Physicians' relationships with industry have long been an ethical tug of war, yet they remain commonplace. And with government's increasing focus on transparency - augmented with the U.S. Supreme Court upholding of the Patient Protection and Affordable Care Act - consulting, research and other relationships with pharmaceutical and medical device companies will become even more visible.
"Relationships with industry ... are ubiquitous in medical research, medical education and medical practice in the U.S.," says Eric Campbell, Ph.D., associate professor of medicine, Harvard Medical School, Boston. And the relationships have benefits and risks, says Dr. Campbell, who is among the authors of the Institute of Medicine's Conflict of Interest in Medical Research, Education and Practice report, released in April 2009. "What we can't do is overemphasize the benefits and underemphasize the risks, or vice versa," he says.
Making the list
Academic institutions and hospitals are joining government with efforts to cap these potential conflicts of interest. Consumer Reports President Jim Guest wrote in a June 2012 "From the President" column about how hospital systems, including Kaiser Permanente, the Department of Veterans Affairs and "several dozen" academic centers are restricting gifts from industry.
"In that (law, government) instructed the Institute of Medicine ... to come up with recommendations for how guidelines should be produced," says Craig Elmets, M.D., professor and chairman of the department of dermatology, University of Alabama at Birmingham and chair of the American Academy of Dermatology's clinical guidelines committee. "The Institute of Medicine recommended that the guidelines committee be comprised of a majority of people who do not have a conflict of interest - they do not have relationships with industry that specifically bear on the topics being discussed."
Dr. Elmets, who has industry ties, can continue to participate in the guidelines process, even if there is a conflict, as long as the majority of committee members for any given guidelines topic is conflict-free. He says he thinks it's possible for a dermatologist to have a relationship with industry and remain unbiased. The problem, he says, is perception - mainly, public perception.