Too much transparency or too little?

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Kaitlyn Dmyterko - 17.10 Kb
Kaitlyn Dmyterko, associate editor

Physicians may need to think twice about accepting that three-course meal or box seats for the Red Sox, especially after September 2013, which is the date the Centers for Medicare & Medicaid Services (CMS) will require industry leaders to publish financial relationships with physicians on public websites.

While most of these relationships deal with medical devices or drugs, some states such as Massachusetts, Vermont and New Jersey are taking it to the next level and making physicians document each industry interaction, which could include a pen or a slice of pizza, to avoid potential conflicts of interest, Russell H. Samson, MD, of the Florida State University Medical School in Sarasota, said during a presentation at the 2010 Society of Vascular Surgery. But are these types of relationship really that detrimental, he asked.

“Do we want to handicap all of these relationships because of a perception that we can be bought for a plastic pen or a slice of pizza … in that it will make us use some expensive, useless device? Do you really believe that industry supporting our annual meetings will make us so obligated that we will forgo our own ethics and intellectual capabilities and do you really believe that we are so morally irresponsible that we cannot resist marketing propaganda?” asked Samson. “I think the answer is no.”

While the “Sunshine Act” was meant to shed light on extensive financial relationships between industry and physicians and academic medical centers, some of these relationships are “fruitful,” George Loewenstein, PhD, and colleagues wrote in a recent JAMA article. While they offered that disclosure may not be a “panacea,” they did say that conflicts of interest come at a lofty price tag.

How prominent are conflicts of interest?  An October study published in British Medical Journal reported that 52 percent of panelists who helped write screening or treatment guidelines for diabetes and hyperlipidemia had financial conflicts of interest.

Even Samson admitted “intimately” involving himself with members of the vascular surgery industry. But, the Physician Payment Sunshine Act will make these types of beneficial relationships more difficult and require the system to disclose any services, i.e. food, entertainment, honorariums, speaking fees, among others, that physicians received from medical manufacturers.

However, Samson said these types of relationships are critical to move clinical research and basic science forward. “The relationship between industry and doctors is mutually beneficial and absolutely needs to be reserved,” he said.

On what side of the teeter totter do you fall and how much is too much? Are conflicts of interest valuable to research or do they have the potential to hinder clinical decision making? Let me know what you think.

Kaitlyn Dmyterko
Cardiovascular Business, associate editor