Rareful readers of P&T know that I have tackled the issue of the relationship between academic medicine and the pharmaceutical industry before. Although my editorial, “Seeking Middle Ground” (P&T, February 2004), laid the framework for this relationship, it did not offer specific guidance. I hope to accomplish aspects of that mission in this editorial.
Allow me to draw on work that was performed at my institution, Jefferson Medical College (JMC), by a special subcommittee appointed by the Dean. The subcommittee was charged with the goal of creating guidelines regarding our relationships between JMC faculty members and representatives from pharmaceutical companies and from industries that manufacture medical devices. We worked hard in this subcommittee to lay out some specific principles, which I will now highlight.
JMC is committed to following the guidelines of the Accreditation Council for Continuing Medical Education (ACCME) as closely as possible. We agree that no JMC faculty member can accept money, including honoraria, directly from any industry representative or activity. We further affirm that JMC controls all content and the selection of speakers, and we reserve the right to place restrictions on advertising, meals, and entertainment associated with activities on our campus.
The JMC faculty has reinforced the policy that even outsiders conducting Continuing Medical Education (CME) activities on our campus must go through our official CME office and must meet all relevant requirements.
Regarding detailing to any JMC faculty member, we have stipulated that all clinical departments must have a defined policy that addresses the location, time, appointment guidelines, and acceptance for the handling of samples from industry salespeople. We specifically prohibit any remuneration by companies in exchange for permission to conduct detailing activities.
We also further prohibit any “shadowing” of physicians by pharmaceutical sales representatives. We require that any industry representative entering patient-care areas must do so with the written approval of department leaders. canadian antibiotics
One particular activity that has been troublesome for us—and I am sure for many of our readers—is the so-called industry training program. Sometimes these programs have not been conducted within appropriate guidelines. To ensure that our working relationship will be preserved in the future, we now require that training programs for industry representatives meet a standard university contract.
We believe that compensation for the university must be at a fair market rate. No patient health information should be disclosed. Patients participating in training programs must give their written consent, and the signature of the pharmaceutical representative must be obtained as well. Any payment from these training programs must go to the department chairperson, who may then disperse funds to faculty members from the department— not from industry.
Finally, many of the same rules will be applied to the medical device manufacturers. For example, departments must have a written approval process in place that allows representatives from these companies to participate in any activities on JMC’s campus. Representatives must sign a confidentiality agreement; any payment to university faculty members is strictly prohibited.
Our committee even went so far as to create boilerplate documents outlining specific requirements for relationships between departments and representatives and developed patient consent forms for participating in representative training programs. Under appropriate circumstances, I would be happy to share these forms with P&T’s readers.
I think we all know that preserving the moral high ground in our ongoing relationships with our colleagues from industry is critically important. Guidance for these relationships must be made explicit and must be easy to implement. I hope that the work of our committee will live on as others around the nation adopt aspects of our activities together.