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Conflict of Interest in Medical Research, Education, and Practice
Physicians should also be circumspect if asked to deliver educational programming developed by a medical education and communication company. Such companies, which are largely financed through the pharmaceutical industry, are for-profit developers and vendors of continuing medical education. It is important that physicians retained as lecturers in such settings control the content of the educational modules they deliver rather than allow their presentations to be scripted by the company. Lecturers should screen industry-prepared presentation aids (such as slides and reference materials) to ensure their objectivity and should accept, modify, or refuse them on that basis. Presenters using such materials should disclose their source to audience members. Paid efforts to influence the profession or public opinion about specific medical products are particularly suspect. It is unethical, for example, for physicians to accept commissions for articles, editorials, or medical journal reviews that are actually ghostwritten by industry or public relations firms in an attempt to “manage the press” about certain products or services. (Coyle et al., 2002a, p. 399)
During the course of the committee’s work, the Council of Medical Specialty Societies (CMSS) initiated a project to collect best practices on disclosure and limitation of conflict of interest and develop a statement on conflict of interest (The Associated Press, 2008). A CMSS task force recently recommended elements that specialty society policies should include, and it also proposed the development by CMSS of a template for such policies. The task force recommended that societies post their policies and provide information about the financial support that they receive from industry (CMSS, 2008). The CMSS earlier adopted a consensus statement on medical ethics that, among other provisions, states that:
Physicians should resolve conflicts of interest in a way that gives primacy to the patient’s interests.
Physicians have an ethical obligation to preserve and protect the trust bestowed on them by society (CMSS, 1999, unpaged).
Although this chapter focuses on individual physicians, professional societies as organizations may also have financial relationships with industry. Such relationships include unrestricted educational grants, income from exhibitions and meetings, industry advertisements in the journals of professional societies, and funding for the development of practice guidelines. As discussed further in Chapter 8, such relationships can constitute institutional conflicts of interest, and the committee recommends the adoption of policies on such institution-level conflicts.
The committee found little information about the positions of state medical societies on individual or organizational relationships with medical product companies. The Wisconsin Medical Society announced in 2008 that