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Professionalism Workshops Managing conflicts of interest (internal medicine) Patient confidentiality (ob-gyn) Honesty with patients (pediatrics) Interclerkship session Maintaining appropriate relations Self-regulation Specialty-specific professionalism challenges Managing Conflicts of Interest Everyone has conflicts Disclosure – does this “cure” a COI? “Gifts” to physicians/students Recognize biases in others Ethics of retainer practice The gynecologist who offers Botox Physician self-referral (imaging, labs) Other topics…drug sampling, research COI Percentage of Survey Respondents Who Strongly Agree or Agree With the Statements About the Pharmaceutical or Device Industry, Stratified by Academic Department Korenstein, D. et al. Arch Surg 2010;145:570-577. Copyright restrictions may apply. Physician Trainees Interactions with Pharmaceutical Industry JGIM 2013; 28:1064 1610 students (49.3% response rate) 739 residents (43.1% response rate) Strongly agree or agree with following statements Receiving gifts or food from pharma representatives increases the chances that I will eventually prescribe the drug company’s products. First yr Fourth yr Residents 33.2% 36.3% 33.5% JGIM 2013;28:1064 Strongly agree or agree with following statements Receiving gifts or food from pharma representatives increases the chances that I will eventually prescribe the drug company’s products. First yr Fourth yr Residents 33.2% 36.3% 33.5% Receiving gifts or food from pharma representatives increases the chances that my fellow students/residents will eventually prescribe the drug company’s product. JGIM 2013;28:1064 Strongly agree or agree with following statements First yr Fourth yr Residents Receiving gifts or food from pharma representatives increases the chances that I will eventually prescribe the drug company’s products. 33.2% 36.3% 33.5% Receiving gifts or food from pharma representatives increases the chances that my fellow students/residents will eventually prescribe the drug company’s product. 51.8% 45.6% 42.4% JGIM 2013;28:1064 Strongly agree or agree with following statements First yr Fourth yr Residents Receiving gifts or food from pharma representatives increases the chances that I will eventually prescribe the drug company’s products. 33.2% 36.3% 33.5% Receiving gifts or food from pharma representatives increases the chances that my fellow students/residents will eventually prescribe the drug company’s product. 51.8% 45.6% 42.4% Medical schools should not permit the pharmaceutical industry to have access to students during their training at clinical sites. 60.3% 53.0% 56.3% JGIM 2013;28:1064 Physician Payment Sunshine Act Manufacturers of drug, device, medical supplies will have to report to CMS any direct payment or transfer of value to physician of $10 or more Data collected as of 8-13; data reported as of 9-14 Pharma Gifts to Physicians and Effect on Patient Trust Phone survey 2029 respondents in 40 large metropolitan area 55% of respondents believe physician receive gifts Respondents of higher socioeconomic class and younger age more likely to believe their physician receives gifts. JGIM 2012 27:274 Pharma Gifts to Physicians and Effect on Patient Trust Beliefs about personal physician and industry gifts Low trust in personal physician(odds ratio) Does not accept gifts ------ Accepts gifts 2.26 P value Low trust in health care system (odds ratio) P value ------ <0.001 2.03 <0.001 JGIM 2012 27:274 Treatment of macular degeneration – Charge to Medicare • Avastin $50 • Lucentis $2000 Commission to physician $3 $120 Results from randomized trials comparing intravitreal bevacizumab and ranibizumab found no difference in visual acuity for the treatment of wet AMD Lancet. 2013;382(9900):1258 AMSA scorecard Managing Conflicts of Interest Everyone has conflicts Disclosure – does this “cure” a COI? “Gifts” to physicians/students Recognize biases in others Ethics of retainer practice The gynecologist who offers Botox Physician self referral (imaging, labs) Other topics…drug sampling, ghost writing, research COI