COMMENTARY

Response to AMA's Council on Ethical and Judicial Affairs Draft Report on "Ethical Guidance for Physicians and the Profession With Respect to Industry Support for Professional Education in Medicine"

Thomas P. Stossel, MD

Disclosures

June 12, 2008

Introduction

In late May, the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA) released a draft report (henceforth "The Report") to provide "ethical guidance for physicians and the profession with respect to industry support for professional education in medicine.[1]" The report concluded that because "industry support of professional education has raised concerns that threaten the integrity of medicine's educational function....individual physicians and institutions of medicine...must not accept industry funding to support professional educational activities.[1]"

Enactment of these regulations will have profound practical consequences for medical education, and stakeholders concerned about these effects should address them in detail. My intention here, however, is to challenge the fundamental beliefs underlying The Report that transcend medical education to affect medical practice and medical research in general. These beliefs are that commerce in general is detrimental to medical professionalism and that "medicine" and "commerce" have sufficiently misaligned interests to justifying their segregation from one another. Such segregation is increasingly becoming policy in academic medical centers in the form of severe prophylactic laws impinging on physicians' freedom of association and action, and similar rules are under consideration in state legislatures and in the Congress.

An article by Brennan and colleagues[2] in JAMA, and prominently cited by The Report, frames the basis of the CEJA's Report and of emerging academic health center regulations. This article has been the most influential example of a burgeoning literature emerging in the late 1980s declaring any situation involving healthcare providers receiving payment in money or kind from private companies a "conflict of interest." The Brennan article broke new ground not only in the severity of its anticommercial sentiments, but also in its insistence that disclosure of financial conflicts of interest is insufficient to control their adverse effects and that therefore these conflicts must be eliminated. The eliminative mechanisms recommended were to channel all corporate support for research and education through academic health center administrations to allocate at their discretion and to curtail at such centers all corporate detailing, gifting, and provision to physicians of product samples. The Report reiterates this reasoning and goes beyond Brennan and colleagues' recommendations to demand eradication of corporate support for all medical education.

I first show that Brennan and colleagues and the derivative Report failed to place their "concerns" in terms of a balanced risk-benefit assessment, and that such an analysis does not support their assumptions or the recommendations. I then argue that Brennan and colleagues and The Report based their conclusions on an arbitrary, obsolete, and frankly untenable definition of professionalism.

 


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