The recent revelation that Steven Nissen, the top Cleveland Clinic cardiologist, failed to disclose his financial ties to the maker of a diabetes drug while detailing a competing drugs cardiac risks in the New England Journal of Medicine is just business as usual in American medicine. A generation of top doctors has gotten rich from sweetheart deals with drug and devicemakers, often promoting them in scholarly journals and speeches without disclosing their conflicts. On a smaller scale, an increasing number of hospital executives have taken lucrative seats on vendor boards that pose an obvious conflict with their day jobs. Amid all this corporate back-scratching, it is heartening to report on signs of a backlash. It is way too soon to say the tide is turning, especially when hundreds of millions of dollars are floating around, but now there at least seems to be some hope of an ethical renewal in healthcare.
The Association of American Medical Colleges last week unveiled the results of a task force on industry funding of medical education. The report, authored by a group that included some pharmaceutical executives as well as medical educators, recommended that drug and medical-device companies be banned from offering free food, gifts, travel and other services to doctors, staff and students at medical colleges.
More importantly, the report recommended that medical schools should strongly discourage participation by their faculty in industry-sponsored speakers bureaus, in which doctors are paid to promote drug and device benefits. Many of these speeches and/or the slides used therein are authored by the drug companies themselves.
It suggested that schools audit independently accredited medical education seminars given by faculty for the presence of inappropriate influence. And it said the rules should apply to faculty even when off-campus.
Though not binding, AAMC recommendations often are followed at many institutions. We will be watching to see how many adopt these laudable steps.
The association is right to focus on young people. The drug and medical-device industries prey on budding doctors, hoping to addict them early to drug money. But the teaching doctors have to lead by example.
Recent anecdotal evidence suggests that a small but growing number of respected medical researchers are doing just that, rejecting payment from vendors. Many of the newly converted had been embarrassed to see their professional integrity questioned by bloggers or colleagues after publishing research that aided manufacturers from which they had accepted money.
Another positive sign among young physicians is the American Medical Student Associations Revitalizing Professionalism campaign, replete with a revised Hippocratic Oath, the Model Oath for the New Physician.
The group asks members to promote standards such as an end to drug company giveaways, and prohibitions on drug reps wandering into patient-care areas.
Part of the new oath reads: I believe that the healthcare system should uphold the interests of patient care over commercial interests and will advocate for reform to ensure that meeting the needs of the patient remains the central focus of the healthcare system.
As Shawn Rhea notes in a new Reporters Notebook on our Web site (modernhealthcare.com), a panel at the recent Greater New York Hospital Associations annual meeting focused on ethics. It was notable that panelists said it isnt enough simply to acknowledge a relationship with a vendor. As Rhea writes: There needs to be a complete overhaul of the culture governing relationships between medical professionals and vendors if the healthcare industry is really going to ensure that doctors practice with only their patients best interests in mind, argued the panelists.