Parting of the Ways: A Sea Change in Business as Usual

A collaborative effort of prominent medical leaders seeking to wean professional medical associations (PMAs) from pharmaceutical and device industry funding serves as a major step toward building best practice models for managing conflicts of interest (COI), said the president of the Institute on Medicine as a Profession (IMAP).

David J. Rothman, PhD, Bernard Schoenberg Professor of Social Medicine at Columbia University in New York, explained that the group (which included current and former medical society officers) debated proposals for some 2 years before publishing its recommendations in JAMA.¹ James Scully Jr, MD, medical director and CEO of the American Psychiatric Association, was among the 10 coauthors who assisted lead author Rothman in developing the recommendations. The views presented in the article represent their own perspectives and not those of their organizations. Pew Charitable Trust funded the work.

The authors offered 10 recommendations for PMAs to follow to prevent what they termed “the appearance or reality of undue industry influence.”

They covered general budget support from industry, national and regional conventions, industry funds for research by PMAs and members, industry funding for fellowships and training programs, practice guidelines committees, industry support of PMAs’ publications, product endorsements, affiliated foundations, COIs for PMA presidents and board members, and guidance for PMA members.

PMAs have enormous influence through their practice guidelines, CME courses, and physician education at the annual meetings, Rothman said. They also play a major role in advocating health policy issues at state and federal levels. “We want to make certain that practice guidelines, medical education, and physician advocacy are based on best medical practices and are not a response to industry that may be supporting those activities financially,” Rothman told Psychiatric Times.

The recommendations are the initial step in creating best practices, similar to a pattern followed for aca­demic medical centers (AMCs). In 2008, JAMA published a similar call to action related to industry COI issues for AMCs.² Subsequently, COI policies from 125 AMCs have been posted on the Institute on Medicine’s Web site .

We plan to compile COI policies from leading PMAs and, with permission, make them available on the Web site, Rothman said. Then, we will begin to identify best practices, using the recommendations in the recent JAMA article as the criteria for best practices.

Rothman acknowledged that the COI recommendations were published during a time of economic downturn.

“Many PMAs have lost money in their endowments . . . so this is not the easiest time in the world to build greater firewalls that might cost PMAs industry support. On the other hand, we do think it is necessary that they begin to think imaginatively about how to wean themselves from industry money,” he said.

The most controversial of the proposals, Rothman said, was the recommendation of working toward a complete ban ($0) on pharmaceutical and medical device funding, except for income from journal advertising and exhibit hall fees.

As an interim step, Rothman and colleagues recommended that PMAs restrict total support from industry (except for revenues from journal ads and exhibit hall fees) to no more than 25% of their operating budgets, with no single industry source responsible for the majority of total industry funding to the PMA.

Another contentious topic involved industry funding of research by PMAs and members. Opinions ranged from banning any industry funding for PMA research to only allowing funding if it were deposited into a central repository of funds and were used to support genuine research that the PMA was eager to do rather than for research in response to an industry request or carrying an industry identifier.

It was recommended that PMA officers receive no personal income and no research support from industry for 2 years before they take office and throughout their tenure, and that the board of trustees sever all financial ties to industry during their term of service. The PMA’s executives and staff would be prohibited from accepting any industry gifts or favors, including travel.