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The new conflict of interest rules promulgated by the Federal government are being rolled out and they are quite remarkable (see: http://grants.nih.gov/grants/policy/coi/). Did you know that any travel expense, including a token for a bus ride provided or reimbursed by a pharmaceutical company, device company, specialty society like the American Heart Association, or almost any other entity, counts as a "significant financial interest" (or SFI)?
If that does not convince you that regulation has gone too far, sit tight. But first, I will admit that we are paying the price for the excesses of a few. We still see an echo of those excesses today, and I'm not here to advocate for them.
However, we now have a monitoring regime in place that will require institutions to add layers of oversight and the taxpayer to foot the bill to support state and federal agents who will pore through our books to find the cab ride that was not disclosed.
Yes, we can and should definitively affirm that the degree to which these COI rules now permeate medicine borders on the absurd.
Case in point: At a scientific meeting last year, signs were posted in the vendor display area that included an alert under the word "Coffee" to wit: "If you are a physician from Massachusetts, you cannot accept coffee."
It seems that the vital beverage that was available for automatic dispensing was provided by a pharmaceutical company, not the society hosting the meeting. Based on that brief glimpse into the new world in which we find ourselves, it would certainly appear that the official rules in at least one New England state were beyond strict. Ironic, given that state's Revolutionary War history and the Tea Party.
Although recently Governor Deval Patrick of Massachusetts signed a state budget bill that "loosened things up" a bit in the gift ban arena, if you eat a turkey sandwich in Worcester or Boston or Springfield provided by an industry sponsor, you will need to report the value of that sandwich to the state.
Underlying these rules must be the conceptual bias that we as physicians are like a tabula rasa; that if you provide a cup of coffee or pay for a shared cab ride, we will robotically pivot and prescribe whatever drug, device or intervention you are selling.
Yes, that describes us well.
I was so struck by the coffee experience that I let my mind wander and I came up with two scenarios.
1. A physician wanders into the vendor area and in a moment of temptation and thirst, pours a cup of coffee. A government agent or whistle-blower is staking out the coffee table and as soon as that physician raises the cup to his lips, a SWAT team arrives and shouts "Drop That Cup, Now!" Plea bargaining and a suspended sentence follow.
2. A tiered coffee menu is devised depending on your state's interpretation and/or strengthening of the Federal COI rules. And yes, I am picking on a few states who have a reputation for draconian oversight, and though the degree of regulation does in fact vary, let’s have a little fun:
Yesterday's Decaf: Massachusetts, Vermont, and Minnesota
Americano only, no milk or sweetener: Illinois
Americano or Espresso, open condiment bar: Missouri
Any specialty coffee, any size, any time: Texas
Actually, I'm all for it, as long as the rules apply to everyone. First, to members of Congress, then the lawyers. If we are revealing all under the convenient but misleading rubric of "transparency," it should be equitable. Let's assume everyone is conflicted and let's have everyone watch everyone else. There is a name for this and it ain't capitalism. The word starts with the letter "F" and has seven letters.
I'll likely return to this issue for it provides almost endless opportunities to skewer the rule makers. Until then, I would invest heavily in yesterday''s coffee grounds.
Dr. Paul Hauptman is Professor of Internal Medicine and Assistant Dean of Clinical-Translational Research at Saint Louis University and Director of Heart Failure at Saint Louis University Hospital. He currently serves as an Associate Editor for Circulation: Heart Failure and blogs while staring out his office window at the Arch.
The new conflict of interest rules promulgated by the Federal government are being rolled out and they are quite remarkable (see: http://grants.nih.gov/grants/policy/coi/). Did you know that any travel expense, including a token for a bus ride provided or reimbursed by a pharmaceutical company, device company, specialty society like the American Heart Association, or almost any other entity, counts as a "significant financial interest" (or SFI)?
If that does not convince you that regulation has gone too far, sit tight. But first, I will admit that we are paying the price for the excesses of a few. We still see an echo of those excesses today, and I'm not here to advocate for them.
However, we now have a monitoring regime in place that will require institutions to add layers of oversight and the taxpayer to foot the bill to support state and federal agents who will pore through our books to find the cab ride that was not disclosed.
Yes, we can and should definitively affirm that the degree to which these COI rules now permeate medicine borders on the absurd.
Case in point: At a scientific meeting last year, signs were posted in the vendor display area that included an alert under the word "Coffee" to wit: "If you are a physician from Massachusetts, you cannot accept coffee."
It seems that the vital beverage that was available for automatic dispensing was provided by a pharmaceutical company, not the society hosting the meeting. Based on that brief glimpse into the new world in which we find ourselves, it would certainly appear that the official rules in at least one New England state were beyond strict. Ironic, given that state's Revolutionary War history and the Tea Party.
Although recently Governor Deval Patrick of Massachusetts signed a state budget bill that "loosened things up" a bit in the gift ban arena, if you eat a turkey sandwich in Worcester or Boston or Springfield provided by an industry sponsor, you will need to report the value of that sandwich to the state.
Underlying these rules must be the conceptual bias that we as physicians are like a tabula rasa; that if you provide a cup of coffee or pay for a shared cab ride, we will robotically pivot and prescribe whatever drug, device or intervention you are selling.
