EDITORIAL - Controlling conflict of interest - proposals from the Institute of Medicine

[Guest guest]

Published at www.nejm.org

29 Apr 2009 (10.1056/NEJMp0810200)

Steinbrook, M.D.

Controlling Conflict of Interest — Proposals from the Institute of Medicine

As Congress considers mandating the disclosure of industry gifts and

payments to physicians on a searchable federal government Web site,1

others have been developing proposals for reforming physician–industry

relations, and key changes are being made to policies at various

academic medical centers, professional societies, and companies. In

late April 2009, the Institute of Medicine (IOM) issued a report on

conflicts of interest that is notable for its breadth — it covers many

aspects of medical research, education, and practice as well as both

individual and institutional financial relationships — and the variety

of its proposals (see Overview of IOM Recommendations about Conflict

of Interest in Medicine).2

The IOM defined a conflict of interest as " a set of circumstances that

creates a risk that professional judgment or actions regarding a

primary interest will be unduly influenced by a secondary interest. "

The primary interests of concern include " promoting and protecting the

integrity of research, the welfare of patients, and the quality of

medical education. " Secondary interests " may include not only

financial gain but also the desire for professional advancement,

recognition for personal achievement and favors to friends and family

or to students and colleagues. " Of course, public attention focused

primarily on financial conflicts of interest, and the IOM did so as

well, viewing them as " not necessarily more corrupting " than other

secondary interests but " relatively more objective, fungible and

quantifiable " and " more effectively and fairly regulated. "

In general, the IOM committee, chaired by Dr. Bernard Lo of the

University of California, San Francisco, supports further restrictions

on and oversight of financial associations — but not " a goal of $0

contributions from industry, " 3 as was recently proposed for

professional medical associations. Some of the IOM recommendations

involve prohibitions, such as bans on faculty participation in

companies' speakers bureaus and other promotional activities in which

they " present content directly controlled by industry " and bans on

gifts of any amount from medical companies. In some areas, such as

research, the committee recommends permitting structured involvement

in exceptional cases of physicians who have substantial financial

interests in industry but also have expertise that is deemed

essential. Noteworthy ideas include standardizing the content and

format of disclosures of financial relationships, a new system of

funding for accredited continuing medical education (CME) that is

" free of industry influence " (although the committee did not agree on

what that system should be) and, for the development of clinical

practice guidelines, restrictions on industry funding and limits on

the participation of individuals with conflicts of interest.

*************************************************

Read the full article here:

http://content.nejm.org/cgi/content/full/NEJMp0810200

Not an MD