Academic medical centers have been tooling up their conflict of interest policies for at least the last decade. In 2008, the University of Pittsburgh Medical Center enacted a new unified policy, which covers the medical center and other health science programs such as dentistry and nursing. “We consolidated a lot of separate pieces into one policy,” Dr. Barnes said, and they studied what other organizations and universities had done.
Explore this issue:December 2014
There were certainly tricky areas, and the university task force created working groups to address such things as industry-sponsored education and consulting agreements.
Dr. Barnes considers the policy a living document. As new challenges arise, whether from external forces (changes in regulations) or internal situations (a faculty member who may fall into a gray area), clarifications are issued in formats such as frequently asked questions. “We refine interpretations as needed,” Dr. Barnes said, though she noted that “the principles have been extremely durable.”
“It’s a culture change and a behavior change,” Dr. Barnes added. “We’re all trying to move things in the right direction.”
Determining a Conflict
Medical students are exposed to conflicts of interest and industry relationships much earlier in their careers than their mentors were. At the University of Pittsburgh, for example, students attend a seminar in their first year. “It’s a new world,” Pierce said, “and patient access to communication is part and parcel of becoming a physician in the 21st century.”
Pierce said that students should understand that the database is not a list of wrongdoing but simply a list of transfers of value. A pizza lunch can appear alongside a textbook purchase or research funding. That means physicians have to decide for themselves what constitutes a conflict and what is justifiable.
How should physicians go about doing that? They can start by perusing established conflict-of-interest policies, such as those provided at academic medical centers or by associations such as AAMC.
—Heather Pierce, JD, MPH
If you work for an academic medical center, you must comply with their institution’s policy. Indeed, you may have to justify data that appears in the Open Payments database to your institution. “For us, it’s another data source,” Dr. Barnes said. “We do query the database.”
Moreover, physicians should also think through what different financial transactions or relationships might entail. “Industry has a different goal than physicians—they’re beholden to shareholders,” said Dr. Nielsen. “whereas physicians’ primary goal is patient health. That must be put ahead of one’s own financial or professional interests.”