Thursday, April 30, 2009

Controlling Conflict of Interest

The prestigious NEJM have published an article in the current on-line edition "Controlling Conflict of Interest - Proposals from the Institute of Medicine", By Sr. Robert Steinbrook.

The article starts by defining what is conflict of interest :"a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest." The primary interests of concern include "promoting and protecting the integrity of research, the welfare of patients, and the quality of medical education." Secondary interests "may include not only financial gain but also the desire for professional advancement, recognition for personal achievement and favors to friends and family or to students and colleagues."

The article covers the recommendations of the IOM and of particular interest to me is the following from the article: Academic medical centers, teaching hospitals, faculty members, students, residents, and fellows should "reform relationships with industry in medical education"; these institutions and professional societies "should provide education on conflict of interest."....

To read the entire article, please follow this link:


  1. Thank you, Former, for this excellent posting. The “Overview of IOM Recommendations …” listed in the link is a good start.

  2. keeping them honestMay 1, 2009 at 8:36 AM

    The IOM has some housecleaning of its own to attend to while it scolds the rest of us. See the Health Care Renewal post by Bernard Carroll, here.

  3. "We should congratulate the IOM committee members for their work, and we hope to see the field embrace their recommendations."
    Bernard Carroll, April 28, 2009
    Health Care Renewal blog

    Two Texas senators have tackled these issues with Senate Bill 1706 and Senate Bill 553. See Senator West and Senator Lucio deliver on their home turf, here:

    Click on Apr 30, Senate Committee on Health & Human Services (Part II), video clip position 47.

  4. Here's something interesting. (link at bottom) I wonder what you all think of it. A new PwC analysis of the pharma industry is suggesting that the future of pharma lies with partnering with other health organizations (hospitals, fitness, insurures, etc) to create a more "holistic" health product to market, where drugs are only one component. It's an interesting concept. However, being a Pharmalot alumni, my first thought was: Doesn't this create lots of conflicts-of-interest? What do you guys think? Is this a viable model for the future of pharma?

  5. Thanks, Nathan. Interesting piece.

    Re: COIs, I may be missing the question. If the relevant company was selling the entire package--say, statin, meditation training, nutritional counseling, exercise program, etc.--than one could imagine it working together.

    But that would also mean a doc rx'ing the package, I assume. So you get a script for that? Or some of it, as indicated? And how would insurance respond? Since the parts may well be a priced below the whole, we'd end up with competition from "generic" meditation training, etc. Sounds messy, but who knows.

    A student of mine found a model in which drug development, marketing, etc. went back to being separate companies. Unclear whether that would be financially viable, but the argument was that the dominance of marketing has ended up painting companies into corners, and suppressing the kind of basic science and risk-taking from which the most important drugs have usually come. If so, that would also yield profit. But would companies take a risks of that kind, I wonder...

  6. It is an interesting concept. However, I think some of the major hospitals are already doing this. For example Sloan Kettering in NYC offers a complete holistic package, meditation, natural health and holistic health alternatives. The programs are peer reviewed by the medical staff. Additionally, Sloan has a website that patients can google to look up "natural herbs" to find out whether they would interfere with the prescribed drugs that patient is taking.

    There is also the stress and wellness clinic at Mass Gen started by Jon Kabbat Zinn. Then of course there is Hippocrates Institute in Florida.

    What drug companies need to do better, is test their drugs for reactions to some of the natural alternative therapies out there. Patients need guidance in this area.

    But none of this is really related to the topic here which is COI....


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