JAMA just published a set of letters in response to the January article by Brennan et al about conflicts of interest (JAMA 2006; 295: 2845-2849). Basically, Brennan and colleagues focussed on conflicts of interest involving pharmaceutical and device companies that affected practicing and academic physicians. They called for the abolition of certain financial arrangements between doctors and these companies, and for transferring other arrangements to academic medical centers (AMCs). Furthermore, they called for AMCs to be empowered to enforce the new rules. (See: Brennan TA et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA 2006; 295: 429-433.)
The letter by three of us Health Care Renewal bloggers, mirroring my previous blog posting, noted that physicians may be affected by conflicts of interest involving organizations other than pharmaceutical and device manufacturers, particularly managed care organizations. In addition, we noted a variety of conflicts of interest could affect health care decision makers other than physicians, notably, leaders of AMCs. Thus, we called for a broad code of conduct for all health care decisionmakers that would address all kinds of conflicts of interest.
Other letters also pointed out the spectrum of conflicts of interest is larger than that discussed by Brennan et al. They noted other sources of conflicts including: clinical income, NIH grants, advertisements in medical journals, and grants to AMCs and mediacal scientific societies (Meader); pharmaceutical advertising directed at physicians (Gozum) and other pharmaceutical promotional practices so directed (Ting); and pharmaceutical company financing of graduate medical education (Goldblum and Franzblau, and Watson and colleagues). They noted other barriers to implementing the reforms suggested by Brennan et al: a culture of entitlement among faculty physicians; (Watson and colleagues); and AMCs need for funding (Watson and colleagues, and Brody). Finally, Angell noted that Brennan and colleagues' estimates of the amount of money pharmaceutical companies spend on marketing may have actually been very low.
Not to toot our own horn too much, we hope that this set of letters has enlarged the scope of discussion of conflicts of interest affecting not only physicians but also the leaders of health care organizations.
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