Transcript “Free Lunch”: Teaching Internal Medicine Residents about

Conflict of Interest
Definition
 “A conflict of interest is a situation in
which financial or other personal
considerations have the potential to
compromise or bias professional
judgment and objectivity.”
From Columbia University’s Conflict of Interest Policy
A Simpler Definition
“Trying to Serve Two Masters”
Lauris C. Kaldjian, MD, PhD
Director, Program in Biomedical Ethics
A Bit of Background
Perceived Influence of Sales Reps
on Prescribing Practices
A lot
1%
A lot
33%
A little
38%
None
16%
None
61%
A Little
51%
“You”
“Other Physicians”
Of Principles and Pens: Attitudes and practices of medicine house staff
toward pharmaceutical promotions Am J Med 2001;110:551
Statements on Conflicts of Interest
from: IOM / AAMC / ABIM
 Commonly held belief that small gifts don’t
influence behavior is disproved by social
science research
 C.O.I. is a rampant problem
 Disclosure of financial interests is also a
myth that incompletely protects patients
 Academic Medical Centers must lead the way
to abolish gifting practices
JAMA 2006; 295:429-433
S.2029
A bill from Senator Grassley
 “...amend Social Security Act to
provide transparency in the
relationship between physicians and
manufacturers of drugs, devices, or
medical supplies…”
And increasingly …
We must also address
patient/public perceptions
that our activities may convey a
potential for conflict of interest
Education Domains
 UME
 GME
 CME
Dealing with drug sampling, free meals, etc.
Biopharma support for CME
Clinical Practice
Drug sampling in Clinics
Purchase decision making for medical devices
Device consulting – for development & usage
Research
 Basic
 Clinical
 Translational
 Entrepreneurial
Completeness of disclosure; is disclosure
adequate?
Intellectual property control & patents
Conflict of Interest Task Force
Membership
 (N=34)
 Broad representation across the College
and University
Planned Approach
 Inventory & Review Existing Policies (local &
national)
 Make recommendations with a
comprehensive policy (across all 3 core
missions)
Timeline
 roughly over 1 year
Comments?
Suggestions?
Questions?