A guest column by the American College of Physicians, exclusive to KevinMD.com.
by Steven Weinberger, MD, FACP
The Council of Medical Specialty Societies (CMSS) recently developed its “Code for Interactions with Companies,” which outlined the principles that should guide relationships between medical societies and commercial entities, including pharmaceutical companies and medical device manufacturers. Although a subsequent editorial in the New York Times praised the fact that CMSS and many of its member societies adopted this code, it also stated that “it was disappointing that it does not make a clean break from industry money.”
This raises the question whether any relationships with commercial entities can be considered “ethical,” or are they all suspect?
In an attempt to simplify the ethical issues, I believe there are three overarching principles that should guide the answer to this question.
First, is there total independence of content developed by the society, i.e. is there an appropriate firewall such that there is absolutely no influence of the commercial entity on the selection, development, or presentation of any clinically-related content by the society? Second, is there total transparency to identify any information that is developed or presented by a commercial entity rather than by the society? Third, does the relationship ultimately benefit patients, either directly or indirectly?
Avoiding Influence on Society-Developed Content: Although there are times when commercial interests can affect the content or presentation of material, there are also times when such influence is totally absent. There is no intrinsic reason that either advertising or unrestricted grants influence content, but organizations need to take the “high road,” being absolutely scrupulous in assuring that no such influence is present. This is particularly critical for development of clinical guidelines for care, when any possible influence or even perception of influence can totally undermine the integrity of the guideline.
Transparency about Commercially Produced Content: In contrast to material developed by a medical society, commercial interests can produce their own materials, such as advertisements or “educational materials” that can reasonably be considered “infomercials” rather than unbiased content. In a society where such commercial interests are played out in virtually every sector of the economy, it is unreasonable to expect that pharmaceutical companies or device manufacturers would be held to different standards.
However, it must then be absolutely clear when any sort of medical content – whether in live, electronic, or printed format, or whether aimed at physicians or patients – has been developed or presented by a commercial interest rather than by an unbiased person or organization.
Direct or Indirect Benefit to Patients: Unbiased education for physicians and information for patients ultimately benefit the care of patients. Although it would be ideal for non-profit medical societies not to accept any advertising or support from commercial entities, exclusion of such support would clearly curtail the educational programs and activities that could be developed and presented by the societies.
Medical societies are non-profit organizations, but they still need to meet expectations for a balanced budget. Without such support, societies would be forced either to decrease their development of valuable programs, products, and services, or to substantially increase fees to members and other users of their products, thus decreasing their uptake. Whereas a decrease in revenue for a for-profit entity often translates to a decrease in profit, a decrease in revenue for a non-profit society typically translates to a decrease in products or service produced in order to avoid or minimize a deficit.
A number of people rail against pharmaceutical companies and device manufacturers as being on “the dark side.” Indeed, many of their advertising and marketing practices cannot be condoned. However, it must be remembered that drugs and medical devices are ultimately targeted to improve health. Without drugs and devices, physicians’ “toolbox” for helping patients would be empty: we would have no antibiotics, no lipid-lowering agents, no anticoagulants, and no artificial joints. Let’s not equate pharma with the true “dark side,” e.g., such companies as tobacco manufacturers.
Absolute exclusion of any relationships between pharmaceutical companies or device manufacturers and medical societies would ultimately work to the detriment of patients. What is needed is not an absolute prohibition of such relationships, but rather scrupulous adherence to principles and thoughtful adherence to guidelines, such as the ones recently developed by CMSS.
Steven Weinberger is Deputy Executive Vice President and Senior Vice President, Medical Education and Publishing, of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.