In a special communication published in the April 1, 2009, issue of the Journal of the American Medical Association, physician leaders called on professional medical associations to sever most of their ties with drug with and device companies.

In the article, "Professional Medical Associations and Their Relationships with Industry: A Proposal for Controlling Conflict of Interest," the authors say that because medical associations have wide-ranging influence over healthcare policy, they must implement uniform and stringent procedures to ensure their scientific integrity.

The article was written by lead author David J. Rothman, PhD, president, Institute of Medicine As a Profession; and Bernard Schoenberg Professor of Social Medicine, College of Physicians and Surgeons, Columbia University, New York; along with 10 co-authors. The work was funded by The Pew Charitable Trusts.

The authors acknowledge that their recommendations would require associations to completely transform how they operate and "perhaps even give up activities of considerable value." Nevertheless, at this critical juncture, when the ties between pharmaceutical companies and healthcare organizations have come under increased media and government scrutiny, professional medical associations "cannot allow relationships with industry to diminish the public's trust," the writers state.

Medical societies should work toward a complete ban of pharmaceutical and medical device industry funding except for income from journal advertising and exhibit hall fees, the authors propose. Since societies cannot achieve this goal overnight, they should adopt interim policies, the authors suggest, such as creating a central repository for drug industry funding, which would allow the association the freedom to use the money as it sees fit. Professional medical associations should also immediately restrict total industry support so that it accounts for no more than 25 percent of their operating budget.

The article offers 10 recommendations for reducing or eliminating conflicts of interest, including some that involve continuing medical education and healthcare meetings.

CME programs need safeguards in addition to those established by the Accreditation Council for Continuing Medical Education, the authors say. Pharmaceutical industry funding for CME should not be targeted for specific activities, but funneled into a central pool. A CME committee whose members are free of all industry ties should be responsible for distributing the funds and selecting program topics and faculty. The article also suggests associations seek alternative funding from independent foundations and organizations such as the National Institutes of Health, and consider raising registration fees.

To distance themselves from pharmaceutical marketing activities, medical associations should not distribute items such as tote bags or lanyards with company logos to their members at annual meetings, and should ban all gifts and food in the exhibit hall, say the authors.

In addition, medical associations should prohibit pharmaceutical companies from holding satellite symposia in conjunction with their annual meetings. Associations should not endorse, facilitate, or accept funding for the symposia; offer conference space to companies; nor assist companies in marketing symposia by sharing attendees' names and addresses. Companies that violate the rules could be banned from exhibiting at future meetings, the article proposes.

Other recommendations involve industry-supported research, fellowships and training programs, and publications. The authors also recommend a ban on medical association product endorsements, and offer conflict-of-interest guidelines for medical association officers, board members, and committee members involved in formulating practice guidelines and developing outcome measures.

The article garnered a favorable reaction from Sen. Chuck Grassley (R-Iowa), ranking member, Senate Committee on Finance. “These recommendations carry a lot of weight and represent a desire to build confidence and take away questions raised by financial ties,” responded Grassley in a statement issued on April 1. “I’ll continue my effort to bring about full disclosure of money from industry to physicians. Letting the sun shine in creates an atmosphere for greater accountability, and that’s good for everyone in the medical profession and the patients who rely on their care.” Grassley is the co-sponsor of the Physician Payments Sunshine Act of 2009, which would require drug and device companies to publicly report payments to doctors. As we reported in "CME in the Cross Hairs," (June 2007) Grassley also spearheaded an investigation into pharmaceutical company influence over CME.

Not surprisingly, the JAMA article sparked concern and debate in the medical meetings and continuing medical education communities. In a statement released April 2, IEG, a sponsorship consulting company based in Chicago, said the JAMA recommendations “are akin to separating boys and girls on a school bus to prevent teen pregnancy. Damning the many to discourage the few, [the article] fails to address the complex issues underlying their concerns. Indeed, this approach could just as easily send the true offenders further into the shadows to find ways to game the system. All the while, those building the right kinds of relationships will be stifled from doing meaningful work, thereby hurting the patient population we all wish to serve.” IEG details its own recommendations for addressing conflict of interest in the white paper “Focusing on Responsibility: Reframing the Healthcare Industry’s Marketing Relationships,” available at, IEG’s Web site.

Some medical societies have already implemented some of the changes proposed in the JAMA piece, or are considering them. At the American Association of Neurological Surgeons, Rolling Meadows, Ill., Joni L. Shulman, associate executive director, has been asked to analyze where AANS stands in relation to the 10 recommendations outlined in the article, and what would be involved if AANS decided to implement them.

In addition to complying with all ACCME criteria, the American Epilepsy Society, West Hartford, Conn., has created a board-level compliance committee to develop an organization-wide policy on all industry relationships, says Jeffrey D. Melin, MEd, CMP, director of education. "We no longer hold satellite symposia, and coincidentally our 2009-2010 annual meeting budget is already projecting industry sponsorship and educational grant support at the 25 percent level advocated for in the JAMA article," he says.