Will Professional Medical Associations End Industry Ties ?

The guidelines published in today’s Journal of the American Medical Association that called on professional medical societies to end most of their financial ties to industry is long overdue. But will any of the major associations pay attention ?

Professional societies are crucial disseminators of knowledge in medicine. They create committees that establish best practices in their fields, write clinical practice guiddlines, conduct continuing medical education for their members, run annual meetings where major research gets released, and lobby on behalf of their members in Washington and in state capitals across the country. At some societies, a substantial portion of general operating revenue comes from the drug, biotechnology and medical device firms that sell products aimed at those specialties.

That’s why it was a fairly radical proposal published in JAMA today, because it called on those societies to :

* Reduce industry contributions to their general budgets to 25 percent immediately with an aim of lowering it to zero within five years ;

* Collect all industry contributions for continuing medical education and research in centralized pools and create panels of physicians without conflicts of interest to develop the programs and distribute the money ;

* Prohibit industry from funding societies to develop and write clinical practice guidelines or establish outcomes measures ;

* "Encourage" the creation of guideline-writing panels where members were without conflicts of interest ;

* Prohibit sitting officers and board members of the societies from having conflicts of interest, starting from the date of their appointments, which usually precedes taking office by about two years ; and

* End endorsement of products as a way of raising revenue.

"We really want to make certain that the recommendations, the education, all that professional medical associations do, has no link or tie to industry marketing," said David Rothman, who heads the Institute for for Medicine as a Profession at Columbia University, which received funding from Pew Charitable Trusts to develop the proposal.

It’s notable that the guideline-writing group did not adopt the strict "no conflicts" policy for members of guideline-writing panels that it used for control of continuing medical education, for instance. "This was a consensus report," said Steven Nissen, a co-signer and past president of the American College of Cardiology.

However, it was nice to see that the proposal said professional societies could establish conflict-free guideline writing committees without harming the end product :

One concern might be that such restrictions will exclude the most qualified individuals from guideline committees. However, there is a tendency to confuse the most qualified with the most visible. Moreover, any difficulties can be easily circumvented by circulating drafts of guidelines widely for comment, but leaving the drafting of the final document to a group of knowledgeable professionals, who are free of conflict of interest insofar as a particular class of drugs or devices is concerned.

During a conference call, three of the 11 co-authors on the paper predicted many major medical societies will seriously consider the proposal. "Ten years ago (concern about conflict of interest) was a breeze, five years ago a wind, now it’s a gale storm," Rothman said. "Change is going to come. The likelihood of these recommendations being implemented is quite strong."

Only two current leaders at professional societies — Ralph W. Hale of the American College of Obstetricians and Gynecologists and James H. Scully of the American Psychiatric Association (APA) — were among the 11 signers. Last week the APA made news by declaring it would stop taking money from industry.

The current report comes two years after a similar guideline written under the auspices of IMAP and published in JAMA called for reducing industry influence at academic medical centers. At the time, just a handful of AMCs had rigorous policies that limited faculty ties to industry. Today’s that up to 25, Rothman said.

The next target on IMAP’s radar screen : patient advocacy groups, many of which receive all or nearly all of their funding from the drug, biotechnology or medical device companies. "We’re going to address these patient advocacy groups, some of which are grass roots and some of which are astroturf," Rothman said.