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Restrictions On Business Relationships With Industries, And Their Unintended Adverse Consequences

Robert Thayer Sataloff
Published 2009 · Medicine, Business
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904 • www.entjournal.com Conflicts of interest have resulted in biases that have affected clinical decision making and medical research. Most such situations breach the highest standards of medical ethics and are legitimate causes of concern for the medical community, the general public, and legislators. Occasionally, biases and their consequences have been egregious. In an effort to control conflicts and prevent undue influence by industry on medical care and research, new rules and guidelines are being implemented. Most medical schools and many hospitals have developed policies that are consistent with a report from the Association of American Medical Colleges, "Industry Funding of Medical Education." The policies are designed to encourage a culture of ethical professionalism and to avoid conflicts of interest. The written policies at most institutions seek to define acceptable interactions between faculty/employees and companies that produce pharmaceutical products or medical equipment, or that provide services to the medical community. They seek to define relationships between industry and physicians in order to be certain that they are principled and do not result in bias, and that they minimize the influence of companies on patient care, purchasing and prescribing decisions, and medical research. Policies emphasize that decisions should be based on evidence-based sources, not marketing efforts. In general, most policies attempt to include all faculty and staff activities, whether on or off campus and whether they occur during the scope of employment or one's own time. Some even attempt to include immediate family members within an institution's policy. In addition, academic institutions also attempt to include within their policies not only employed faculty, but also noncompensated volunteer faculty and their "significant others." While the feasibility, practicality, and legality of such policies are still being debated, their existence provides some insight into the scope and vigor with which this problem is being attacked. A review of typical restrictions highlights the current regulatory ardor. Typical policies regarding "meals and gifts" hold that professionals may not accept gifts, hospitality, services, or subsidies of any sort from industry, and neither may guests of professionals. This means, for example, that the pizza that used to be provided by various companies during resident lectures and rounds has disappeared, leaving many medical schools "food-free" in their educational programs. While it is hard for most of us to remember which companies bought pizza or Chinese food for our conferences once a year, and while most of us are quite certain that a slice of pepperoni pizza did not influence our prescribing patterns, this kind of minor industry support during physician training has become a tradition of the past. Similarly, policies hold that industries can only provide financial support for CME (Continuing Medical Education) or nonCME activities directly to an institution or department, not to an individual physician. Such support requires a formal letter of agreement with the industry, full transparency, and disclosure by any presenter whose activities are funded by such industry-derived support. Contact by industry members with academic physicians is also limited. Industry representatives are precluded from informing professionals on institutional property (education, administrative, or clinical offices, for example) of promo-
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