SVS: Conflicts of interest reporting might actually be more opaque

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BOSTON—Industry relations play a key part in the success of private practices, and while new transparency laws are meant to make the relationships between industry and physicians more ethical, in reality, they have the potential to hurt more than they may help, said Russell H. Samson, MD, of the Florida State University Medical School in Sarasota, Fla., during a presentation at the 2010 Society of Vascular Surgery (SVS) annual meeting on June 10.

“I’m completely guilty in believing that vascular surgery is intimately involved in industry,” said Samson, who is from Florida State University Medical School in Sarasota, Fla.,. “Some of my most valuable insights into vascular surgery have occurred through interactions with various industry representatives.”

However, new guidelines and policies like the Physician Payment Sunshine Act passed in 2009 under the Patient Protection and Affordable Care Act (PPACA) that was moved through the Senate by Sen. Chuck Grassley, R-Iowa and Herb Kohl, D-Wis., are making these industry/physician relations more and more difficult.

To make the system more transparent physicians must disclose any services, i.e., food, entertainment, honoraria, speaking fees, and others, that they received from any medical manufacturer to prevent conflict of interests. If physicians neglect to report these disclosures, penalties no less than $1,000 will ensue.

And, Samson believes that if industry support was banished many surgeons from third-world countries would not be in practice and regional and local medical societies would not exist.

Additionally, Samson said that without industry-supported outreach programs like screening, vascular surgeons would have fewer patients to treat.

"My mantra is that…we operate, dilate and medicate, but we don’t always use scalpel, needles and thread. We use a vast array of devices and we use a multitude of medications and these are all in a constant state of flux,” said Samson.

“We need to be exposed to all new advances and be given the opportunity to decide on which ones most properly fit our practice patterns and if that means that I have to have industry support, than I need industry support.”

One way to provide optimal care at private practices is having the ability to meet with referring physicians—through industry run dinners and community lectures—to educate them on new therapies used to treat the patients, he said. “This is certainly aided by industry support.”

But, Samson said that as much as doctors depend on the industry for support, the industry also needs the doctors. “Clinical research is an absolute necessity and basic sciences of course lead to pioneering therapies—this happens with meeting with the industry.”

“The relationship between industry and doctors is mutually beneficial and absolutely needs to be reserved,” said Samson. “I have a terrible feeling many of these things [rules and regulations] are going to get in the way of our relationship with industry and prevent major events from happening in the future.”

Because of the now stringent guidelines and laws, medical device and pharmaceutical companies instead of going straight to the physician, are now advertising directly to the patient—a “disaster method of advertising,” said Samson.

Though Samson admits that a code of ethics is needed to restore trust with the patients and hamper down on exuberant dinners and outrageous fees, state regulations in New Jersey, Vermont and Massachusetts, among others, are “draconian,” he said. These states are even making you pay for the “hot dog provided to you at company headquarters.”

While “we are all jumping through hoops,” he said that academic institutions and foundations can sometimes get around the reporting of monies to state and national databases by redistributing industry money around the institution. Samson said that this is nothing more than “money laundering.

“Private surgeons are being hung out to dry,” he said because private practices have no hospital or institutions supplements or money to fall back on and will not gain industry support any further for seminars, dinners and meetings.

“Do we want to handicap all of these relationships because of a perception that we can be bought for a plastic pen or a slice of pizza…in that it will make us use some expensive, useless device? Do you really believe that industry supporting our annual meetings will make us so obligated that we will forgo our own ethics and intellectual capabilities and do you really believe that we are so morally irresponsible that we cannot resist marketing propaganda?” asked Samson. “I think the answer is no.”

Samson suggested that further talks with legislators and policymakers would help configure  these laws to be beneficial to both establishing a code of ethics and providing the most optimal care.