AAMC targets conflicts of interest in clinical care

Spurred by increased scrutiny of interactions between medicine and commercial interests, many academic medical centers have developed conflict-of-interest policies on research and education in recent years.

Now, the Assn. of American Medical Colleges is urging teaching hospitals to expand such policies to clinical care.

In a report released June 30, the AAMC spelled out guidelines to help academic medical centers identify, evaluate and manage financial interests that have the potential to affect patients. The report asks teaching hospitals to examine payment systems, financial relationships between physicians and industry groups, and institutional relationships with those groups.

AAMC Chief Health Care Officer Joanne M. Conroy, MD, said health care professionals must "maintain a high standard of professionalism" to ensure that relationships with companies such as pharmaceutical or medical device makers don't impact patients negatively.

Treatment decisions "should be based on the best interest of patients and free of any bias," she said. While many academic medical centers have conflict-of-interest policies for research and education, fewer than 1% have such policies on patient care.

"In clinical care, this is a very new concept," Dr. Conroy said.

But some say conflict-of-interest policies negatively affect patient care.

Thomas P. Stossel, MD, professor of medicine at Harvard Medical School in Boston, said such policies create false fears, stifle innovation and block the exchange of valuable clinical information among physicians.

"Industry relationships with physicians are the major reason that medicine is profoundly better today than it was when I started 40 years ago," said Dr. Stossel, also director of translational medicine at Boston's Brigham and Women's Hospital. He helped establish the Assn. of Clinical Researchers and Educators, which defends physician-industry relationships.

Developing policies

Dr. Conroy said relationships between physicians and industry are essential to medical advancement and create powerful collaborations that benefit patients. But when accompanied by financial interests, those relationships can create perceived or real conflicts with patient care, she said.

"The primary responsibility is to the patient," Dr. Conroy said.

The report is the AAMC's third on managing conflicts of interest. The first two focused on research and medical education.

Washington University School of Medicine in St. Louis has had a policy on conflicts of interest in clinical care since 2006. James P. Crane, MD, the school's associate vice chancellor for clinical affairs, said officials recognized that academic relationships with industry could hasten medical advancements, but they wanted to protect patients from any negative effects.

"Academic medical centers ought to be leaders. We have a special responsibility in that we train generations of health professionals," said Dr. Crane, also CEO of the university's Faculty Practice Plan.

Dr. Crane said the AAMC's recommendations are "spot on" and also would serve as a useful tool for medical societies on how industry relationships impact physicians.

Maintaining transparency

The AAMC report recommends establishing committees to evaluate financial relationships with industry and defining the dollar value of gifts or income from industry that physicians must report. The recommendations also call for determining when patients should be informed of such relationships and what circumstances would trigger a review and disciplinary action.

Institutions must be transparent, Dr. Conroy said. "The devil is really in disclosing and managing those relationships."

But Lance Stell, PhD, a professor of philosophy at Davidson College in North Carolina and an ethicist at Carolinas Medical Center, said a physician disclosing financial interests to patients would create only confusion. Patients may see such disclosures as a warning, bragging or proof of the physician's confidence in a drug, device or procedure.

"Patients would have no idea what to make of such a disclosure," said Stell, also a member of the Assn. of Clinical Researchers and Educators.

In the next few months, the AAMC will release examples of clinical scenarios to further aid institutions in developing conflict-of-interest policies in clinical practice.

"We believe these recommendations will provide guidance for how to implement policies that will meet the needs of both patients and the institutions that care for them, while more research is conducted on this issue," according to a statement by Patrick J. Brennan, MD, chair of the 20-person AAMC task force that wrote the report.