Specialty societies set new policy on drug company influence

Under scrutiny from politicians and physician critics, some medical specialty societies are pledging to disclose the industry funding they receive and say what that money pays for.

The promise comes as part of a code approved in April by the Council of Medical Specialty Societies, whose member organizations together represent more than 650,000 American physicians. The pressure on physician organizations to tell the public about industry support and limit the companies' influence on their educational, research and advocacy activities has been building over the last year.

In April 2009, doctor-led expert-panel reports published by the Institute of Medicine and the Journal of the American Medical Association called on physician organizations to fundamentally change how they interact with industry, emphasizing greater disclosure and tighter management of financial conflicts. The health system reform law enacted in March includes "sunshine" provisions that, starting in 2013, mandate disclosure of any industry payments or gifts of $10 or more to physicians and teaching hospitals.

The specialty societies wanted to set their own conflict-of-interest standards before politicians or other groups did, said Allen S. Lichter, MD, who chaired the council's task force.

"The goalposts were constantly moving," said Dr. Lichter, CEO of the American Society of Clinical Oncology, which has signed on to the code.

Actions that had been considered ethical became the subject of concern or inquiry six months or a year later, he said. "We felt the best thing to do was to say, 'Here is a set of boundaries.' "

Several drugmakers already are disclosing their payments to individual physicians, and many academic medical centers tell the public about their doctors' financial ties to industry. After 2008 guidance was issued by the Assn. of American Medical Colleges, many medical schools have banned faculty from serving on industry-sponsored speakers' bureaus.

In addition to disclosing industry support, the council's new voluntary code also bars society presidents and journal editors-in-chief from having financial relationships with for-profit health companies. It says the majority of physicians serving on guideline-writing panels should have no ties to drugmakers or other health companies.

Societies should bar company-sponsored "reminder" items at their meetings, the code says. They also should clearly distinguish between the accredited continuing medical education courses, industry-sponsored satellite symposia and nonaccredited programs offered at those meetings.

"This is the profession walking the walk," said Norman B. Kahn Jr., MD, the council's CEO. The code ensures the needs of patients come first, and that doctors are "voluntarily regulating ourselves as a profession" and are being transparent about it, he added.

Thirteen council member societies had signed on to the code at this article's deadline. Signers include the American Academy of Pediatrics, the American College of Cardiology, the American College of Obstetricians & Gynecologists and the American College of Physicians.

Dr. Kahn said he expects most of the 32 member organizations to adopt the code by the end of the year. All the societies are at least considering the code, he said, and none has yet rejected it.

Assessing the code

Some advocates of greater separation between industry and organized medicine lauded the new code.

"It's terrific that they're acting voluntarily to put policies in place to reassure the public and their members," said Bernard Lo, MD, who chaired the IOM's conflicts-of-interest panel last year. "They really took to heart most of our recommendations. They were very comprehensive in scope. They addressed medical education, practice guideline development -- the things that medical societies play a really key role in."

Dr. Lo said he was impressed that the council barred officers in the presidential line of succession -- the president, president-elect and immediate past president -- from having financial ties to health firms.

"It says that these societies are really putting their desire to place themselves beyond question ahead, in some instances, of the financial interests of their most talented members," said Dr. Lo, director of the program in medical ethics at the University of San Francisco, California, School of Medicine.

Others disagreed. J. Michael Gonzalez-Campoy, MD, PhD, said the council's code wrongly accepts the "framing bias" that relationships between physician organizations and industry pose conflicts of interest. He said barring doctors with financial ties to for-profit health firms from certain roles in organized medicine will hurt patients.

"We've gone from disclosing working relationships to preventing working relationships," said Dr. Gonzalez-Campoy, who serves on the steering committee of the Assn. of Clinical Researchers and Educators, an advocacy group that defends physician-industry collaboration.

On the other side is Steven E. Nissen, MD, who served on the 11-member expert panel that authored an April 1, 2009, JAMA paper saying that medical societies should aim to eliminate commercial funding.

The council's code is "very weak and voluntary," said Dr. Nissen, chair of the Dept. of Cardiovascular Medicine at the Cleveland Clinic. "It will not likely reduce the pervasive influence of industry on professional societies. Disclosure is insufficient. We are seeking true independence."

Such critics of industry support for organized medicine groups will "never be mollified by anything other than complete divestiture," said Daniel J. Ostergaard, MD, vice president for professional activities at the American Academy of Family Physicians, which has signed on to the code.

"We think that the ability to provide education and other services to physicians and therefore affect the health of the public is enhanced, not diminished, by appropriate relationships between organizations such as ours and companies."