With disclosure becoming the key mechanism promoted to manage COI in academic — and especially biomedical — conferences and other educational events, its interesting to see that there is still enormous work to do so that academics and clinicians even understand what and when to disclose. As the following story reports “Conflict of Interest Reporting Varies Among Spine Meetings”
There is a lack of uniformity among disclosure policies of various medical associations, and confusion regarding what relationships need acknowledgement results in variability in the reporting of financial conflicts of interest in clinical research, according to research published in the January issue of The Spine Journal [full text of the study]
In a very interesting development, the Office of the Inspector General of the US Department of Health and Human Services recently released a report (summary and complete report) that found that while there have been important improvements in the development of policies to manage individual researcher COI, there are real problems with the management of institutional COI. [See also Report prods NIH to address institutional conflicts of interest]
The OIG argues that the
NIH should require grantee institutions to identify, report, and address institutional conflicts in a consistent and uniform manner. It is important that NIH know of the existence of such conflicts so it can ensure that the related research is free from any intended or unintended bias. Therefore, we recommend that NIH promulgate regulations that address institutional financial conflicts of interest.
The January edition (11/1) of the American Journal of Bioethics (AJOB) has an excellent article by Howard Brody – Clarifying Conflict of Interest – which stimulated a flurry of interesting peer commentaries. My editorial/commentary in this issue, entitled Beyond a Pejorative Understanding of Conflict of Interest, makes the argument (to which readers of this blog will be familiar), that one of the major problems with COI is that there is still a widely held view that COI = financial fraud. A result of this pejorative or negative connotation is that the term loses much of its utility, in practice. So in line with Howard Brody, I argue that we in the academic community need to do a much better job of clarifying the concept, and in particular, that we move beyond a focus on financial COI to deal with the range of other personal interests at stake, in order to better manage COI when they cannot be avoided.
[Unfortunately these articles aren't open access].
The 2010 AMSA PharmaFree Scorecard — which “evaluates conflict-of-interest policies at 152 medical colleges and colleges of osteopathic medicine in the United States” – came out December 15th, and as noted in their executive summary, “over 50% of medical schools, now have grades of A or B (78 schools). This is a tremendous increase over 45 A and B schools (30%) in 2009 and shows a continued progression from 29 A and B schools in 2008.”
This improvement (see the AMSA ranking methods) would seem to bode well for the increasing oversight and regulation of COI across academic institutions. But as the following stories show — Med school docs still break conflict-of-interest rules and Faculty still paid by drug firms — even the “best” policies will still be limited if 1) there aren’t effective and transparent procedures in place, and 2) there isn’t an institutional culture that promotes disclosure and dialogue, and ensures that people now how to manage COI situations when they cannot be avoided.
P.S. Feb 8, 2011: See this story about applying the AMSA ranking to Australian medical schools [and full text of study]
When surgeons get royalties from the operations they perform, its worth questioning whether these operations are all that necessary or appropriate (Top Spine Surgeons Reap Royalties, Medicare Bounty). Similarly, when going to the pharmacy and seeking advice from a pharmacist, people – as consumers of health care services/patients – might quite reasonably expect that the health professional serving them will provide guidance in their, the patient/consumer’s, best interests (Some pharmacies may have conflict of interest with Medicare). At issue in both these stories is the trust that an individual should have (and can reasonably expect) in a health professional, something that is seriously threatened when their are important financial COI.
