Council of Medical Specialty Societies issues voluntary code for interactions with companies

The Council of Medical Specialty Societies released a code for medical specialty societies, their members and publications to voluntarily follow regarding appropriate interactions with for-profit companies in the health care sector.

The Council of Medical Specialty Societies (CMSS) said its “Code for Interactions with Companies” is designed to ensure that relationships with companies are independent and transparent, and advance medical care for the benefit of patient care populations. The code is more stringent than the Physician Payment Sunshine Act, which was incorporated into the Patient Protection and Affordable Care Act (PPACA), commonly known as the health care reform act — signed into law by President Obama last month.

Core principles

According to the CMSS, the code includes core principles and detailed guidance on implementation. The principles included in the code and guidance suggestions for each are:

• Conflicts of interest: Develop and publicly post policies and procedures to disclose and manage conflicts of interest among those who participate in society activities — medical meetings, clinical practice guidelines and scientific journals.
• Financial disclosure: Publicly disclose donations and support received from for-profit companies in the health care sector, and disclose board members’ financial and uncompensated relationships with companies.
• Independent program development: Develop and make publicly available policies and procedures that ensure that educational programs, advocacy positions, and research grants are developed independent of industry supporters.
• Independent leadership: Prohibit society leaders (presidents, CEOs, and editors-in-chief of society journals) from having direct financial relationships with relevant for-profit companies in the health care sector.

According to a CMSS press release, it represents 32 medical professional societies with a collective membership of more than 650,000 U.S. physicians.

“Physicians and patients count on medical societies to be authoritative, independent voices in science and medicine,” Allen Lichter, MD,chief executive officer of the American Society of Clinical Oncology, and chair of the CMSS Task Force on Professionalism and Conflict of Interest, stated in the press release. “By adopting this code, societies demonstrate their commitment to the highest level of ethical standards in their activities and to providing the best possible care for patients and populations.”

Physician Payment Sunshine Act

The Physician Payments Sunshine Act of 2009, originally introduced by Sens. Charles Grassley (R-Iowa) and Herb Kohl (D-Wisc.) put the onus of disclosure on industry — requiring device and biologic makers to report payments to doctors to the Department of Health and Human Services. That bill was not passed independently, but included as a provision of the PPACA and is scheduled to go into effect in March 2013.

“Shedding light on industry payments to physicians would be good for the system,” Grassley said when introducing the bill to the Senate. “Transparency fosters accountability, and the public has a right to know about financial relationships.”

Under the Sunshine Act, manufacturers must disclose any “in kind” payments made to physicians or teaching hospitals in the form of: compensation; food, entertainment or gifts; travel; consulting fees; honoraria; research funding or grants; education or conference funding; stocks or stock options; ownership or investment interest; royalties or licenses; charitable contributions; and any other transfer of value as described by the secretary of the Department of Health and Human Services.

“Appropriate” relationships

As of press time, 13 medical societies have adopted the CMSS code, including the American College of Cardiology, the American Academy of Pediatrics and the Accreditation Council for Continuing Medical Education. The full code and the list of signers who have adopted it thus far are available on the CMSS Web site.

“The private sector plays a central role in developing new treatments and medical advances, and medical societies collaborate with industry in many ways that benefit medical practice,” Norman Kahn, MD, executive vice president and chief executive officer of CMSS, stated in the release. “We developed this code to ensure that those relationships are appropriate, and to ensure public confidence in our objectivity and commitment to high-quality care.”

Doesn't this code cross a line? Won't it restrict free speech and thus violate the First Amendment? Aren't the unintended consequences of so doing yet to be known? Ultimately couldn't the patient be harmed? In the past, those in leadership positions were required to make known and acknowledge their various financial relationships when serving on boards or giving presentations. But now, by merely having those relationships, one is to be precluded from participating in certain activities. For example, one will not be able to discuss practice recommendations if 'unmanageable conflicts' are deemed to be present. Instead, such people will only be able to present on general topics such as pathophysiology. It is recommended that another person be added to the program to make the practice recommendations in such cases if the speaker has these 'unmanageable conflicts'. How will such conflicts be defined and by whom? Perhaps the reviewer monitoring the presentation who is 'trained to recognize bias' would make the final decision on that. Thus a presentation could easily require three people whereas in the past one person would do — one person to present, another to present those topics that the first was not allowed to and a third to review and monitor the presentation for bias. Now instead of flying one person in and providing hotel accommodations for him/her, three people may be needed. How much more will this cost and therefore how many less presentations will be made because of this? In the end, less information will be freely flowing to help our patients. Time will tell what other unintended consequences will ultimately occur. The communication and various relationships between physicians and the medical industry have served as a conduit for the development of new drugs and devices. These are valid, necessary and legitimate relationships, which ultimately benefit the most important person — the patient!

– Richard Dolinar, MD
Endocrine Today Editorial Board member

I applaud the formulation, articulation and publication of a code by the CMSS outlining a guide for health care professionals in their interactions with for-profit companies in the health care sector. Overall, I believe that this is good. As health care professionals and providers we must be accountable to the public and to ourselves in all our interactions. This responsibility applies to interactions with patients, colleagues, employers, third-party payers and for-profit health care companies. The CMSS code as articulated embodies the principles we must embrace and utilize. Independence and transparency are the foundation. These two standards will positively guide us in all our interactions – whether it is accepting sponsorships, contributions, grants, trips or trinkets. As an orthopedist, I believe that if all orthopedic surgeons had conducted themselves and their practices according to these principles, we would not have become embroiled in the Department of Justice mess.

– Ramon L. Jimenez, MD
Orthopaedic surgeon, senior consultant, Monterey Peninsula Orthopaedic and Sports Medicine Institute, Monterey, Calif.

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