Should the Financial Link Between Industry and Physician Consultants be Severed?

Abstract

Robert M. Sade, MD Conflicts of interest come about when one must choose between two or more options that are incompatible. In medicine, they usually relate to choices between serving the interests of patients directly or indirectly versus serving one’s own interests, which might be career-related or financial. A particularly controversial area lies in the relations between physicians and pharmaceutical or device companies. For cardiothoracic surgeons, the most frequent interactions are with device companies. The high level of public attention to such conflicts of interest has led the drug and device industries and medical specialty societies, including the STS and AATS, to develop guidelines for physician-industry interactions.1 The guidelines generally are not intended to eliminate conflicts of interest, which is impossible, but to “manage” them. To Congress, however, self-imposed management is not enough. Scandalous payments of millions of dollars have received front-page coverage. A recent New York Times article reported, “… the extent of [Dr. David Polly’s] financial entanglements with the company, as detailed by those records, could raise questions about the ability of academic medical centers to manage potential conflicts of interest by faculty members who are also highly paid consultants to medical product companies.”2 Many other newspapers, such as The Wall Street Journal, have printed stories about other egregious transgressions.3 Senator Charles Grassley of Iowa has been the bulldog behind Senate investigations, and introduced a bill that require all health care-related companied to report publicly all payments to physicians: the Physician Payments Sunshine Act. The provisions of this bill were included in the new health care reform law, the Patient Protection and Affordable Care Act of 2009, amending the Social Security Act.4 In the view of Congress, medical centers may not be capable of managing industry payments to physicians, so it seems altogether possible that Congress will eventually enact laws that will entirely sever the financial link between industry and physicians. At the least, we are in a regulatory atmosphere that seems headed toward ever-increasing restrictions on such financial interactions. In a point-counterpoint discussion that took place at the Society of Thoracic Surgeons 46th Annual Meeting, an argument for institutional oversight of physician-industry financial interactions was made by Stephen Immelt, an attorney who focuses primarily on complex enforcement litigation, representing pharmaceutical companies, medical device companies, academic medical centers and medical schools, and other providers of health care in connection with a wide variety of governmental investigations, both civil and criminal in nature. Taking exception to Immelt’s views, Vincent Gaudiani, a cardiothoracic surgeon who has had long-time interests in quality assurance in cardiac surgery and in relations between physicians and industry, argues that institutional oversight is inadequate and collaboration between physicians, health care institutions, industry, and Congressional leaders is needed to legislate rationality into a chaotic area.