Ethicists discuss ties between HCWs, pharma

Professionals can become biased, distracted

Conflicts of interest created when health care professionals form ties with the pharmaceutical industry are a mixed bag, according to experts from the Veterans Health Administration’s (VHA) National Center for Ethics in Health Care.

On one hand, physicians who accept compensation from pharmaceutical companies might be unduly biased toward those companies; they might not be influenced, but because their patients and peers know of the relationships, their reputations might be adversely affected.

On the other hand, consulting or serving as a speakers’ bureau member for a pharma company can allow health care professionals to bring new insight and breadth to their work, benefiting their patients and their institutions, according to Michael Cantor, MD, JD, chair of the National Ethics Committee (NEC) and clinical director of the geriatric research, education, and clinical center at the VA Boston Health Care System. (The NEC is responsible for analyzing and reporting on health care ethics topics that relate to the VHA.)

Cantor was one expert who participated in a teleconference on the National Ethics Committee report "Compensation to Health Care Professionals from the Pharmaceutical Industry," an examination of the ethical implications of gifts to individual health care professionals from pharmaceutical companies, and how institutions and physicians should address those concerns.

The NEC report examines relationships between health care professionals and the pharma industry in which the medical professionals are compensated for services, such as consulting and speaking, and how those relationships might compromise objectivity, integrity, and patient and peer relationships.

However, says Ken Berkowitz, MD, FCCP, chief of the ethics consultation service at the VHA’s Center for Ethics in Health Care, conflicts posed by relationships between the pharmaceutical industry and health care professionals "is not a problem that is unique to VA."

"If I remember the data correctly, I think either two-thirds or three-fourths of all CME [continuing medical education] in the country is pharmaceutical-sponsored, which is a staggering statistic when you think about what we really want from our education," Berkowitz said in the Feb. 28 teleconference. (A transcript of the conference is available at www1.va.gov/vhaethics/download/Transcripts/NET2-28-06.doc.)

Of concern are not just arrangements that yield large amounts of money or other valuable compensation for the professional; the report indicates that objectivity and judgment are affected no matter how much — or little — money is involved.

Cantor says the ethical problems reach beyond loss of objectivity. Diverting more time to secondary, pharma-sponsored activities can alter the professional’s priorities and loyalties, he suggests.

The NEC report does not address compensation relating to research or clinical trials; those areas are the subject of a report being prepared by VHA researchers for future release.

The NEC report is available at www1.va.gov/vhaethics/download/reports/Compensation_2006.pdf.

For more information on the VHA National Center for Ethics in Health Care, e-mail vhaethics@hq.med.va.gov.