Ethical conduct is the cornerstone of any professional organization, particularly when its decisions have an impact on public health. The ACR recognizes the importance of upholding ethical standards and has established a Code of Ethics to guide its members. Here we explore the practical application of the ACR’s Code of Ethics.1
Manage Potential Conflicts
Central to the ACR’s Disclosure Policy is the identification of relationships that pose actual or potential conflicts of interest (COI).1 This policy helps maintain transparency and integrity within the organization’s decision-making processes.
*Scenario: Dr. Smith serves as a committee member tasked with recommending ACR policies related to rheumatology diagnostic imaging technologies. Dr. Smith holds a position within a medical device company specializing in diagnostic imaging equipment.
When the committee convenes, Dr. Smith recognizes the potential for COI. In accordance with the ACR’s COI procedures, Dr. Smith discloses his relationship with the company to the committee. This disclosure allows the committee to assess the potential impact of Dr. Smith’s conflict and take measures to mitigate any undue influence.
As part of the procedure, Dr. Smith abstains from participating in discussions or decisions directly related to policies that could impact the market for diagnostic imaging equipment, ensuring his personal interests do not compromise the integrity of the committee’s recommendations. The committee records Dr. Smith’s abstention using the designated “Record of Abstention During a Meeting,” providing transparent documentation of his adherence to ethical guidelines.
By implementing and adhering to COI procedures, the ACR committee helps safeguard the integrity of its decision-making processes. This not only strengthens the credibility of the organization, but also ensures policies are formulated in the best interest of patients and the broader healthcare community.
Volunteer members and staff should endeavor to avoid both actual COI and the appearance of COI. This policy could have broad implications and different interpretations.1
“Conflicts of interest are circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest,” states Basil Varkey in “Principles of Clinical Ethics and Their Application to Practice,” Medical Principles and Practice.2
Scenario (gifts of food and beverages): Stopping at an elegant booth at ACR Convergence for an espresso or gelato could pose a conflict for ACR volunteer members and staff. It is also common for office staff of clinicians to be offered beverages or food by a pharmaceutical representative. Even if clinicians do not meet a representative nor personally partake in the food, their staff partaking in such gifts could also constitute a COI for them.
Scenario (gifts of drug samples): A more challenging example regards the acceptance of drug samples from pharmaceutical representatives, which is a widespread practice.2 Many patients struggle to obtain their medications due to delays or rejections in the prior authorization process.3 Some patients experience worsening of their rheumatic disease, sometimes having to resort to glucocorticoids while a prolonged appeals process is underway.4 Drug samples can help these patients who cannot otherwise afford the medications. However, the availability of drug samples may be associated with the prescription of brand name drugs when less expensive options are available. Some research also indicates that low-income patients are not the primary recipients of drug samples.4 A counterargument to this is that it is increasingly common for copays and other out-of-pocket expenditures for advanced therapies to be prohibitive for most patients, including those with higher incomes.
The principle of proportionality serves as a valuable tool for assessing COI in this context.3 Is our decision being directed to the most important conflicts? Would our policy and implementation be overly scrupulous and interfere with the conduct of reasonable clinical practice? Notably, the National Academy of Medicine has advocated that clinicians in academic medical centers and teaching hospitals adopt policies that prohibit the use of drug samples except in specified situations for patients who lack financial access to medications.3 Although the ACR Code of Ethics does not prescribe specific recommendations, it encourages practitioners to consider the issue in the context of overarching principles. This enables us to tailor our policies to individual circumstances.
