New Code of Conduct Formalizes APA's Relationship With the Pharmaceutical Industry

Caroline Cassels

June 28, 2010

June 28, 2010 — The American Psychiatric Association (APA) has released a new code of conduct (COC) to formalize a number of initiatives the association has already undertaken to better manage potential conflicts of interest with the pharmaceutical and medical equipment industries and other external organizations.

The COC establishes a new board-level Conflict of Interest Committee, which will oversee the APA's relationships with outside organizations and implement the code's standards and principles.

"The new APA code [of conduct] is a living document that establishes a framework to address potential conflicts of interest as they develop," APA Chief Executive Officer and Medical Director James H. Scully, MD, told Medscape Psychiatry.

Although passed by the APA's Board of Trustees April 26, the COC was not publicly released until June 11. This time lag, said Dr. Scully, was due to the need to finalize some of the language.

According to Dr. Scully, the APA recognizes that there is a growing public demand for greater transparency with respect to the medical profession's relationship with industry and that this was the main impetus behind the development of the new code and subsequent creation of the Conflict of Interest Committee.

However, he noted that before adoption of the COC the APA had already taken steps to address the conflict of interest issue. Perhaps most notably, 3 years ago it undertook to reduce and, starting next year, eliminate all industry-sponsored symposia at its annual meeting.

"This process has been under way for some time, but the new code simply formalizes it and helps clarify where we're going," said Dr. Scully.

No Bias

He added that the APA has a long-established process in place with respect to its industry-sponsored activities that included independent review and monitoring of all content to ensure there is no bias.

He pointed out that in 2005 the association received a commendation from the Accreditation Council on Continuing Medical Education (ACCME) for its management of industry-sponsored continuing medical education (CME) programs.

According to Dr. Scully, the APA believes that there is a place for industry support within the association but that there should be a clear line between marketing and educational activities.

The new COC states that "any relationship with an outside organization must foster and aid an aspect or element of the APA mission."

In addition, under the new code:

  • Financial relationships between developers of educational programs and research activities and outside organizations are to be clearly stated;

  • The development by the APA of educational programs, whether or not they provide CME credits, are to follow the ACCME standards for independent and unbiased presentations; and

  • Advertising in APA publications, at meetings, or on Websites does not entail endorsement of any product or manufacturer.

Economic Impact

Dr. Scully estimated that reducing the number of industry-sponsored symposia from its annual meeting cost the APA approximately $2 million in lost revenue in 2009 — an amount that accounts for approximately 3.3% of the APA's annual $60 million budget.

This move, coupled with the overall economic downturn in the United States, which subsequently resulted in significant cuts to drug company advertising budgets, resulted in a total revenue shortfall for the APA of $7.5 million in 2009, said Dr. Scully. In response, the APA had to cut expenses, which included reducing the size of its staff.

It is clear, said Dr. Scully, that the public demand for greater transparency between industry and the medical profession "is not going away" and is an issue that all of medicine — at both the organizational and individual levels — will need to address.

In addition to producing its own COC, the APA will also be considering its potential endorsement of an ethics code governing medical societies' relationship with industry, which was released in April by the Council for Medical Specialty Societies (CMSS).

Because of the timing of its release, said Dr. Scully, the APA has not had an opportunity to consider the CMSS code, but it will be on the agenda at the next APA Board of Trustees meeting in September.

Furthermore, said Dr. Scully, the board will also be considering a report containing proposed recommendations to guide individual psychiatrists' relationships with industry, which were drafted by an 11-member work group led by APA Past-President Paul Appelbaum, MD.

Known as the "Appelbaum report," this same document was rejected by the APA Assembly at its last meeting in late May as previously reported by Medscape Psychiatry. Dr. Scully acknowledged the report has been a contentious issue for the association's membership.

'Process of Enlightenment'

"I attended the assembly meeting and some people objected [to the report] because they felt it was too complicated or objected to its tone or felt it was too restrictive," said Dr. Scully.

However, he added, the fact that the assembly did not recommend the report go to the APA Board of Trustees does not prohibit the board from considering it.

This has been a process of enlightenment, and when you go through this kind of process not everybody is going to be on the same page all the time, and I think that is what is going on at the moment.

"This has been a process of enlightenment, and when you go through this kind of process not everybody is going to be on the same page all the time, and I think that is what is going on at the moment," he said.

Commenting on the board's approval of the COC, Dr. Appelbaum said it represents a "cautious step forward for APA in responding to the potential for conflicts of interest to arise in APA's relationships with industry."

He stated that the principles it outlines are "broad" and "often vague," adding that "the most substantive provision is the requirement that all educational programs abide by ACCME standards, which are designed to insulate educational efforts from industry influence. But much of the rest has been relegated to the new Conflict of Interest Committee, so a great deal will depend on how well they do their job."