the ACCME Standards for commercial support with a few additions:
· Follow ACCME Standards for Commercial Support;
· Retain control over use of grants;
· Have Planning committees;
· Not solicit suggestions on topics or speakers;
· Prohibition on company controlled presentation material;
· Presenters to give balanced view of therapeutic options;
· Not seek support for product-specific topics;
· Reasonable effort for multi support of programs;
CME Satellite Symposia
For CME Accredited Satellite Symposia (symposia that is held independent of the meeting but in conjunction with the meeting):
· Application process;
· Comply with ACCME Standards of Commercial Support;
· Clear distinction and disclaimers from society program;
· Not permit key society leadership as faculty;
They added a recommendation that in order to minimize potential bias in CME symposia but not their own CME, that societies may consider the following best practices requirements:
· Presentations to be evidenced based;
· Peer review of slides;
· Limiting presenters with unmanageable conflicts to present on pathophysiology or research data;
· Require presentations to be monitored by reviewers trained to recognize bias;
Non CME Informational /Educational Programs
For non CME Informational/Educational programs the only requirement is that the programs be clearly distinguished from society CME.
Comment
With the exceptions of the monitors and limiting presenters in symposium and prohibition on key society leadership from speaking at satellite symposium the code is consistent with the current ACCME Standards for Commercial Support.
Clinical Practice Guidelines
Many of the recommendations meet current practices within almost all organizations and include:
· Evidenced based with a rigorous independent process;
· Transparent guideline development process;
· No company support of practice guidelines or guideline updates including
o Initial printing, publication and distribution;
· Panel members to disclose relationships;
· Majority of guideline development panel members free of financial interests;
· Panel chair free of financial interests;
· Multiple levels of review including another medical society;
· Additional review by journal or other publication;
· Publish panel member’s disclosure information along with guidelines;
· Cooling off period for speaking on guidelines in direct corporate events;
· Panel members or staffs are not permitted to discuss unpublished guidelines;
Comment
These restrictions have the potential of greatly slowing down the guidelines process which are typically two to three years in the making. With the pace of innovation exponentially expanding especially in the area of cancer treatments, practicing to guidelines may be considered practicing very old medicine.
Summary
Though many of the recommendations are reasonable and thought out. The underlying problem with codes like these is they imply that the ultimate goal of a medical society member is to aspire to leadership and not work with industry to develop new products that save lives and improve quality of life. It is unfortunate that because of the political environment the CMSS has gone down this path.
It is up to each individual medical society to determine implementation of the code. We should be hearing more from various organizations as they discuss these restrictions.
America is a free country and we have seen the rise of small practice specific associations and organizations that are in-fact putting together guidelines that protect both society and individual rights. These societies are developing codes of their own, allowing for interaction with companies that is both ethical and preserves a productive working environment to develop the next generation of treatments and cures.
For a complete copy of the CMSS Code of Interaction with Companies