Managing Conflicts of Interest

SEPTEMBER 01, 2007
James C. McAllister III, MS, FASHP

Most hospitals have policies in place that outline organizational expectations with respect to accepting gifts from external organizations, which could potentially create a conflict of interest for those making decisions regarding contract awards, pharmaceutical prescribing, formulary management, and other activities. Similarly, most Pharmacy and Therapeutic (P&T) Committees have procedures in place that require voting members to declare potential conflicts of interest in an effort to ensure objectivity and fairness during deliberations and voting. At University of North Carolina Hospitals and Clinics, potential conflicts of interest of members are listed on each P&T Committee agenda, and visitors are expected to declare any potential conflicts at the beginning of the discussion. Over the years, I have been impressed by this process, and lately it would appear that declared conflicts of guests are very carefully considered (and sometimes even discussed) as the committee sits in executive session to vote on the proposed formulary issue being considered. One realizes, however, that the effectiveness of this process relies on self-reporting potential conflicts.

In early August, Sen Charles Grassley (R, Iowa), ranking Republican on the Senate Finance Committee, announced that he will propose legislation requiring drug makers to disclose payments that they make to prescribers for services provided, including consulting, giving presentations, or attendance at seminars. Senator Grassley also announced that he and his staff had begun an investigation into these practices. To date, payment for researchrelated services has not been included in comments from Senator Grassley. He and several other legislators aspire to create a federal registry of such payments similar to those registries in Maine, Vermont, and Minnesota. He and others are concerned that even when payments are disclosed to hospitals and universities, they depend on self-reporting. In addition, most employers do not share the information with patients. Senator Grassley?s interest was apparently piqued by a prominent psychiatrist who received $180,000 over 2 years from a manufacturer of an antipsychotic drug now widely prescribed to children.

Some drug manufacturers have expressed opposition to such registries because the public may construe payments as bribes and because the education doctors receive at seminars may not be readily available in the future. It should be noted that on May 1, 2007, Eli Lilly & Co issued a press release announcing that it will publish information on grants and contributions.

I have no idea how much physicians are being compensated for their services to drug companies. I admit a morbid curiosity to learn the data, but I am skeptical that, even as a presumably welleducated patient, it would affect my relationship with my physician. I see little harm, however, in a federal registry to which hospitals, health systems, and payers have access that contains accurate payment information. Such a system might help physicians decide whether to participate in some activities considered questionable by others if they knew colleagues, payers, and institutions were reviewing the information.

Now for the clincher. If such a system were approved, shouldn?t pharmacists be included in the reporting requirements? What do you think?

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