The Institute of Medicine Calls for Voluntary and Regulatory Measures to Reduce Conflicts of Interest

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New voluntary and regulatory measures can strengthen protections against financial conflicts of interest in medicine without hindering patient care or the advancement of medical knowledge, claims a new report by the Institute of Medicine. The April 2009 report tackles conflicts of interest across the spectrum of medicine, from biomedical research to clinical care, from physician training to continuing education.

The report calls on researchers, medical school faculty, and private practice physicians “to forgo gifts of any amount from medical companies and to decline to publish or present material ghostwritten or otherwise controlled by industry.” Also recommended are several actions to improve disclosure of financial ties between the medical community and industry, limit company payments and gifts, and remove industry influence from medical education and the development of practice guidelines. “It is time to end a number of long-accepted practices that create unacceptable conflicts of interest, threaten the integrity of the medical profession, and erode public trust while providing no meaningful benefits to patients or society,” said Dr Bernard Lo, chair of the committee that wrote the report and professor of medicine and director of the program in medical ethics at the University of California, San Francisco.

“All academic medical centers, journals, professional societies, and other entities engaged in health research, education, clinical care, and development of practice guidelines should establish or strengthen conflict-of-interest policies,” the report says. “Disclosure by physicians and researchers not only to their employers but also to other medical organizations of their financial links to pharmaceutical, biotechnology, and medical device firms is an essential first step in identifying and managing conflicts of interest and needs to be improved.”

The committee noted substantial variations in institutions' conflict-of-interest policies and shortcomings in physicians' and researchers' adherence to policy requirements. “The format for disclosure and categories of relationships should be standardized to help institutions judge the risk that a relationship poses and to ease the burden for individuals who must report information to multiple organizations with different policies.”

In addition, the committee calls on Congress to require pharmaceutical, biotechnology, and device firms to report through a public Web site the payments they make to doctors, researchers, academic health centers, professional societies, patient advocacy groups, and others involved in medicine. “A public record like this could serve as a deterrent to inappropriate relationships and undue industry influence. It also would provide medical institutions with a way to verify the accuracy of information that physicians, researchers, and senior officials have disclosed to them.”

Although the report calls for some new legislation and regulations, it also emphasizes the role of voluntary efforts by medical groups, industry, and individual professionals. “Voluntary action is more likely to reinforce professional values and foster policies that minimize unintended consequences and administrative burdens. However,” the report warns, “if the industry and the medical community fail to strengthen their conflict-of-interest policies, practices, and enforcement, more policymakers may turn to legislative solutions, as officials in some states have.”

Copies of Conflicts of Interest in Medical Research are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu.