Much has been made about conflicts of interests in the medical community’s relationships with industry. This includes relationships with physicians as well as those with medical schools and professional organizations. Some reports, in fact, suggest egregious findings that make all of us concerned. Transparency about our relationships with industry is critical to a fair and balanced review of available science.
The American College of Cardiology (ACC) is committed to professionalism and to a transparent relationship of all our industry sources of funding. In fact, we have among the most stringent policies in place to ensure that support from industry has no influence on any of our reports or the content of medical education that we sponsor. Some have suggested that there should be no use of industry funds for any medical school or organization activity, but, given the scarcity of public funding for research and the relatively high cost of education, this position would make for trying times for professional societies and medicine.
We depend on industry support to help carry out our mission. Without such funding, our efforts to provide meaningful unbiased education and to improve quality would be crippled. Rather than restricting industry funding for such activities, we should instead focus on actively managing relationships with industry and the potential for conflicts of interest in our relationships.
For example, the ACC has rigorous policies in place to ensure that our scientific and educational activities are protected from possible conflicts. We do this not by mandating a zero-tolerance policy, but by having policies and oversight. Some of these restrict activities and possible participation of individuals while others specify the level of transparency required. The latter allows us to include knowledgeable individuals who might otherwise have been excluded from a writing committee or educational activity because of a relationship.
Disclosure is key. For example, potential writing committee members disclose relationships with industry—including those of their spouse and any dependent children—at the time of their invitation to participate. Guideline chairs with significant relevant relationships with industry must have a co-chair, and some relationships prohibit being a writing chair. Committee members with significant relationships recuse themselves from confidential balloting. All relationships with industry are included in the written document and the agenda of every committee meeting and disclosed verbally by members at the beginning of each meeting.
ACC staff members also follow strict policies designed to separate the interests of those responsible for managing relationships with industry from those responsible for developing educational programming and other scientific or educational activities. These policies ensure that the ACC’s relationships with drug and device companies would never influence the scientific or educational content the college produces. And, when necessary, we take action to seriously sanction violators of our policies, even when such violations were unintended.
Educate media, public and policymakers
As we as a nation begin to tackle healthcare reform, it will be critical to determine a uniform definition of the term “conflict of interest,” and a universal code of ethics for our dealings with industry. In the meantime, we need to help the media, the public and policymakers better understand the beneficial role of industry in promoting research, education and innovation in medicine. And we need to correct them when they get it wrong. We must create a culture of openness in order to rebuild trust in our healthcare system and avoid pressing threats to physician autonomy.
William J. Mayo once said that “the best interest of the patient is the only interest to be considered.” If we keep patients first, the rest will take care of itself. Our job is to make sure that any relationship is managed in a way that ensures unbiased, evidence-based, patient-centered and balanced reviews of science, regardless of funding sources.