Yes, that describes us well.
I was so struck by the coffee experience that I let my mind wander and I came up with two scenarios.
1. A physician wanders into the vendor area and in a moment of temptation and thirst, pours a cup of coffee. A government agent or whistle-blower is staking out the coffee table and as soon as that physician raises the cup to his lips, a SWAT team arrives and shouts "Drop That Cup, Now!" Plea bargaining and a suspended sentence follow.
2. A tiered coffee menu is devised depending on your state's interpretation and/or strengthening of the Federal COI rules. And yes, I am picking on a few states who have a reputation for draconian oversight, and though the degree of regulation does in fact vary, let’s have a little fun:
Yesterday's Decaf: Massachusetts, Vermont, and Minnesota
Americano only, no milk or sweetener: Illinois
Americano or Espresso, open condiment bar: Missouri
Any specialty coffee, any size, any time: Texas
Actually, I'm all for it, as long as the rules apply to everyone. First, to members of Congress, then the lawyers. If we are revealing all under the convenient but misleading rubric of "transparency," it should be equitable. Let's assume everyone is conflicted and let's have everyone watch everyone else. There is a name for this and it ain't capitalism. The word starts with the letter "F" and has seven letters.
I'll likely return to this issue for it provides almost endless opportunities to skewer the rule makers. Until then, I would invest heavily in yesterday''s coffee grounds.
Dr. Paul Hauptman is Professor of Internal Medicine and Assistant Dean of Clinical-Translational Research at Saint Louis University and Director of Heart Failure at Saint Louis University Hospital. He currently serves as an Associate Editor for Circulation: Heart Failure and blogs while staring out his office window at the Arch.
The new conflict of interest rules promulgated by the Federal government are being rolled out and they are quite remarkable (see: http://grants.nih.gov/grants/policy/coi/). Did you know that any travel expense, including a token for a bus ride provided or reimbursed by a pharmaceutical company, device company, specialty society like the American Heart Association, or almost any other entity, counts as a "significant financial interest" (or SFI)?
If that does not convince you that regulation has gone too far, sit tight. But first, I will admit that we are paying the price for the excesses of a few. We still see an echo of those excesses today, and I'm not here to advocate for them.
However, we now have a monitoring regime in place that will require institutions to add layers of oversight and the taxpayer to foot the bill to support state and federal agents who will pore through our books to find the cab ride that was not disclosed.
Yes, we can and should definitively affirm that the degree to which these COI rules now permeate medicine borders on the absurd.
Case in point: At a scientific meeting last year, signs were posted in the vendor display area that included an alert under the word "Coffee" to wit: "If you are a physician from Massachusetts, you cannot accept coffee."
It seems that the vital beverage that was available for automatic dispensing was provided by a pharmaceutical company, not the society hosting the meeting. Based on that brief glimpse into the new world in which we find ourselves, it would certainly appear that the official rules in at least one New England state were beyond strict. Ironic, given that state's Revolutionary War history and the Tea Party.
Although recently Governor Deval Patrick of Massachusetts signed a state budget bill that "loosened things up" a bit in the gift ban arena, if you eat a turkey sandwich in Worcester or Boston or Springfield provided by an industry sponsor, you will need to report the value of that sandwich to the state.
Underlying these rules must be the conceptual bias that we as physicians are like a tabula rasa; that if you provide a cup of coffee or pay for a shared cab ride, we will robotically pivot and prescribe whatever drug, device or intervention you are selling.
Yes, that describes us well.
I was so struck by the coffee experience that I let my mind wander and I came up with two scenarios.
1. A physician wanders into the vendor area and in a moment of temptation and thirst, pours a cup of coffee. A government agent or whistle-blower is staking out the coffee table and as soon as that physician raises the cup to his lips, a SWAT team arrives and shouts "Drop That Cup, Now!" Plea bargaining and a suspended sentence follow.
2. A tiered coffee menu is devised depending on your state's interpretation and/or strengthening of the Federal COI rules. And yes, I am picking on a few states who have a reputation for draconian oversight, and though the degree of regulation does in fact vary, let’s have a little fun:
Yesterday's Decaf: Massachusetts, Vermont, and Minnesota
Americano only, no milk or sweetener: Illinois
Americano or Espresso, open condiment bar: Missouri
Any specialty coffee, any size, any time: Texas
Actually, I'm all for it, as long as the rules apply to everyone. First, to members of Congress, then the lawyers. If we are revealing all under the convenient but misleading rubric of "transparency," it should be equitable. Let's assume everyone is conflicted and let's have everyone watch everyone else. There is a name for this and it ain't capitalism. The word starts with the letter "F" and has seven letters.
I'll likely return to this issue for it provides almost endless opportunities to skewer the rule makers. Until then, I would invest heavily in yesterday''s coffee grounds.
Dr. Paul Hauptman is Professor of Internal Medicine and Assistant Dean of Clinical-Translational Research at Saint Louis University and Director of Heart Failure at Saint Louis University Hospital. He currently serves as an Associate Editor for Circulation: Heart Failure and blogs while staring out his office window at the Arch.