Thursday, April 2, 2009

JAMA Recommendations for Medical Societies and Industry; or, Breaking Up Is Hard To Do

This week, JAMA published a major paper outlining recommendations for what kinds of money professional medical societies should and should not accept from the pharmaceutical industry.

The short version is that the authors believe that PMAs can continue to accept advertising and exhibit booth money, but that all other funding should eventually be eliminated. But they realize that many associations would probably cease to function if they had to divorce their patrons immediately, so they recommend a number of “interim” measures. Below are some of their key recommendations, followed by how the American Psychiatry Association deals with some of these issues.

·PMA leadership. All leaders, elected or non-elected, should have no financial relationships with industry.

APA: New rules now require that anybody involved in any level of governance, including committees, task forces, and councils, must declare their conflicts of interest at the beginning of meetings. While there are no restrictions on conflicts for leadership, most of the current officials (with the conspicuous exception of the president-elect, Dr. Schatzberg) have no relationships with industry. This should become a requirement of election.

·Practice guidelines committees. Typically, such committees are comprised mainly of academics with industry relationships. Furthermore, PMAs often accept industry grants to support the proceedings of such committees and to disseminate the resulting practice guideline materials. The paper recommends no industry involvement of any kind.
APA: Most of the members of APA practice guideline committees have industry relationships, although the organization does not accept industry grants to support the committees. In addition, most of the DSM-V committee members have industry relationships, although they are required to limit such income to no more than $10,000 per year while sitting on the committee. Should we exclude members with industry relationships from participating on any treatment guideline committees or on the DSM committee? The problem with this is that many of the most knowledgeable clinicians do industry-sponsored research and I wouldn’t want to exclude their expertise. Instead, I would propose that we allow a maximum quota of members with industry ties (perhaps no more than 25%), as long as these relationships do not include clear marketing activities, such as promotional speaking, participation in industry-funded CME events, or marketing consultation.

·Product endorsements. The group recommends that PMAs never solicit or accept deals from companies that allow them to offer their services to members.

APA: The APA currently has a number of such relationships, seen as important incentives for psychiatrists to become members of the organization. This includes, most egregiously, an official endorsement of PRMS, a malpractice insurance carrier that accepts money from Eli Lilly to put on pseudo-educational programs. I have written about this topic here. I agree that entering into deals with these companies is fraught with ethical pitfalls, as the PRMS fiasco shows. It’s just not worth it.

·Conference sponsorship. The group would allow industry support of meetings, as long as the money does not influence the content. However, they call for the elimination of industry-supported satellite symposia at meetings.

APA: The APA has just voted to phase out industry support of symposia, and once this is accomplished, there will be no industry support for the annual meeting, other than payments for exhibit booths. I disagree with the report’s willingness to allow even arms-length industry support of educational meetings, which I believe will inevitably lead to promotional activities in the guise of education. Theoretically, setting up “firewalls” between industry money and choice of content is a good idea, but the example of industry-funded CME shows that it is rarely effective in practice.

·Research and fellowships. The group is willing to allow industry grants for research and for fellowships, but they specify that research grants should not be pegged to specific research projects. Furthermore, fellowships should not be named after companies, and the fellows should not be told which company supports their fellowship.

APA: The APA currently accepts industry funding for a variety of research projects and for research or travel fellowships, often awarded to residents in support of travel to the annual meeting. I support the paper’s recommendations, but I think it is naïve to believe that any company would support a fellowship if nobody is allowed to know they supported it. Nor do I believe it would possible to keep such information secret.


Doug Bremner said...

Thanks for summarizing the highlights of this somewhat tedious paper. IMO that the practice guidelines committees tend to involve proportionally more pharma-linked guys who tend to aggregate. In other words there are a lot of people out there who have the expertise to make a contribution but who don't have such links. The guidelines are potentially harmful as currently devised and about half of the recommendations are based only on personal opinion of physicians on pharma payroll.

Anonymous said...

Agreed with Bremner. We've got an old pharma boys network out there, and it's time to being limiting their influence.

Anonymous said...

Daniel, What do you think about today's article in the globe

We would like to hear your thoughts,

Flavio Guzmán said...

I agree with you in the fact that is irrealistic to think that a drug company would give a fellowship in exchange of nothing (as it would be in the case if the fellowship donations were anonymous). But I think that is a subtle way the writers are saying that money from big pharmas shouldn't go at all to fellowship training.
That reminds of the case of a friend of mine who was interested in a program in oncology from a respected University, here in Argentina. Sadly, she couldn't afford it since she was at the beginning of her career.
One day, I run into her and she tells me that she is finally starting it. "Great! I am glad that you manage to raise the money" I said. "No, I don't have to pay a single dollar, Pfizer will cover the whole costs".
Of course she will feel thankful but alse in debt with the company, so you can imagine how objective her desitions will be in the future.

Anonymous said...

I have a completely random question, not really associated with your current post. So: I was hoping you might address the issue of academic salaries at some point in your blog. I am an assistant prof in an academic psychiatry department, and the negotiation (or lack thereof) of salaries is a big issue in my mind. How do the drug funded, and NIMH funded, guys get such high salaries, and how high are they? Apparently, we are all banned from discussing our salaries - one colleague told me that she was made to sign a form stating that she would not discuss her salary. The lack of transparency makes me feel very paranoid, but I imagine there is a reason I feel that way.

PDX97217 said...

Thanks for this post.

Medworldmedia said...

It’s about time that we clean up the abuse and regain the respect from the general population.

Lets get it done now before the federal government steps in.