Academics must stamp out conflicts of interest: JAMA

Academic medical centers should take the lead in eliminating conflicts of interest that still pervade the relationship between doctors and the healthcare industry, a group of academics said in an article appearing in the Journal of the American Medical Association (JAMA). Allowing “obvious conflicts” to continue poses a “serious threat” to professionalism and to the “trust that patients have in physicians,” wrote the JAMA authors, who hail from institutions including Harvard Medical School, Columbia University and the University of California, Berkeley. The authors propose curtailing or barring such interactions as CME for which teaching physicians pay no fee, provision of ghostwriting services and payment for consulting relationships. Regarding CME, the authors call on funds for education activities to be disbursed to ACCME-accredited programs from a central repository. Manufacturers should not be allowed to provide support directly or indirectly through a subsidiary agency to any ACCME-accredited program, they wrote, since it leads to a mixing of promotional and educational goals. In addition, faculty should be prohibited from publishing articles and editorials that are ghostwritten by industry employees. While consulting with or accepting research support from industry should not be stopped, they want consulting agreements and grants to researchers to be posted on a publicly available Web site to increase transparency. Some of these interactions have been examined by a variety of physician and industry groups, including the AMA, ACP, ACCME, PhRMA and the OIG. However, the group dismisses the assumption that disclosure to patients, a requirement of certain guidelines, is an adequate safeguard against bias. Moreover, none of the guidelines from these groups establish monitoring or delegate responsibility for enforcement, according to the JAMA article. The authors say medical schools should perform these functions, while educating colleagues and “building a consensus around the principles.”