Academic medical centers need better conflict of interest policies

by John Gever

Academic medical centers need comprehensive policies to manage their physicians’ relationships with industry and other commercial interests, according to the Association of American Medical Colleges (AAMC).

Disclosure of such relationships — both to patients and to their institutions — should be more detailed than is currently the case at many medical schools, an AAMC task force recommended in a new report.

In particular, significant potential conflicts should be reported annually to the institutions, which in turn should develop methods of informing patients.

The AAMC task force did not specify exactly how medical centers should report their physicians’ conflicts of interest to patients, indicating that the best method is likely to vary among institutions and the communities they serve.

“Our healthcare decisions, and how we model decisions for our students … must be free of any bias” resulting from physicians’ financial interests, said Joanne Conroy, MD, the AAMC’s chief healthcare officer, in a conference call with reporters.

She estimated that fewer than 1% of member institutions “really have an official policy” on managing or disclosing physicians’ conflicts of interest as they relate to patient care.

Conroy pointed to Washington University in St. Louis, the Cleveland Clinic, and the Mayo Clinic as having relatively comprehensive policies that met the general principles outlined in the report.

Notably, the recommendations did not discourage physicians from having relationships with industry or other outside financial interests. Instead, the major focus was on disclosure.

Conroy argued that these relationships are not a problem in themselves. “It’s not the conflict itself, it’s the disclosure of the conflict and the management of the conflict,” she said.

“Not all of these relationships are necessarily negative,” she added, asserting that patients want their physicians to be active in research and innovation.

However, the task force did recommend that medical schools eliminate one type of potential conflict: compensation schemes for doctors within their own clinical centers that may provide incentives running counter to patients’ best interests.

Other major recommendations for academic medical centers included:

* Establishing detailed reporting systems for physicians describing the nature and scale of all their commercial interests, including royalties, consulting and speaking relationships, and stock ownership
* Set specific dollar thresholds for what must be reported
* Develop standards for determining which relationships should be disclosed to patients and how to disclose them
* Address institution-level relationships with industry, including personal financial interests of top officials
* Seek input from patients on the appropriate ways to disclose conflicts to patients

Conroy said websites were one way, but not the only one, to communicate potential conflicts to patients and the public. She noted that some companies now report payments to physicians online, but “patients rarely go to those websites,” she said.

On the other hand, she was also skeptical about simply handing patients a printed list of their physicians’ commercial interests, as some medical centers do. “It doesn’t really explain how meaningful or not meaningful those relationships are,” she said.

For institutions that choose to publish physician disclosures on the Internet, the report included a sample form. A footnote suggested that institutions establish dollar ranges for reporting, in $5,000 increments at the low end and increasing to $50,000 increments for large payments.

The report called on physicians without academic affiliations as well as professional medical associations to adhere to the same general principles.

“Though the task force was charged with addressing clinical conflicts of interests only in academic medicine, it believes that the principles that have guided its work and that shape its report are applicable generally to the practice of medicine,” according to the report.

The 20-member task force was chaired by Patrick J. Brennan, MD, chief medical officer of the University of Pennsylvania Health System in Philadelphia.

“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,” Brennan said in a statement released by the AAMC.

The report is the third and last in a series from AAMC. The previous reports, issued in 2008, addressed conflicts of interest in academic research and medical education.

John Gever is a MedPage Today Senior Editor.

Originally published in MedPage Today. Visit for more ethics news.