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: 30.39). 02/2006; 295(4):429-33. DOI: 10.1001/jama.295.4.429
Source: PubMed

ABSTRACT 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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Available from: Jerome Kassirer, Aug 25, 2015
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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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    • "Ethical issues in health care and the practices of health care professionals have been, and continue to be, a topic of much debate (Brennan et al., 2006; Dana & Loewenstein, 2003; Garner, 2010; Hawkins, Hamill, & Kukula, 2006; Katz, Caplan, & Merz, 2003; Margolis, 2007; nofreelunch, n.d.; Palmer, 2009; Wazana, 2000; Wazana & Primeau, 2002; Windmill, Freeman, Jerger, & Scott, 2010;). Physicians, medical residents, and the public have raised ethical concerns over pharmaceutical marketing to physicians, which commonly includes gifts, sponsorship of educational activities, and recreational activities. "
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    ABSTRACT: This study examined the opinions of audiologists and hearing aid users on ethical issues related to the provision of hearing aids and interactions with hearing aid manufacturers. With support from two national organizations, Canadian Association of Speech-Language Pathologists and Audiologists and Canadian Hard of Hearing Association, audiologists and hearing aid users from across Canada were recruited to participate in an online survey. A total of 302 respondents (109 audiologists and 193 hearing aid users) completed a questionnaire where they rated the ethicalness of 20 scenarios posing potential ethical dilemmas faced by audiologists. Results showed that, although hearing aid users and audiologists exhibited similar patterns of perception regarding the ethicalness of the scenarios, the actual ratings for the two groups were significantly different for the majority of the scenarios. When differences were observed, hearing aid users tended to consider the scenario more ethically problematic than did audiologists. In general, views were similar between private practice audiologists and public practice audiologists for most scenarios.
    Canadian Journal of Speech-Language Pathology and Audiology 01/2012; 36(2):94-105.
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