Facing Conflicts: The Battle between Medicine and Industry

Refocusing on Our Role as Health Care Professionals

Following the tenets of medical ethics, physicians can be guided in appropriate management of these situations:

• Beneficence-the patient’s best interest must always come first.
• Non-maleficence-protect patients from harm.
• Autonomy-respect patients’ right to informed choice.
• Justice-equity in care.

 

These principles can serve to guide physician-industry interactions. The intent of clinical research and education should be to advance the common goals of improvement of patient care, augmentation of trainee education, and maintenance of research integrity. Secondary interests, such as personal financial gain or personal advancement, must not dominate or appear to dominate over the primary interests.(15)

Regulatory Measures

Given the recent focus on the issue of transparency surrounding physician-industry relationship, a number of additional regulatory steps are rapidly beginning to evolve.

Individual State Policies

Several states, including Maine, West Virginia, Minnesota, and Vermont, as well as the District of Columbia, have created laws that provide for public access to payments made to physicians from pharmaceutical or device companies.

Association of American Medical Colleges (AAMC)

Citing the need for an effective and principled partnership between academic medical centers and various health industries in order to fully realize the benefits of biomedical research and ensure continued advances in the prevention, diagnosis, and treatment of disease, the AAMC published a position statement on industry funding for medical school programs.(16)

University-Based Policies

Recognizing that many universities fail to adequately address industry marketing, approximately one-third of US medical schools have implemented or are developing policies that offer guidance to faculty and promote disclosure of real and apparent conflicts.(14) Some universities are going even a step further by publicly reporting physicians’ financial ties with industry.(17)

Pharmaceutical Company Disclosure

An increasing number of pharmaceutical and device companies are joining in the spirit of full disclosure with announcements that they, too, will be disclosing on their Web sites payments to physicians.(17)

Physician Payment Sunshine Act

This bill, introduced January 22, would require yearly reporting of all payments to physicians or medical practices over a cumulative value of $100 from manufacturers and group purchasing organizations. Beginning in 2011, all payments that meet the threshold including consulting fees, honoraria, gifts, entertainment, food, travel, education, research grants or funding, and royalties would be included. The information will be made available to consumers, consumer advocates, and other interested parties. Penalties or enforcement actions under the bill will also be made public. Failure to report this information is subject to penalties up to $1 million per year. The bill will preempt state disclosure laws for the payments described in the bill, but states will still be able to establish their own disclosure laws for items such as drug samples or rebates that aren’t included in this bill.(18)