Inspired by the AAN and other organizations that developed conflict-of-interest policies at their own initiative, the Council of Medical Specialty Societies (CMSS) has approved a code to guide medical specialty societies on how to interact with for-profit companies.
The code, which is voluntary, has been adopted by the AAN and 14 other societies since it was released in April. CMSS represents 32 medical societies, and many of its other members are expected to sign on later this year.
The CMSS Code for Interactions with Companies is the latest of a growing number of conflict-of-interest codes designed to stop the taint that money has brought to some medical situations.
“This is significant because it is the first time that all of the specialty medical societies have adopted anything similar to this,” said Murray Sagsveen, the Academy's general counsel.
The AAN developed its own “Principles Governing AAN Relationships with External Sources of Support” in 2004, so many tenets of the CMSS code were already in practice.
One provision of the CMSS code that is not addressed in the AAN Principles applies to “key society leaders,” defined as the president, president-elect, immediate past president, as well as the CEO and editors-in-chief of journals.
The rule: No key society leader… may have direct financial relationships with companies during his or her term of service.
“Direct financial relationships create a fiduciary responsibility to the company,” said Norman B. Kahn Jr., MD, CMSS' executive vice president and CEO. “The group (drafting the code) felt that they did not want any confusion about who the key leader spoke for so it asked the key leaders to relinquish direct financial relationships.”
That provision was the most controversial point during the code-development process, Dr. Kahn said. And that provision of the new code that will require the Academy to change the process for choosing new leaders.
“As we go through the election cycle coming up next year, that will be an obvious consideration in the nomination and election process,” Sagsveen said.
While some potential candidates may opt out of leadership opportunities because they have direct financial relationships with industry, he thinks the Academy's “bench strength” will serve it well.
“It may be that one or two people may decide not to seek elective office, but there's such a pool of great leadership in the Academy that I think it will not have a detrimental effect,” he said.
HISTORY OF THE CODE
The CMSS code was developed partly in response to a 2009 Institute of Medicine report entitled “Conflict of Interest in Medical Research, Education and Practice.” That report called on professional societies, along with academic medical centers, journals and other entities engaged in health research, education, clinical care, and development of practice guidelines to establish or strengthen conflict-of-interest policies.
“Dr. Kahn said the IOM's call to action came after CMSS leaders had already begun working on a conflict-of-interest policy and, just a year later, the document was complete. Both Sagsveen and Academy CEO Catherine M. Rydell helped draft the CMSS code.
It follows the publication of other codes designed to regain the public's confidence in the health care industry. Those include the Advanced Medical Technology Association (AdvaMed) Code of Ethics on Interactions with Health Care Professionals, which governs the medical device industry, the Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Healthcare Professionals, and the Accreditation Council for Continuing Medical Education's Standards for Commercial Support.
“When you add up the PhRMA code, the AdvaMed code and the AACME guidelines with the CMSS code, there is very significant self-policing in the medical community, which doesn't get the attention that one bad egg does,” Sagsveen said.
By definition, conflict-of-interest codes are designed to help prevent undue influence from financial relationships and, thus, limit some types of financial support.
For example, specialty societies will no longer be able to accept corporate support to develop clinical practice guidelines, which are expensive to develop. But Dr. Kahn said a majority of the societies that belong to CMSS have already cut such ties with for-profit companies.
“In reality, a majority of the societies have already recognized that accepting commercial support for guideline development creates a conflict of interest,” he said. “So, to a great degree we are codifying behaviors that societies have already recognized as important in managing the potential for conflict of interest.”
In the Academy's case, the adoption of the conflict of interest principles in 2004 formalized the Academy's practice of not accepting industry support for the board of directors and standing committees, as well as the development of clinical practice guidelines.
“There have been financial ramifications, but we have attempted to generate other non-dues revenue to compensate for it,” Sagsveen said. “The Academy was ahead of the game on this issue, and the board just decided we can't have even the perception that industry is influencing the board, the committees, the clinical practice guidelines or the journal.”
THE CMSS CODE: IN SUMMARY
In addition to prohibiting a medical society's top leaders from maintaining direct financial relationships with for-profit companies, the code requires the Academy and other medical societies to:
- Develop procedures to disclose and manage conflicts of interest among those who participate in medical meetings, the development of clinical practice guidelines, and the publication of scientific journals.
- Disclose financial support received from for-profit companies in the health sector.
- Disclose the financial and uncompensated relationships that board members have with companies.
- Ensure that educational programs, advocacy positions, and research grants are developed independent of industry supporters.
The full text of the 25-page Code for Interactions with Companies can be found at http://tinyurl.com/243wohe.