Towards Patient-Centered Conflicts of Interest Policy

Peter D Young,Dawei Xie,Harald Schmidt

doi:10.15171/ijhpm.2017.128

Abstract

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians’ medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians’ reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians’ professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices.

Highlights

The importance of disclosing conflicts of interest has been recognized by key international health organizations including the World Medical Association,[1,2] the World Health Organization (WHO),[3] the Council for International Organizations of Medical Sciences,[4] and the Nuffield Council on Bioethics.[5]
US Context In light of a growing concern for conflicts of interests (COIs) in the United States, and in response to the need for more empirical evidence documenting their existence, the US Institutes of Medicine (IOM) released a comprehensive report in 2009 titled Conflict of Interest in Medical Research, Education, and Practice, which found among other things that a physician who has a financial relationship with a third party company, may be influenced to prescribe that company’s medicine even when other therapies are indicated to be more beneficial.[17]
COIs risk undercutting the principle of informed consent with the potential to harm patients physically, psychologically, and financially

Summary

Introduction

The importance of disclosing conflicts of interest has been recognized by key international health organizations including the World Medical Association,[1,2] the World Health Organization (WHO),[3] the Council for International Organizations of Medical Sciences,[4] and the Nuffield Council on Bioethics.[5] Despite international agreement on the need for transparency from leading policy organizations, conflicts of interests (COIs) are still problematic world-wide.[6,7,8,9,10,11] To help document interactions between physicians and industry, the United States,[12] Japan,[13] Australia,[14] France,[15] and more than 30 European countries represented by the European Federation of Pharmaceutical Industries and Associations (EFPIA)[16] implemented public databases detailing financial interactions between physicians and industry While this trend of public disclosure is gaining precedence within wealthier countries, similar public databases could become useful in low- and middle-income countries in an effort to strive toward a higher standard of good governance. Patients can search the OPP for individual physicians and view their total annual payments, as well as 16 payment subcategories, including consulting and speaking fees, honoraria, gifts, entertainment, food and beverage, travel and

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