Recognizing that situations involving ties with the pharmaceutical industry and conflicts of interest are often not black and white, the ACR’s Committee on Ethics and Conflict of Interest has collected feedback on four ethically challenging scenarios to gauge how rheumatology providers think about them.
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The survey generated responses that were often mixed, showing that when it comes to the most difficult questions regarding conflicts of interest, rheumatology providers are often not on the same page. The survey results offer a window into the challenge of trying to come to clear conclusions about the course of action that is proper in situations when industry connections and patient care predictably become intertwined.
The committee decided to start working on the feedback before recent news events propelled questions about conflict of interest in the medical field into the spotlight. But it comes as examination of the topic by the public intensifies. In September 2018, the chief medical officer for Memorial Sloan Kettering Cancer Center resigned after reports that he didn’t disclose financial stakes in the outcomes of studies he published. Other questions about conflicts of interest at the center have also surfaced, and the center has since made changes to its policy.
Jane Kang, MD, MS, chair of the ACR’s Ethics & Conflict of Interest Committee, says the ACR thinks about conflict of interest in an ongoing way, and the survey wasn’t a reaction to news events.
“It helps everyone rethink conflict of interest again,” says Dr. Kang, associate professor of medicine at Columbia University Irving Medical Center, New York. “The ACR was already thinking about various conflict of interest considerations. The combination of real-world events and managing conflicts of interest for the ACR inspired us to explore it further.”
‘The major threat is losing the public’s trust. If the public doesn’t trust physicians, we won’t be able to do what we need to do to help patients.’ —Dr. Kang
In the survey, the committee presented 2018 ACR/ARHP Annual Meeting attendees with four situations, each with four statements in response to the situations. Attendees were asked to pick the statement they most agree with. For three of the four situations, three of the statements received percentages of votes that were within about 20 points of one another, indicating an interesting divide in viewpoints. A statement was chosen by a majority of respondents for just one of the proposed scenarios. The survey emphasized that there were “no right or wrong answers.”
The scenarios were chosen after members of the Ethics Committee submitted a case and a question. Dr. Kang, who has training with survey research, found most of the scenarios fit into one of four buckets and chose a question to represent each of those areas. She then edited the cases and answers so the wording was appropriate for generating useful results.