Recently in Conflict of Interest Category

Please don't hold the Mayo
Peter Pitts
One of the more interesting subtexts surrounding King James' move to Miami is the negative economic impact it will have on the economy of Cleveland specifically and the Ohio in general. 

A similar subtext (albeit one that has been entirely ignored) is the negative economic impact the State of Michigan will experience following the University of Michigan's recent announcement that it will ban any industry-sponsored CME.

The Fighting Wolverines currently receive about $1,000,000 in such services.  And in cash-strapped Michigan that ain't chump change when libraries are being shuttered and teachers are losing their jobs.

And for what larger purpose?  The U-M's intent in banning industry funding for CME is "to dispel the risk or appearance of conflict of interest."

It will also result in less CME for the university systems physicians. The school expects the number of CME courses to decline "somewhat" as a result of the new policy.
 
(According to the ACCME, the university produced 499 separate CME activities last year, reaching more than 130,000 physicians.)

"Somewhat" less CME is not acceptable.  Does the university expect the taxpayers of Michigan to make up the difference - so that they can exult in their political correctness?

Since healthcare reform is about lowering costs, how will similar moves by other large public universities (motivated not by public health but by "perceived conflicts") be justified?

Speaking of Cleveland, in the January 2010 issue of Academic Medicine (Acad Med. 2010; 85:80-84.), four researchers from the Cleveland Clinic published a paper entitled, "The Effect of Industry Support on Participants of Bias in Continuing Medical Education."

The purpose of the study: "To obtain prospective evidence of whether industry support of continuing medical education (CME) affects perceptions of commercial bias in CME activities."

The method: "The authors analyzed information from the CME activity database (346 CME activities of numerous types; 95,429 participants in 2007) of a large, multispecialty academic medical center to determine whether a relationship existed among the degree of perceived bias, the type of CME activity, and the presence or absence of commercial support."

The study's conclusion: "This large, prospective analysis found no evidence that commercial support results in perceived bias in CME activities. Bias level seem quite low for all types of CME activities and is not significantly higher when commercial support is present."

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have adopted a new policy regarding the disclosure of conflicts of interest.

Here's the key paragraph:

"There is no inherent conflict of interest in the working relationships of physicians with industry and government.  Rather, there is a commonality of interest that is healthy, desirable, and beneficial.  The collaborative relationship among physicians, government, and industry has resulted in many medical advancements and improved health outcomes."

What a unique perspective -- a "commonality" rather than a "conflict" of interest.

We should all pay attention to our nomenclature.  It's not really about "conflict of interest" - it's about (as Secretary Sebelius correctly says) "interest."  And having an "interest" is not necessarily a bad thing - as long as you're transparent about it.

When it comes to CME and "interest," we need to weigh interest versus benefit. And, as with drugs and devices, we must consider the "safe use" of industry-sponsored CME.

"The best interest of the patient is the only interest to be considered."
-- William Mayo, MD

Comments are welcome and encouraged.