Should Docs Disclose Drug Company Ties?

Meanwhile, in an attempt to increase transparency at Duke University, all researchers who have received royalties or equities in excess of $10,000 are required to fully disclose the information publicly on the Duke Clinical Research Institute Web site.

Though other institutions, such as the University of Iowa and the Mayo Clinic, have not gone as far as to air potential conflicts of interest publicly, they instead depend on a Conflict of Interest Review Board to monitor and review each case in which a researcher has a financial relationship with a pharmaceutical company.

However, the University of Iowa plans to move a step further in its monitoring of doctors' ties to the pharmaceutical industry. According to Dr. Michael Cohen, professor of medicine and co-chairman of the Carver College of Medicine Conflict of Interest task force, the university is in the final stages of developing a policy that will "require full disclosure from not only faculty -- on whom it is focused -- but also by staff and trainees, [including] students, residents [and] postdoctoral fellows."

At the Mayo Clinic, in addition to its Conflict of Interest Review Board, the clinic provides a written statement in the patient information materials that encourages each patient to ask his or her physicians about industry relationships or to call the clinic's Conflict of Interest office, ensuring patients that all relationships would be disclosed if they so much as inquire.

Stricter Measures Needed?

But the Association of American Medical Colleges, a nonprofit group of medical schools, teaching hospitals and academic societies, supports far stricter measures on preventing potential conflicts of interest by discouraging academic physicians, faculty members, residents and students from receiving gifts or sponsored education from industry.

Many experts align themselves with the more stringent recommendations by the AAMC regarding conflicts of interest, stating that the measures being taken by medical institutions to provide full disclosure to patients are simply inadequate in preventing conflicts of interest from harming the doctor-patient relationship.

"I actually think that the push to disclose is rather a reproach to the ethical compass of my profession," said Dr. Nortin Hadler, a professor of medicine and microbiology at the University of North Carolina at Chapel Hill. "The fact that we think that disclosing somehow means that there is no further conflict of interest seems a rather flimsy argument."

Hadler said that the push for full disclosure among many medical centers accomplishes very little in terms of eliminating doctors' conflicts of interest, and instead highlights how widespread the problem of pharmaceutical and industry ties are among the nation's physicians and researchers.

"A significant portion of the budget of some of the best centers in the country is from some sort of arrangement with the industry," Hadler said. "It's systemic and it is intolerable that the sanctity of the patient-doctor relationship, the trustworthy nature of it, is being buffeted not just by individual conflicts of interest but by institutional conflicts of interest."

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