AAMC Report Offers Guidelines for Managing Conflicts of Interest in Clinical Care

By News Staff
Posted: 7/21/2010, 4:05 p.m.

The Association of American Medical Colleges, or AAMC, is urging U.S. teaching hospitals to establish policies to manage financial relationships between physicians and industry to avoid any potential influence on patient care. The organization also says specialty societies and professional medical associations have a responsibility to be free of conflicts of interest because of their role in providing CME and developing clinical practice guidelines.

Stock artwork showing PHARMA profession insignia balanced against dollar symbol

The AAMC's position is spelled out in the report, "In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision-Making." According to an AAMC news release, the report provides guidance on how academic medical centers can identify, evaluate and disclose conflicts of interest in clinical care.

Although the report points out that partnerships between academic medical centers and industry are essential to innovation and create powerful collaborations that benefit patients, it also acknowledges that individual or institutional financial interest in these relationships can create perceived or real conflicts of interests in patient care.

"Because patients and the health of the public are top priorities for the nation's medical schools and teaching hospitals, we must uphold the highest standards of professionalism while maintaining principled relationships with industry to improve patient care," said AAMC Chief Health Care Officer Joanne Conroy, M.D., in the press release.

The report made a number of recommendations aimed at helping academic medical centers manage industry relationships.

Review Shows Patients Think Financial Ties Weaken Clinical Care, Research Validity

Patients believe that physicians' financial ties to pharmaceutical, biotechnology and medical device companies influence their professional behavior and should be disclosed, according to a systematic review in the April Archives of Internal Medicine.
Moreover, the authors said, patients and others think such financial ties among physician-researchers decrease research quality.

In a systematic review of 11 studies involving patients', research participants' and journal readers' views about physicians' financial ties to industry, the authors found that

as many as 70 percent of patients believe that any such tie decreases the quality of care,
between 27 percent and 56 percent of patients believe physician gifts affect prescribing behavior,
26 percent to 67 percent of patients think gifts to physicians drive up the cost of care, and
disclosure of these ties led journal readers to question the validity of published evidence or trustworthiness of study authors.

In the clinical setting, patients wanted their physician to verbally disclose relevant ties to them, with the greatest interest and concern coming from younger and more educated patients. In the research setting, researchers' disclosure of financial ties sometimes lessened patients' willingness to participate.

"These attitudes and effects are particularly relevant today as the nation increasingly relies on disclosure as a response to financial conflicts of interest," the authors said.

Compensation mechanisms at academic medical centers should be aligned with the best interests of patients. The centers should carefully evaluate their compensation systems to determine whether the bases for compensation and reward amounts adversely influence physician behavior.
Academic medical centers should address their physicians' financial relationships with industry in the context of the clinical care they deliver. For example, they could establish mechanisms to identify physician-industry financial relationships and evaluate the potential of those relationships to bias physicians' clinical practice. Such relationships should include the receipt of royalties by physicians and consulting or other services physicians perform for industry, as well as physicians' ownership in related companies.
These medical centers should set thresholds for physician reporting of industry interests to their institutions and for those institutions' evaluation of such interests. The centers should determine when an individual physician's financial interest relating to drugs prescribed or devices used on patients should be disclosed to these patients.
The centers also should disclose the industry ties of their physicians to their respective patient communities as a way of managing actual and perceived conflicts of interest in clinical care. Various disclosure mechanisms, including websites and brochures, can be used to communicate the realities of physician-industry relationships.
Finally, academic medical centers should take responsibility for helping patients understand the benefits, risks and management of bias resulting from physicians' financial relationships with industry.

Although the report focuses on academic medical centers, it also describes the "special responsibility" of specialty societies and professional medical associations to be mentors in developing standards of professionalism.

These societies serve as "conveners, arbiters and educators of society members and as powerful sources of the specialty's standards and ethics," the report says, adding that these societies need to be particularly mindful of the potential for conflicts of interest in clinical care because many develop CME activities and clinical practice guidelines.

One specific recommendation included in the report was that medical societies should set standards to address their own relationships with industry.

According to the report, these societies must recognize the influence of their "hidden curriculum" on clinicians' professionalism. Professional societies that have, or are developing, new or revised standards to manage their own conflicts of interest should be supported, says the report, because "such policies, or their absence, have profound influence on the inculcation of the highest standards of medical professionalism."

The AAMC report was developed by a 20-member task force comprising senior leaders of U.S. medical schools and teaching hospitals. The report is the AAMC's third and final publication on managing financial conflicts of interest.