“I don’t think it’s practical to think that we shouldn’t [have those relationships] because we are doing a service to patients as we develop new therapies,” Dr. Weselman said. “We as physicians need to remember though that our primary goal and allegiance is to the patient sitting in front of us, and the relationship between the patient and physician has to be at the forefront to do our job the way we need to in order to maintain trust with the patient.”
That may mean not accepting gifts from a company or having any pharma company-based relationships front and center when enrolling patients in clinical trials.
“I think it’s really on us to be aware that these biases occur and not to deny that [they] can be there,” she said.
This area can become challenging when the ACR develops guidelines on medications to use for certain conditions, realizing that experts in the field are needed for guideline development, but also recognizing that they cannot have a team of people conflicted with developing those guidelines.
“The way it stands right now is the [principal investigator] of the guideline or the guideline project must be free of conflicts related to that topic or related to any company that would have a positive or negative stake in the topic. After that, we must have a majority or 51% of the participants must be unconflicted,” she said.
“For the most part, I think we’ve been able to make it work, and we’ve come up with guidelines that are fair. Full disclosure is important for anyone who’s participating in any kind of guideline project. We take disclosure very seriously. But it’s an ongoing issue that we are constantly juggling,” Dr. Weselman said.
Help for Ethical Dilemmas
Dr. Hausmann asked where rheumatologists should turn to if an ethical dilemma arises.
“I can’t tell you how many times I wish there was an ethics policeman I could just call up to tell me the right answer,” Dr. Weselman said.
Short of that, some resources are available.
A literature review on PubMed may provide help. “I’ve been pleasantly surprised at how many articles I can find relating to the principles of ethics and same clinical situations and the best way to make those decisions,” she said.
Some organizations, particularly hospitals that handle end-of-life care, will have a department of ethics.
