CHICAGO – After 5 years of discussion and attempts at passage, the American Medical Association’s House of Delegates adopted a conflict of interest policy to help guide physicians on the ethics of receiving pharmaceutical or device company funding for continuing medical education.
The House was asked to approve a report on financial arrangements prepared by the AMA Council on Ethical and Judicial Affairs (CEJA). But because so many members continued to be divided on what the AMA policy should be, the Reference Committee on Amendments to Constitution and Bylaws recommended that delegates put off any formal action and refer the matter yet again, this time to the AMA Board of Trustees.
When the resolution to refer came to the House floor, the vote was close, with 48% of delegates wanting to put off any action, and 52% voting against referral. Delegates were then asked whether to adopt the CEJA report. The vote was less ambiguous, with 60% voting in favor of adoption.
The report was supported by primary care delegations and many state delegations. Dr. Lori J. Heim, board chair of the American Academy of Family Physicians, said on the House floor that the latest iteration of the report addressed her organization’s concerns and should be adopted.
"I hope we can deal with this today rather than refer it back," said Dr. Heim, a family physician and hospitalist in Laurinburg, N.C. "The CEJA has found a compromise that we can all live with."
Dr. William Golden, a delegate from the American College of Physicians, and a professor of medicine and public health at the University of Arkansas, Little Rock, said on the House floor that "version 5.0 is ready for distribution," and urged passage of the policy.
Several delegates said that although most specialty societies have conflict of interest policies, it was important for the AMA to have its own.
But some delegates from surgical societies said that passage of the policy might harm important relationships between surgeons and industry. The American College of Surgeons spoke against adoption of the policy.
In the report, the CEJA said it recognized that it could have looked more broadly at conflict of interest issues, but decided to focus on pharmaceutical, biotechnology, and medical device company sponsorship of continuing medical education.
"Narrowing our focus to CME allows us to explore the complex considerations at stake in a manageable context and to provide practical ethical guidance on issues that increasingly challenge physicians as professionals," according to the CEJA report.
The CEJA concluded that "physicians should strive to avoid financial relationships with industry."
Instead, physicians should "cultivate alternative sources of support, should design and conduct educational activities so as to reduce costs, and should insist that content developers and faculty members not have problematic ties with industry, to ensure independent, unbiased, high-quality educational programming that best meets physicians’ needs and is accessible and affordable for all practitioners," according to the report.
The report recognized that "it is not always feasible, or necessarily desirable, for professional education to disengage from industry completely." In the cases where industry funding could not be avoided, "vigorous efforts must be made to mitigate the potential influence of financial relationships."