Dr. McMains' Real and Perceived Conflicts of Interest. Stryker- Consultant, Instrument DevelopmentOlympus- Consultant Endoscopy Development, SpeakerMedtronic- Consultant, Biofilm studiesDaichi-Sankyo- Speaker's Bureau. Why are we talking about this?. Retail spending on prescriptions has more than doubled between 1995 and 2000 from 64.7 billion to 132 billion (www.nihcm.org/innovations.pdf)Marketing accounts for over 30% of revenues in the pharmaceutical industryApproximately 90% of the 21 b23
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1. Ethical Interactions with Industry: Avoiding the Siren Song… K. Christopher McMains, MD
Associate Program Director
Department of Otolaryngology
March 11, 2008
2. Dr. McMains’ Real and Perceived Conflicts of Interest Stryker- Consultant, Instrument Development
Olympus- Consultant Endoscopy Development, Speaker
Medtronic- Consultant, Biofilm studies
Daichi-Sankyo- Speaker’s Bureau
5. Scenario While rotating on the Otolaryngology service as a medical student, you encounter a pharmaceutical representative who offers you a copy of a recent article on the drug that he details.
What issues are involved in this interaction?
8. What is ‘Conflict of Interest’ in the clinical setting? When interests of the clinician do not align with the interests of their patients.
9. Therapeutic Role of Trust Trust has been called “a basic building block for healing doctor/patient interactions.” (Rogers DE, 1994)
Outcomes may be related to patient ratings of their doctors. (Franks P, et al, 2005)
10. What do patients think? Patients surveyed thought “it is not alright” for physicians to accept:
Dinner at a restaurant 48.4%
Baby formula 44.2%
Coffee Maker 40.7%
Ballpoint pens 17.5%
Medical books 16.9%
Drug Samples 6.9%
11. What do patients think? Patients thought gifts more influential and less appropriate than physicians.
Half of patients were unaware of gifts to doctors from industry.
Of those who were previously unaware, 24% had an altered perception of the medical profession.
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13. Scenario #1.1 The same representative has left medication samples, lunch and pens in the ENT clinic.
What are the issues here?
15. Samples are for the good of needy patients, right? Int. Med residents’ prescribing patterns of 5 drug class pairs were studied
Decreased use of unadvertised drugs
Decreased use of OTC drugs
Trend towards a decrease in use of less expensive drugs
16. Are Medical Students insulated? Survey of Finnish medical students
44% attended industry sponsored presentations >2 times per month
Importance attached to industry-supplied information and intensity of interaction increased through training
17. Or is it? Survey of 105 residents at an Internal Medicine residency program:
Judged appropriateness based on cost
All who viewed lunches/pens as inappropriate had accepted them
61% believed that industry contact did NOT affect their own prescribing
16% believed that others in their program were unaffected
19. Attitudes of Practicing Physicians “Strongly disagree” that their prescribing behavior could be influenced
“Slightly disagree” that taking gifts was inappropriate
“Slightly averse” to having relationships made public SELF-SERVING BIAS
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24. Scenario #1.2 You are offered a stipend to attend a meeting being held in scenic and lovely Del Rio at which data on his company’s new drug will be discussed. No CME is offered for this event.
What are the issues here?
25. Industry and CME Study of GPs in Scotland
½ of meetings/conferences were funded by industry
1/3 of meetings would not have been attended without industry funding
40% thought industry funding created COI
86% denied that industry involvement affected their drug selection.
26. Industry and Research Funding Industry-funded studies are more likely to report positive outcome.
Involvement of drug company employee has a much greater effect on outcome than financial sponsorship
27. Industry and Research Funding Study of NEJM and JAMA articles (2001)
16.6%-32.6% of articles had one or more authors with COI
38.7% of drug studies had authors with COI
Strong association between authors with COI and positive reported finding.
28. Summary Relationships with industry can create conscious and unconscious conflicts of interest.
If is morally and therapeutically vital that we uphold our patients’ trust in our interactions with industry.
29. Final Thoughts “You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love, and tenderness to your fellow-men. Once you get down to the purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with abreadth of charity that raises you far above the petty jealousies of life.