Medical Conflict of Interest

On April 28, 2009, the Institutes of Medicine released a report titled, "Conflict of Interest in Medical Research, Education, and Practice." This large report starts off by noting that there are some benefits from collaborations between physicians, medical researchers and pharmaceutical or biotechnology companies. But the report goes on to note, "However, relationships between medicine and industry may create conflicts of interest, potentially resulting in undue influence on professional judgments."

In 2007, the Institute of Medicine (IOM) appointed the Committee on Conflict of Interest in Medical Research, Education, and Practice to examine conflicts of interest. This committee was chaired by Dr. Bernard Lo, chair of the committee that wrote the report and professor of medicine at the University of California, San Francisco.

The report also generated an article in the April 29, 2009 New England Journal of Medicine (NEJM) as well as news stories like the one that ran on April 28, 2009 in the Reuters UK news service. In the Reuters article Dr. Lo commented, "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." He then added, "We also need more specific disclosure of the financial relationships that doctors and researchers have with medical industries."

In the NEJM article, author, Robert Steinbrook, M.D noted that in 2007, nearly half of the $2.54 billion in income for continuing education for medical doctors was from companies with a product in the marketplace. The suggestion being that the ongoing education that doctors take is funded and directed by companies with products and services to sell and therefore have a financial stake in what medical doctors do in their practices.

The report also noted problems with basic medical education in the schools themselves and urges professional societies, government agencies and groups that accredit medical schools to push for implementation of conflict-of-interest policies. The committee added, "If medical institutions do not act voluntarily to strengthen their conflict of interest policies and procedures, the pressure for external regulation is likely to increase."

The report contained many recommendations to address the problems. These include:

• Physicians should not lend their names to ghostwritten articles or participate in presentations that industry sources can control.
• Physicians should not accept drug samples "except in certain situations for patients who lack financial access to medications."
• Drug and device companies should establish and enforce policies "against providing physicians with gifts, meals, drug samples."
• Members of an institution (research, education, clinical care, academic) should disclose all financial ties to industry, with no dollar-limit attached to the recommendation.