Managing Conflicts of Interest

Most hospitals have policies inplace that outline organizationalexpectations withrespect to accepting gifts from externalorganizations, which could potentiallycreate a conflict of interest for thosemaking decisions regarding contractawards, pharmaceutical prescribing, formularymanagement, and other activities.Similarly, most Pharmacy and Therapeutic(P&T) Committees have proceduresin place that require votingmembers to declare potential conflicts ofinterest in an effort to ensure objectivityand fairness during deliberations andvoting. At University of NorthCarolina Hospitals and Clinics,potential conflicts of interestof members are listed oneach P&T Committee agenda,and visitors are expected todeclare any potential conflictsat the beginning of the discussion.Over the years, I havebeen impressed by thisprocess, and lately it wouldappear that declared conflictsof guests are very carefullyconsidered (and sometimes even discussed)as the committee sits in executivesession to vote on the proposed formularyissue being considered. One realizes,however, that the effectiveness ofthis process relies on self-reportingpotential conflicts.

In early August, Sen Charles Grassley(R, Iowa), ranking Republican on theSenate Finance Committee, announcedthat he will propose legislation requiringdrug makers to disclose payments thatthey make to prescribers forservices provided, includingconsulting, giving presentations,or attendance at seminars.Senator Grassley alsoannounced that he and hisstaff had begun an investigationinto these practices. Todate, payment for researchrelatedservices has not beenincluded in comments fromSenator Grassley. He and severalother legislators aspire tocreate a federal registry ofsuch payments similar tothose registries in Maine,Vermont, and Minnesota. Heand others are concernedthat even when paymentsare disclosed to hospitals anduniversities, they depend on self-reporting.In addition, most employersdo not share the informationwith patients. SenatorGrassley?s interest wasapparently piqued by aprominent psychiatrist whoreceived $180,000 over 2years from a manufacturer ofan antipsychotic drug nowwidely prescribed to children.

Some drug manufacturershave expressed opposition tosuch registries because thepublic may construe payments as bribesand because the education doctorsreceive at seminars may not be readilyavailable in the future. It should be notedthat on May 1, 2007, Eli Lilly & Co issueda press release announcing that it willpublish information on grants and contributions.

I have no idea how much physiciansare being compensated for their servicesto drug companies. I admit a morbidcuriosity to learn the data, but I am skepticalthat, even as a presumably welleducatedpatient, it would affect my relationshipwith my physician. I see littleharm, however, in a federal registry towhich hospitals, health systems, andpayers have access that contains accuratepayment information. Such a systemmight help physicians decide whether toparticipate in some activities consideredquestionable by others if they knew colleagues,payers, and institutions werereviewing the information.

Now for the clincher. If such a systemwere approved, shouldn?t pharmacistsbe included in the reporting requirements?What do you think?