One scenario dealt with an issue addressed recently in published literature: conflicts of interest and clinical practice guidelines. In the scenario, a physician organization has decided to write a guideline for a new immunologic disease. Disclosure statements showed that 20% of the guideline group recently participated in an industry-funded trial involving the disease, and 20% received consulting fees from the leading manufacturer of a treatment for the disease.
Meeting attendees were asked which statement they most agree with: 1) All of the current members can stay on the guideline group; 2) members who have industry ties should be excluded from the guideline group; 3) the members who received the consulting fees from the leading manufacturer of a treatment for the new immunologic disease should be excluded from the guideline group; or 4) the members who recently participated in industry-funded trials for the new immunologic disease should be excluded from the guideline group.
The most common choice was No. 3, with 38.98% of responses, but choice No. 2, with its tighter restriction, was a close second (33.9%). About 24% said all the current members could stay on the guideline group.
In another scenario, a 46-year-old woman was recently diagnosed with seropositive rheumatoid arthritis (RA) and is on 15 mg of prednisone a day. Her rheumatologist is in private practice with an infusion center and has participated in industry-funded trials for a new intravenous (IV) biologic medication that is now FDA approved for RA. The doctor discussed the options with the patient, and the patient received the new IV biologic.
Attendees were asked what they thought was the most likely reason the patient received the new IV biologic medication: 1) the rheumatologist believes IV medications may work better than oral or subcutaneous medications; 2) the rheumatologist believes the new IV biologic medication is superior to other options; 3) the rheumatologist has a financial relationship with the company that makes the new IV biologic medication; or 4) the rheumatologist prefers IV medication because it will be more profitable.
About 40% chose No. 2, and about 9% chose No. 1—meaning that about 49% assigned a primarily medical motive to the physician. But about 30% chose No. 4, and about 21% chose No. 3—meaning about 51% assigned a primarily monetary motive to the physician.
On how to handle a situation in which a pharmaceutical representative offers to provide educational materials for a fellowship program that has had its funding decreased, about 40% said the fellows should be able to receive the materials through the program director. But about 31% said the best choice was for the university to provide more funding.
