Institute of Medicine Calls for Medical Conflicts-of-Interest Reform

A new report from the Institute of Medicine calls for significant reforms to prevent financial conflicts-of-interests in medicine from hindering patient care or the advancement of medical knowledge.

We have long reported on the way the financial arrangements between the medical community and industry influence patient care and research. For example, documents revealed in the course of <"">drug marketing litigation

recently revealed that a prominent Harvard psychiatrist promised to deliver positive results to major drug maker Johnson & Johnson before the start of some clinical trials for Risperdal (Risperidone), an atypical antipsychotic medication. In addition, an investigation by Senator Charles Grassley (Republican-Iowa) found that from 2000 through 2007, the same psychiatrist received $1.6 million from the drug maker, with only a fraction of that reported to Harvard.

Such scandals have prompted calls for reform, and various institutions, including the American Psychiatric Association, Johns Hopkins Medical Center, and Harvard University’s Partners in Health Care medical system, have recently instituted rules banning or limiting industry gifts and payments to physicians and medical researchers.

In the same vein, the Institute of Medicine report released yesterday recommends several actions to improve disclosure of financial ties between the medical community and industry, limit company payments and gifts, and remove industry influence from medical education and the development of practice guidelines.

“It is time to end a number of long-accepted practices that create unacceptable conflicts of interest, threaten the integrity of the medical profession, and erode public trust while providing no meaningful benefits to patients or society,” s Bernard Lo, chair of the committee that wrote the report and professor of medicine and director of the program in medical ethics, University of California, San Francisco, said in a statement issued by the Institute. “We also need more specific disclosure of the financial relationships that doctors and researchers have with medical industries. This report spells out a strategy to protect against financial conflicts while allowing productive relationships between the medical community and industry that contribute to improved medical knowledge and care.”

The Institute has called on academic medical centers, journals, professional societies, and other entities engaged in health research, education, clinical care, and development of practice guidelines should establish or strengthen conflict-of-interest policies, the report says. In a press release, the Institute noted that disclosure by physicians and researchers not only to their employers but also to other medical organizations of their financial links to pharmaceutical, biotechnology, and medical device firms is an essential first step in identifying and managing conflicts of interest and needs to be improved. The format for disclosure and categories of relationships should be standardized to help institutions judge the risk that a relationship poses and to ease the burden for individuals who must report information to multiple organizations with different policies.

The Institute also recommended that researchers, medical school faculty, and private-practice doctors to forgo gifts of any amount from medical companies and to decline to publish or present material ghostwritten or otherwise controlled by industry. Consulting arrangements should be limited to legitimate expert services spelled out in formal contracts and paid for at a fair market rate. Physicians should limit their interactions with company sales representatives and use free drug samples only for patients who cannot afford medications, the Institute said.

The report also called on Congress to require pharmaceutical, biotechnology, and device firms to report through a public Web site the payments they make to doctors, researchers, academic health centers, professional societies, patient advocacy groups, and others involved in medicine.

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