Health Industry Practices That Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers

Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 02/2006; 295(4):429-33. DOI: 10.1001/jama.295.4.429
Source: PubMed


Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.

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    • "COI is influenced by how providers are paid; different payment models may incentivize undertreatment or overtreatment (Deber et al. 2008). Another potential source of COI may arise when the pharmaceutical or medical device industry attempts to align professional interests with that of the industry instead of the patient (Brennan et al. 2006; Thompson 1993; Tonelli 2007). Influence may be exerted through gifts, continuing education sponsorship and support, guideline development or consultancy roles (Coyle 2002; Guyatt et al. 2010; Marco et al. 2006). "
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    ABSTRACT: How do self-regulated health professions' regulatory bodies address financial conflict of interest (coi) and ensure accountability to the public? using document analysis, we examined how four ontario regulatory colleges (physicians, nurses, physiotherapists, audiologists/speech-language pathologists) defined coi and the education, guidance and enforcement they provided for coi-related issues. These colleges are upholding the mandates to define, identify and address financial coi by providing regulations or standards and guidelines to their membership; they differed in the amount of educational materials provided to their registrants and in the possible coi scenarios they presented. Although there were few disciplinary hearings pertaining to financial coi, findings for the hearings that did occur were documented and posted on the college public registers (the listing of all registered college members along with all relevant practice information), informing the public of any limitations or restrictions placed on a member as a result of the hearing.
    09/2014; 10(SP):110-120. DOI:10.12927/hcpol.2014.23850
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    • "Then if anyone asks why we assumed that participated physicians answered the question of low cost gift in a real way and not other questions? This can be answered in that some medical guidelines considering the acceptance of small low cost gift permissible [22] besides that most physicians make distinctions about the ethical appropriateness of gifts on monetary basis [18] so they feel that small gifts do not significantly alter or influence their prescribing behavior [23], so they are not ashamed from announcing their acceptance of low cost gifts. However, social science research demonstrates that the impulse to reciprocate for even small gifts is a powerful influence on people's behavior. "
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    ABSTRACT: Background: The interaction between physicians and medical representatives (MRs) through gift offering is a common cause for conflicts of interest for physicians that negatively influence pre-scribing behaviors of physicians throughout the world. This study aimed to evaluate the interac-tion between MRs and Iraqi specialist physicians through the acceptance of MRs gifts and the ef-fect of such acceptance on physician's prescribing patterns. Methods: A survey in a questionnaire format for specialist physicians was done during March-October 2013 in Iraq, Baghdad. The ques-tionnaire involves four major parts regarding the approximate number of patients and medical representatives, gift acceptance, medical conferences, and prescribing pattern. Results: In Iraq specialist physicians were visited by 1 -3 MRs/day. 50% of the Iraqi physicians like to get the educational information by attending conferences outside Iraq. Regarding Gift acceptance, 41% of participated physicians showed a general acceptance to promotional gifts, and 91% of physicians accept low cost gifts but only 41% of them accept high cost recreational gifts. Free samples were used by 59% of Iraqi physicians to treat some people. 77% of physicians prefer prescribing new medications, while more than 95% of participated physicians stated that they stop prescribing these new drugs either due to their ineffectiveness or due to their side effects. On the other hand physicians significantly change their prescribing behavior through shifting not only among ge-neric drugs, but also from brand to generic drugs in their prescriptions. Gift acceptance is directly correlated with such shift and change in prescribing behavior. Conclusion: Iraqi physicians accept various types of gifts from pharmaceutical companies; this can influence physician prescribing pattern and result in early adoption to prescribe newly medications depending on promotional information even in absence of clinical evidence about the drug effectiveness or side effects, which may result in undesirable outcomes to the patient.
    Pharmacology & Pharmacy 05/2014; 5(5). DOI:10.4236/pp.2014.57080
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    • "While many academic medical centers have taken steps to curtail influence of the pharmaceutical industry on the continuing education of their clinicians, family physicians in small independent practices may continue to rely on industry for prescribing information as well as the provision of drug samples [10,19]. The Institute of Medicine’s consensus report entitled “Conflict of Interest in Medical Research, Education, and Practice” published in 2009 recognizes the information needs of clinicians and proposes that academic detailing programs may be an attractive alternative for clinicians to obtain non-commercial prescribing information [20]. "
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    ABSTRACT: Background Academic detailing is an interactive, convenient, and user-friendly approach to delivering non-commercial education to healthcare clinicians. While evidence suggests academic detailing is associated with improvements in prescribing behavior, uncertainty exists about generalizability and scalability in diverse settings. Our study evaluates different models of delivering academic detailing in a rural family medicine setting. Methods We conducted a pilot project to assess the feasibility, effectiveness, and satisfaction with academic detailing delivered face-to-face as compared to a modified approach using distance-learning technology. The recipients were four family medicine clinics within the Oregon Rural Practice-based Research Network (ORPRN). Two clinics were allocated to receive face-to-face detailing and two received outreach through video conferencing or asynchronous web-based outreach. Surveys at midpoint and completion were used to assess effectiveness and satisfaction. Results Each clinic received four outreach visits over an eight month period. Topics included treatment-resistant depression, management of atypical antipsychotics, drugs for insomnia, and benzodiazepine tapering. Overall, 90% of participating clinicians were satisfied with the program. Respondents who received in person detailing reported a higher likelihood of changing their behavior compared to respondents in the distance detailing group for five of seven content areas. While 90%-100% of respondents indicated they would continue to participate if the program were continued, the likelihood of participation declined if only distance approaches were offered. Conclusions We found strong support and satisfaction for the program among participating clinicians. Participants favored in-person approaches to distance interactions. Future efforts will be directed at quantitative methods for evaluating the economic and clinical effectiveness of detailing in rural family practice settings.
    BMC Family Practice 12/2012; 13(1):129. DOI:10.1186/1471-2296-13-129 · 1.67 Impact Factor
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