Almost weekly, news reports bring us fresh examples of business practices in healthcare that defy any notion of appropriate ethical behavior: doctors paid eye-popping sums by drug or device companies to “conduct research,” give speeches or “author” ghostwritten articles for health products; academic medical centers that seem to cast a blind eye on physicians' ties to industry; seemingly independent research tainted by industry influence; all-too-cozy ties between Food and Drug Administration panel experts and industry.
Healthcare reform should tackle conflicts of interest, too
Conflict of interest has become a serious, pervasive problem in healthcare. Too often it has corrupted the delivery of care itself by affecting doctors' clinical decisions. It has undermined public trust in pharmaceuticals and medical devices. And it has cast doubts on the integrity of continuing medical education and medical research. A landmark Institute of Medicine report on conflict of interest issued in April soberly acknowledged the scale and scope of the problem and the need for action. We agree.
Consumers Union supports enacting new rules as part of health reform that require drug and devicemakers to publicly report all payments made to physicians and other health providers, researchers and facilities. Hospitals and medical schools should also report all money received from drug and device companies. We believe that even the smallest of gifts should be reported because research shows they can affect physician behavior.
Health reform legislation should also include clear guidelines on conflicts of interest regarding expert advisory panels and “governance” committees. Congress should set a very high bar for all such efforts. We agree with the IOM report that “the central goal of conflict-of-interest policies in medicine is to protect the integrity of professional judgment and to preserve public trust rather than to try to remediate bias or mistrust after it occurs.” It is time to stop managing conflicts via disclosure and start avoiding them.
We believe there is an ample supply of academic medical and health-system experts who do not get money from industry and who can wisely advise on medical matters. Stakeholders with industry connections should be given plenty of opportunity to provide input, in public and on the record, to government health panels, but that doesn't mean they have to be formal members.
In rare situations where a compelling need for specific expertise makes it impossible to avoid conflicts for panel members, such members should be limited to a distinct minority, conflicts should be fully and publicly disclosed, and the members with conflicts should be strictly excluded from deliberating or voting on recommendations that involve areas in which they have a conflict.
Moreover, it's time to match action to rhetoric when it comes to consumer and patient engagement in healthcare. There is a long history of token consumer or patient representation on federal health panels. For a reformed health system to have meaningful consumer engagement, a substantial number of slots on important advisory panels and other bodies should be allotted to consumer and patient representatives.
Government action can take us only part way. New laws or regulations to eliminate conflicts and achieve genuine consumer involvement must be complemented by voluntary measures in the marketplace. We urge organizations representing doctors and hospitals to reassess their conflict-of-interest policies. The American Medical Student Association, National Physicians Alliance, Institute on Medicine as a Profession, Association of American Medical Colleges and No Free Lunch program are groups already moving in this direction.
It's also time for doctor and hospital groups to work out arrangements with drug and device companies that ensure 100% independence from industry influence. For continuing medical education, for example, independent not-for-profit third-party organizations could be established to receive funds and set up programs—with no strings attached.
Further, we strongly believe it's in the physician community's self-interest to advise, or indeed require, all doctors to eliminate or severely limit any ties to industry not related to bona fide research projects. Professional codes of behavior dictate that physicians act in the best interests of their patients. But when a doctor has financial relationships with industry or a financial stake in testing laboratories, hospitals or other healthcare organizations, it's almost unavoidable that this will compromise care and increase costs.
Finally, we recognize that research is the lifeblood of medical science. We believe all researchers should be required to disclose their funding sources wherever their findings are distributed—conference presentations, journals and online. This should include full-disclosure statements from every member of the team. We're pleased to see that medical journal editors are increasingly demanding full conflict-of-interest disclosure with uniform reporting guidelines. Health policy journal editors should do the same. We also urge that all clinical trials be registered with the funding sources listed, and that medical centers publicly report this on their Web sites.
We share the excitement that significant healthcare reform may be at hand this year. Addressing conflicts of interest and consumer representation, we believe, will greatly enhance the chance that reform will begin to create a system worthy of our values.
Jim Guest is the president and CEO of Consumers Union, the not-for-profit publisher of Consumer Reports magazine, consumerreports.org and consumerreportshealth.org.
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