The NASPGHAN Ethics Committee Activities

Abstract

The NASPGHAN Ethics Committee Activities Over the last 50 years the practice of medicine has evolved from small private practices delivering mostly primary care into a complex, integrated health care industry with subspecialty providers and tertiary care medical centers supplementing primary care to deliver state-of-the-art care. Discoveries through medical research and innovations in technology enable us to now diagnose and treat illnesses previously considered incompatible with life. The pace of success in these endeavors would not have been possible without partnerships between researchers and governmental agencies, nonprofit organizations, and for-profit pharmaceutical and device manufacturers. Costs for medical research and the education of health care providers have rapidly increased and continue to do so. Funding for these endeavors from governmental agencies has become increasingly difficult to obtain. As a consequence our dependence on industry for financial support has grown and since the 1980's the proportion of governmental funding for medical research from the National Institutes of Health has relatively decreased. While this relationship between the medical profession and industry has been of immense benefit to the health of our society, it has also created a situation that has potential for abuse. During this exciting era of progress in medicine, NASPGHAN has emerged as a leader in the advancement of the science and clinical care of children with disorders of the digestive tract, liver, and nutrition. Our organization has raised funds to support innovative research and educate medical professionals through our annual meeting and this journal. We have created clinical practice guidelines based on current scientific research and educational materials for physicians and the families of our patients. NASPGHAN has justifiably earned the respect and trust of the scientific community and the general public as a reliable and authoritative source of information on childhood digestive, liver and nutritional disorders. Maintenance of this respect and trust is of utmost importance to NASPGHAN. The relationship between physicians and for-profit entities is being increasingly scrutinized. As a result, the reputations of the National Institutes of Health, American Academy of Pediatrics, and the American Medical Association, to name only a few, have been tarnished after financial conflicts of interest became public knowledge. In an effort to protect themselves, professional organizations have turned to the study of ethics for resolution of these issues. NASPGHAN has been proactive in this regard, and in 2004 Dr. Mitchell Cohen, then president of the Society, appointed an Ethics Committee to create policies that will enable us to advance our mission in an ethical manner while maintaining the trust and respect we have worked so hard to achieve. So far, the Committee has created four policies. The first three relate to the activities of our entire membership as they represent NASPGHAN to the general public. The Code of Conduct policy recommends guidelines for behavior by members when acting on behalf of our organization. The Conflict of Interest policy defines mechanisms for disclosing and dealing with instances of conflict of interest and is based on current federal guidelines and new requirements from the Accreditation Council for Graduate Medical Education for accreditation of CME activities. This policy emphasizes that having a conflict of interest is not inherently bad, but failure to disclose and deal with it can lead to perceptions of bias. The policy helps members evaluate and deal with their individual situations so that we as a Society can continue to advance our mission of clinical care and scientific research in as free and unbiased a manner as possible. The Due Process policy provides a framework to address and resolve any allegations of misconduct in a fair manner. These three documents have been approved by the Executive Council and are available for review on the NASPGHAN website. The Ethics Committee will continue to review and suggest modifications of this framework to remain compliant with changing regulations and improve the ability of our organizational committees to function harmoniously. The fourth and most recently approved policy, Ethics in Journalism, provides guidelines for publications endorsed or produced by NASPGHAN. This policy can be divided into two parts. The first part deals with educational materials or publications endorsed by NASPGHAN and clearly mandates that it is the responsibility of the Executive Council to ensure that all such material is scientifically rigorous, socially responsible, ethically defensible and free from commercial bias. The second part of the policy relates to ethical issues governing the editorial leadership of the Journal of Pediatric Gastroenterology and Nutrition (JPGN) and publication of manuscripts therein. The Committee used recommendations from the World Association of Medical Editors and the International Committee of Medical Journal Editors in preparing the policy document. We believe we have been fortunate in the past to have had excellent, fair, and ethical Editors of our journal. Dr. Sondheimer, as current NASPGHAN Editor-in-Chief of JPGN, provided expertise and personal editorial experience for our Committee to devise more specific guidelines for future Editors. The policy is designed to serve as a guarantee that materials published in JPGN meet the highest scientific and ethical standards and are as free as possible of bias introduced by the interests of authors, editors, or financial sponsors. Because the NASPGHAN Editor-in-Chief controls the North American contributions to the journal, it is important to choose an individual who is able to evaluate manuscripts as freely and fairly as possible. Thus, all future applicants must declare any potential conflict of interest that might have an impact on his/her ability to perform the duties of Editor in a fair and impartial manner. Applicants with potential conflicts of interest are required to resolve these prior to assuming the duties of Editor. Associate Editors and the members of the Publications Committee are also held accountable and must declare and resolve any potential conflicts of interest before being appointed. The Ethics Committee is charged with reviewing all conflict of interest disclosures from members of the Publications Committee, and the Publications Committee in turn will review the disclosures from the editorial staff. The Ethics Committee is also charged with reviewing any allegations of ethical misconduct on the part of the editorial staff and reporting their findings to the Executive Council who shall have the final say in the matter. In an attempt to maintain the highest scientific and ethical standards, authors submitting manuscripts will have to declare any pertinent conflicts of interest. It is the responsibility of the Editor-in-Chief to develop a policy for this purpose and revise it from time to time as necessary. The Editor-in-Chief has sole responsibility for deciding whether a disclosed conflict of interest needs to be published with an accepted manuscript or can remain a private matter between the author and the Editor. The policy also creates a mechanism to deal fairly with instances of conflict of interest or professional or ethical misconduct involving published materials. The Ethics in Journalism policy was approved in October 2005 by the Executive Council and is available for review on the NASPGHAN website. The Ethics Committee has been very productive in the past year. It will continue to provide recommendations for our organization to enable us to operate in a fair and ethical manner. The Committee welcomes input from the membership of NASPGHAN. Comments, suggestions or questions about these policies, or any other ethical issue, should be directed either to a member of the Ethics Committee or the Executive Council. Ellen Blank, MD Chair, Ethics Committee Ivor D. Hill, MB, ChB, MD Immediate Past Chair, Ethics Committee