Industry and the profession of medicine: balancing appropriate relationships with the need for innovation.

Much has been made over the last few years about conflicts of interest in the health care community's relationships with industry members, including individual physicians, academic medical centers, and professional organizations. Not only has the Department of Justice (DOJ) been investigating questionable relationships, but House and Senate Oversight Committees have also weighed in on real and perceived conflicts. Most recently, the Physician Payments Sunshine Act of 2010 requires companies to begin recording any physician payments, including stock options, research grants, knickknacks, consulting fees, and travel to medical conferences that are worth more than ten dollars in 2012 and report them on March 31, 2013. To date, the American College of Cardiology (ACC) has developed and instituted one of the most stringent policies in the medical community to ensure that support from industry has no influence on any of its clinical documents. Furthermore, the need for the ACC's "Principles for Relationships with Industry," the organization's guide in nine key operational areas, are critical given that, when it comes to industry, properly managed partnerships are absolutely essential to maintaining scientific progress in cardiology and other specialties. The ACC relies on industry funding to advance cardiovascular research, as well as cardiovascular workforce training, practitioner diversity, medical education, and life-long learning. Without this funding, the ACC's ability to provide meaningful, unbiased education and to improve quality of care would be far more limited than that which is currently offered to its members and, ultimately, patients. Rather than restricting industry funding for such activities, the focus should instead be on transparency and actively and appropriately managing industry relationships. Ethical and appropriate partnerships with industry can prove beneficial in funding of education, research, and quality improvement activities. In addition, they are critical in the advancement of the quality of care for patients. The challenge is for medical societies to help the media, the public, and policymakers better understand the role of industry in promoting research, education, and innovation in medicine.

Lewin J ，Arend TE Jr 《-》

New paradigms for physician-industry relations: overview and application for SVS members.

Relationships between physicians and their industry partners have ranged from spectacular collaborations that produce extraordinary advances in patient care, such as endovascular aneurysm repair, to humiliating scandals such as extravagant trips and bogus "consulting" agreements resulting in legal actions. It is the latter which have led many to call for the end of all physician-industry relationships, and the former which mandate their preservation. While these two examples are representative of extremes at each end of the spectrum of this issue, in reality the majority of physician-industry relationships are far more complex, and the line between appropriate and inappropriate, and ethical and unethical, is hard to draw. The benefits of our relationships with industry are many: partnering to develop new therapies and technologies, educating and training physicians around new therapies and technologies, support of continuing medical education (CME), fellowship training, and patient education. The pitfall and danger of this relationship is that support from industry, be it a meal, a pen, an educational grant, or flattery, may unduly and inappropriately influence physician decision making around a specific company's product. While it is clear that free trips are not within the realm of proper interaction, what about unrestricted educational grants to institutions, or support of CME activities, professional society meetings, and new device training? As a result of the intense scrutiny of relationships between physicians and industry recently, multiple diverse entities (Association of American Medical Colleges, American Medical Association, Accreditation Council for Continuing Medical Education, professional medical associations, academic medical centers, industry, and government) have generated guidelines and policies with very different perspectives, reflective of their different missions. These policies range from vague and lenient, with only basic limitation of the physician-industry relationship, to extremely rigid and strict, with only minimal interaction and mission support permitted. Given the many changes in oversight and expectations for the relationship between physicians and industry, it is important for vascular surgeons to be aware of the background behind these modifications, the evidence that they are needed, and the positions of the diverse organizations and institutions that have already defined their policies on this issue.

Singh N ，Bush R ，Dalsing M ，Shortell CK ... -  《-》

Industry working with physicians through professional medical associations.

The physician/surgeon's interactions with industry have come under scrutiny in recent years for several reasons. Although some think that the professional medical association or society may provide an avenue to allow such interactions with less risk, there are concerns and challenges for such organizations as it relates to ethical and professional norms of their members. This is one surgeon's review of some pertinent information regarding what the professional medical society provides to its members and what role industry plays in the society's ability to provide these benefits. There is an exploration of the risks involved and practical methods to control inherent conflicts of interest involved in this interaction.

Dalsing MC 《-》

The new CMSS code for interactions with companies managing relationships to minimize conflicts.

Conflicts of interest in medicine have received significant attention in recent years, through the public and professional media, federal and state governments, and through a 2009 report of the Institute of Medicine on Conflict of Interest in Medical Research, Education and Practice. The Council of Medical Specialty Societies (CMSS) Code for Interactions with Companies was adopted by the CMSS in April 2010. The Code guides specialty societies in the profession of medicine in ethical relationships between societies and the pharmaceutical and medical device industries. The Code serves to protect and promote the independence of specialty societies and their leaders in corporate sponsorships, licensing, advertising, society meetings, exhibits, educational programs, journals, clinical practice guidelines, and research.

Kahn NB Jr ，Lichter AS ，Council of Medical Specialty Societies 《-》

Managing perceived conflicts of interest while ensuring the continued innovation of medical technology.

If it were not for the ongoing collaboration between vascular surgeons and the medical technology industry, many of these advanced treatments used every day in vascular interventional surgery would not exist. The flip side of this coin is that these vital relationships create multiple roles for surgeons and must be appropriately managed. The dynamic process of innovation, along with factors such as product delivery technique refinement, education, testing and clinical trials, and product support, all make it necessary for ongoing and close collaboration between surgeons and the device industry. This unique relationship sometimes leads to the perception of conflicts of interest for physicians, in part because the competing pressures from the multiple, overlapping roles as clinician/caregiver/investigator/innovator/customer are significant. To address this issue, the Advanced Medical Technology Association (AdvaMed), the nation's largest medical technology association representing medical device and diagnostics companies, developed a Code of Ethics to guide medical technology companies in their interactions with health care professionals. First introduced in 1993, the AdvaMed Code strongly encourages both industry and physicians to commit to openness and high ethical standards in the conduct of their business interactions. The AdvaMed Code addresses many of the types of interactions that can occur between companies and health care professionals, including training, consulting agreements, the provision of demonstration and evaluation units, and charitable donations. By following the Code, companies send a strong message that treatment decisions must always be based on the best interest of the patient.

Van Haute A 《-》