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Why should ophthalmology, and medicine in general, concern itself with questions surrounding industry-physician relationships?
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Industry dollars have helped ophthalmology
 Kerry D. Solomon |
Considering that we are talking about continuing medical education, the CME guidelines for ophthalmologists need to be in line with the CME guidelines of other subspecialties. A lot of the CME rules are common sense, and a lot of the CME guidelines are not new, but in today’s environment, there is an even greater awareness of the need to be transparent, open and honest.
A lot of the new rules coming about in 2009 are really not new, but hopefully people will look at them in the way they are meant to be: an attempt to improve education because our patients are at the end of all of these activities.
There is no question that we have gotten to where we are today in so many areas of ophthalmology because of a strong working relationship between industry and clinicians. Industry needs the side of clinicians to help further along the development of new devices and pharmaceutical agents. Physicians need industry to commit dollars in the appropriate areas to help with these advances.
Grants from the National Eye Institute and the National Institutes of Health are becoming increasingly more difficult to obtain, and for the last several decades, industry has been effective at helping to develop, promote and foster terrific advances in ophthalmology. From the beginning with phacoemulsification to the implants that we use to the pharmaceutical agents, our procedures today are better than they ever were, and patients have more options and choices.
What is important, though, is to make sure that scientific methodology is maintained, that everyone is honest and ethical about what they’re doing, that there be full disclosure with any potential conflicts, and that any conflicts that occur be appropriately managed.
Kerry D. Solomon, MD, is an OSN Refractive Surgery Section Member.
Medicine is a profession, not a business
 Arnold S. Relman |
Industry should not be involved in any way in medical education, although cooperation with industry may sometimes be appropriate in the area of clinical research. There is a difference between commercial advertising and marketing, which is the legitimate and proper role of industry, and professional education, in which industry should not be involved.
It is long past time for the medical profession to take responsibility for its own education. The ethics of medicine cannot survive in an industrial, commercially controlled marketplace.
Industry-supported education is only necessary if you want to make it an entertainment for the attendees. However, it is perfectly possible to provide CME much less expensively than is now the case, and doctors do have some responsibility to fund their own education.
The Council on Ethical and Judicial Affairs report last year on conflicts of interest was excellent, but unfortunately, the report was referred back by the American Medical Association leadership to the Council. The voluntary regulations of the Accreditation Council for Continuing Medical Education Standards are unenforceable. The Council does not have the resources to enforce the way CME is conducted. Its standards allow medical education companies to be in charge of providing CME, and that is a direct contradiction of the Council’s claim that it wants to separate business from professional education. Clearly, new and stronger standards are needed.
The choices will become stark soon: either physicians will be captured by industry and lose their professional independence, or they will be taken over by government and become government employees. And neither of those scenarios is compatible with an independent medical profession.
Arnold S. Relman, MD, is a professor emeritus of medicine and social medicine, Channing Laboratory, Harvard Medical School and Brigham and Women’s Hospital, Boston.