Conflict of Interest in Health Care

Conflict of Interest Definition

"A conflict between a person's private interests and public obligations." A potential conflict of interest occurs when there is a possibility that an individuals private interests, or his or her family's interests, may influence the individual's professional actions, decisions or judgment. A conflict of interest involves the abuse of trust.

Gifts from industry

"Evidence... that gifts from industry often misdirect physicians from their primary responsibility... to act consistently in the *best interest of their patients*"

Why has there has been an increase in regulatory guidelines in the area of conflict of interest with a focus on physician relationships with the pharmaceutical industry

- Potential influence of pharmaceutical marketing on patient care - Bias in research and results reporting - Rising costs of health care - Fraud and abuse

PT Practice and Biomedical Equipment

1. Scheduled appointment to speak to any provider If contact with patient, permission and consent obtained Industry rep may offer technical advise about their equipment but cannot give advice about patient care Industry rep is prohibited from manipulating equipment while in use on a patient, may not touch the patient or scrub in on any procedure

DMU Conflict of Interest Policy

Access of Industry Representatives to DMU Must have an appointment with a specific individual - Students may attend meeting with direct faculty supervision Meeting in a non-patient care area Limit contact time to receive the necessary information and not impact patient care work flow Immediately after the meeting, the representative will leave

Unintentional Limitations

Difficult to have collaborative lunches with other healthcare providers Cost to patients to trial different medications or equipment due to no samples Limited educational information about new products or medications that are developed

Students Interactions with Industry

Medical student-industry interactions can be common. Students may tend to be **regarding the acceptance of gifts. Students underestimate the influence of gifts may have on their behavior. It is important as a student to understand physician-industry relationships and the potential risk for conflict of interest.

Industry and Pharmaceutical Samples

Policy to have limited pharmaceutical samples available to DMU patients on the financial assistance program Pharmaceutical Review Committee (PRC) will review and approve the sample or product Samples kept in a designated locked storage cabinet Industry rep will log in sample and clinic staff must log it out at distribution.

Countries that admit to Direct Consumer Advertising

USA and New Zealand only $4.5B US/year for adverts (Kantar Media via AMA)

Contributions to Research

Biomedical research expenditures by industry exceed that of the Federal government.

Addressing Conflict of Interest

Recognition of the conflict Disclosure of the conflict appropriately Management of conflicts of interest

Contributions to Education

Approximately 40% of clinical departments receive funding for resident and fellowship training - Grants - Devices, supplies Training time with industry representatives is necessary when new products or procedures are being introduced to healthcare providers As of 2006, approximately 62% of medical school CME (continuing medical education) income comes from commercial support As of 2012, 35-40% of CME delivered to healthcare professionals was funded by unrestricted educational grants from the pharmaceutical industry where pharma companies are not permitted to have any influence whatsoever on the content

Procedure in Family Practice

Clinic Manager is the 'gate keeper' and meets with the sales representative Clinic Manager accepts the information and shares with the providers Provider follows-up with the sales rep if desired *Accepts appointments mainly with immunization reps due to providing useful information for the practice with new programs and vaccines being developed

Physician/Pharmaceutical Relationship

Note that in 2012, the pharmaceutical industry spent more than $27 million on marketing to physicians and that 84% of US physicians reported receiving drug samples, payments, meals, other gifts, and/or travel from the pharmaceutical industry. (Pew Prescription Project 2014) Physicians have gradually started to question the ethics and integrities of such interactions as well as the impact drug rep visits have on their prescribing habits and on patients' health.

Professional Practice

Provider discussion should include: - How were the studies conducted - Patient population outcomes - Absolute contraindications of product use No gifts of any monetary value No food (unless associated with an approved CME event) No promotional items - even if received at vendor fairs! All reps must have an appointment, confine their activities to a designated area, and abide by the PhARMA code for interactions with health professionals Lectures permitted if speaker discloses financial interests, uses EBM.

What should we ask when facing Direct Consumer Advertising

Question everything! Don't be a cynic, be a skeptic Know thine (enemy/adversary.) In what business is the pharmaceutical company? Does this population resemble mine? Are they for real?! Is this a disease v "undiscovered opportunity"? And who is paying for what? You are (time) and so is your patient ($).

Current ACOG Committee Opinion

Relationship of Ob/Gyns with industry structured to *ENHANCE, rather than detract*, from patient obligations Current: "Sunshine Act": requires industry to report any "payment or other transfer of value" to physicians or teaching hospitals: *PUBLICLY AVAILABLE* and promotes transparency - patients can see if patients have gone to dinners hosted by drug companies

Conflict of Interest in Health Care

The term conflict of interest refers to circumstances in which this commitment to the fiduciary relationship is compromised. Conflict of interest contains two elements: 1) an individual with an obligation, fiduciary or otherwise, and 2) the presence of conflicting interests that may undermine fulfillment of the obligation.

Transparency

is well and good, but accuracy and objectivity are even better. Wall Street doesn't have to keep confessing its sins. It just has to stop committing them.

Sunshine Act

signed into law in 2010 and requires disclosure to the public of all financial relationships between physicians and medical device companies and pharmaceutical manufacturers.

For every $1 spent on research and development by pharmaceutical companies ...

those same companies spend $19 on promotion and advertising.