Conflicts of Interest Poorly Defined in Clinical Setting, Says Report

A new report from the Association of American Medical Colleges (AAMC) is urging academic medical centers to establish policies to help physicians disclose industry relationships to patients.

Although many academic medical centers have conflicts of interest policies that govern research and corporate relationships, only a small number of these institutions have adopted policies that define and address conflicts of interest in clinical care, says the report, which was developed by a 20-member task force. Entitled, “In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making,” the report is designed to provide guidance on how teaching hospitals can identify, evaluate, and disclose conflicts of interest in clinical care.

The guidelines suggest that institutions first evaluate their own compensation systems to determine whether they influence physician behavior and conflict with the best interest of patients.

AAMC also recommends the following:

• Establish mechanisms to identify physician-industry financial relationships and evaluate their potential to bias the clinical decision-making of physicians;
• Consider payments for services, royalties, and ownership when assessing individual related financial interests;
• Set thresholds for physician reporting and institutions’ evaluation of reported interests;
• Make available information on the industry relationships of their physicians, their value, and efforts to mitigate any bias resulting from these relationships.

The report also urges teaching hospitals to involve patients in helping them to determine what information about physician-industry ties is useful to them and how it should be presented to specific patient groups.

“Many of the concerns regarding conflicts of interest in clinical care are not unique to the academic medicine community, and can be applied across the practice of medicine,” said Patrick J. Brennan, M.D., chair of the task force, who is also chief medical officer and senior vice president of University of Pennsylvania Health System. “We believe these recommendations will provide guidance for how to implement policies that will meet the needs of both patients and the institutions that care for them, while more research is conducted on this issue.”