Report Calls for Stricter Regulation of Medical Conflicts of Interest

Yesterday, the Institute of Medicine released a report entitled "Conflict of Interest in Medical Research, Education, and Practice". As far as I can tell, the full report is only available for a fairly substantial charge, but these are some of the main recommendations summed up in the report's press release:

All academic medical centers, journals, professional societies, and other entities engaged in health research, education, clinical care, and development of practice guidelines should establish or strengthen conflict-of-interest policies, the report says. Disclosure by physicians and researchers not only to their employers but also to other medical organizations of their financial links to pharmaceutical, biotechnology, and medical device firms is an essential first step in identifying and managing conflicts of interest and needs to be improved. The committee noted substantial variations in institutions' conflict-of-interest policies and shortcomings in physicians' and researchers' adherence to policy requirements. The format for disclosure and categories of relationships should be standardized to help institutions judge the risk that a relationship poses and to ease the burden for individuals who must report information to multiple organizations with different policies.

In addition, Congress should require pharmaceutical, biotechnology, and device firms to report through a public Web site the payments they make to doctors, researchers, academic health centers, professional societies, patient advocacy groups, and others involved in medicine. A public record like this could serve as a deterrent to inappropriate relationships and undue industry influence. It also would provide medical institutions with a way to verify the accuracy of information that physicians, researchers, and senior officials have disclosed to them.

The report calls on researchers, medical school faculty, and private-practice doctors to forgo gifts of any amount from medical companies and to decline to publish or present material ghostwritten or otherwise controlled by industry. Consulting arrangements should be limited to legitimate expert services spelled out in formal contracts and paid for at a fair market rate. Physicians should limit their interactions with company sales representatives and use free drug samples only for patients who cannot afford medications. Several professional organizations and industry groups have set new limits on gift giving and other relationships between industry and the medical community, but it is too soon to gauge the effects these changes, the committee noted.

Basically, drug companies are currently virtually free to effectively bribe doctors and medical educators to a worrying degree, and such a system really should not be allowed to continue. It should go without saying that these are totally reasonable recommendations, and it's really a poor state of affairs that our system has strayed so far from these ideals. For more, The New York Times has an article today that puts the report's release in context, noting that it comes on the heels of a similar report from the Association of American Medical Colleges. (However, based on what I've read in the press release, the Times article seems a bit exaggerated, but I can't really say without having accessed the full report).

The report calls for a variety of actions to take place--some voluntary, some enforced by law. Specifically, the report calls for a mandatory public record of drug companies' payments to medical and academic personnel. In fact, Senator Chuck Grassley (R-IA) has already introduced such legislation multiple times, and his Physician Payments Sunshine Act (S. 301) is currently in committee. I don't really have a feel for what chances it has of (ever) passing, though.

Of all of the various payments and gifts that drug companies regularly give to doctors, the one that I think could conceivably be justified would be free drug samples. I'm not a medical professional, though, and it's possible that someone else with more experience in this area can probably give me a good reason why I'm wrong about this. However, having briefly volunteered at a community clinic many years ago, I remember how effectively these free samples were put to use to provide medicines for people who would otherwise not be able to afford them. Apparently, the report seems to agree, as the press release says that physicians should "use free drug samples only for patients who cannot afford medications." That seems pretty reasonable to me.

Otherwise, though, the status quo really needs to change.

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An improvement has been required for many years.
Having said that I wouldn't underestimate the ability of the pharmaceutical and biotechnology companies, and their lobbyists, to ensure that any improvements aren't implemented for at least a decade.