Assessing conflicts of interest

San Francisco - Faced with a jungle of potential conflicts of interest in their various roles as providers, educators, students, advisers, committee members and investigators, physicians might consider their answers to a few pragmatic questions in judging the ethics of their conduct, according to David M. Pariser, M.D., speaking at the 64^th Annual Meeting of the American Academy of Dermatology (AAD), here.

When it comes to handling conflicts of interest, medicine is a self-regulating profession, and through its codes and guidelines, the AAD has done an outstanding job of ensuring it remains a professional organization, says Dr. Pariser, who is also secretary-treasurer of the AAD.

With an eye to strengthening its guidelines on conflict of interest, the AAD board is reviewing a broadened policy on conflicts of interest disclosure for speakers at AAD programs. Currently, speakers have to list the names of companies for which they have adviser, board of director, consultant, employment, founder, investor or speaker relationships, as well as the nature of compensation they receive, e.g., equipment, grants, honoraria, etc. However, if the new proposal is approved, speakers may also have to disclose the exact amount of financial or other compensation received from each source.

"By adopting these standards, the AAD will be taking a high road. The information can be eye-opening and will allow listeners to better judge whether there is any bias in a speaker's presentation. Of course, this full disclosure will depend on an honor system and will not involve any auditing, but any speaker who is embarrassed to reveal the whole truth should not be on the podium in the first place," Dr. Pariser says.

In his talk, Dr. Pariser also reviews a number of other considerations for dealing with potential conflicts of interest. With respect to industry gifts, subsidies and equity ownership, there are guidelines from both the AAD and AMA. For example, gifts are defined as any tangible item provided at no cost or at an unreasonably reduced cost and are deemed acceptable if they have minimal value and are related to patient care. Items of significant value or that primarily benefit the physician rather than the patient are regarded as unacceptable. Also to be taken into account is whether acceptance of a gift influences a physician to use or promote the sponsor's product.

For guidelines on industry support for continuing medical education (CME) programs, the AAD strictly adheres to standards from the Accreditation Council for Continuing Medical Education (ACCME) that are designed to identify conflicts of speakers, regulate industry subsidies and curtail commercial bias in the program content.

"We all appreciate that because of the associated costs, most CME programs would not exist without industry support. However, there are guidelines in place to assure that financial support is appropriate and program content remains independent," Dr. Pariser says.

The ACCME guidelines do state that it is appropriate for faculty to accept reasonable honoraria and reimbursement for reasonable expenses covering travel, lodging and meals. However, provision of such honoraria and expenses is not allowed at the AAD meeting, Dr. Pariser notes.