At least seven medical-profession associations are among the names appearing on payment-disclosure lists posted on orthopedic-device makers Web sites, prompting some policymakers to suggest the payments are further evidence of how far-reaching industry influence is on the practice of medicine.
The disclosures, posted in late October, were mandated as part of a recent settlement that Biomet, DePuy, Smith & Nephew, Stryker Corp. and Zimmer Holdings reached with the U.S. Justice Department on charges they created phony consulting deals to pay physicians to use their orthopedic devices (Was physician-kickback settlement severe enough? Dec. 3).
While industry relationships with individual physicians were the focus of the influence-peddling investigation, the appearance of medical-profession organizationswhich together collected up to $1.5 millionon the lists should also prompt concern, says David Rothman, director of the Center for Medicine as a Profession at Columbia University.
These organizations are saying that when a surgeon receives compensation from a devicemaker or pharmaceutical company, it presents a potential conflict of interest, Rothman says. But youve got those same organizations taking money (from the industry). In fact, theyre taking a substantial amount of money, and many of these groups write guidelines (on appropriate practitioner-industry relationships). So, the question is: What are their rules about conflict of interest for leadership that may be on guideline committees?
Among the recipients of industry funds within the past year are the American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, American Orthopaedic Association, American Osteopathic Academy of Orthopedics, American Society of Orthopaedic Physician Assistants, National Association of Orthopaedic Nurses and National Association of Orthopaedic Technologists.
A number of regional and state professional associations also appear on the lists.
I think its a very good point to ask: How do associations involved in setting guidelines that affect patient care make sure that (their) taking money from industry presents no conflicts of interest? There needs to be a firewall between those who make the guidelines and industry, says Sharon Levine, associate executive medical director of the Permanente Medical Group and an adviser on the guidelines committee that created industry disclosure and access rules for the California-based managed-care provider.
But while medical-ethics watchdogs may question whether associations receiving devicemaker and drugmaker money can truly remain free of industry influence, the groups themselves believe it is possible. All of the organizations contacted by Modern Physician say their groups primary use of industry funds is to pay for continuing education courses for their membership. Companies are prohibited, however, from having any input into curriculum content or selection of speakers and faculty.
I think if orthopedic-implant companies are contributing to continuing education with no input into the curriculum and speakers, then thats as arms-length as you can get, says Jim Beaty, M.D., president of the American Academy of Orthopaedic Surgeons.
Beaty concedes, however, that while devicemakers have no direct influence on his academys curriculum and presenters, medical professionals with industry consulting and research agreements or those who receive royalties as a result of product development are not banned from presenting at continuing education events. They are, however, required to disclose their involvement with such companies.
Other organizations have stricter requirements. Kaye Englebrecht, executive director of the National Association of Orthopaedic Nurses, says her organization minimizes industry influence over medical education by prohibiting any medical professional with consulting or other types of industry-compensated relationships from presenting at its forums.
Such a dichotomy of standards leaves the door open for industry to push the envelope in efforts to influence product purchasing and patient-care decisions, Rothman says. What we have right now is a patch quilt of standards when what we need is a clear, consistent and appropriate set of rules regarding industry donations.
To that end, Rothmans organization, the Center for Medicine as a Profession, along with a group called the Prescription Project are in the second phase of an effort to develop guidelines for relationships between professional associations and industry. Among the recommendations the policymakers will consider is whether medical associations should ban vendor marketing events from annual conferences and continuing education events. Such a ban would require that vendor sales and marketing activities take place off-site or at completely different times as stand-alone events.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.