At its founding in 1847, members of the fledgling AMA revolutionized medicine through unanimous adoption of the world’s first national code of professional medical ethics.
Today, the AMA has three ethical opinions that emphasize the need for independence, transparency and accountability in continuing medical education (CME) and in interactions with the medical drug/device industry.
- Opinion 9.011: Continuing Medical Education
- Opinion 9.0115: Financial Relationships with Industry in CME
- Opinion 8.061: Gifts to Physicians from Industry
In addition, the AMA’s popular Virtual Mentor online ethics journal serves as a guidepost for medical students, residents and fellows (and their academic physician mentors) seeking to explore the many ethical challenges in modern medical education and practice.
The changing environment of physician-industry interactions
The three opinions listed above have been adopted or updated since 2011. As noted in a Council on Ethical and Judicial Affairs’ report, “Medicine-industry relationships have evolved significantly since E-8.061 was last updated in 1998 and so has public and professional unease about the possibility that gift relationships between physicians and pharmaceutical, medical device and equipment, and biotechnology companies will have inappropriate effects.”
Indeed, today there is increased scrutiny and oversight of physicians’ relationships with the medical drug/device industry, as embodied in the federal Physician Payments Sunshine Act, also known as “Open Payments,” which took effect in August. (A similar initiative now is underway in the European Union.)
The AMA has developed an online toolkit to help physicians navigate the parameters of the act and its reporting requirements. The AMA also is continuing to monitor the act’s implementation to ensure that it is not unduly onerous to physicians and does not inadvertently undermine quality-of-care efforts.
This legislation has had an impact not only on physicians but on the medical industry as well, as reported in The New York Times: GlaxoSmithKline is phasing out its practice of paying physicians to speak about its products or about diseases targeted by drugs the company manufactures. Also, the firm will no longer pay doctors to attend medical conferences.
At the same time, a recent study in the Journal of the American Medical Association raises concerns about medical communication companies and their role in CME. An accompanying editorial asks whether such companies are “clouding the sunshine,” and states, “Continuing medical education that is tainted by promotion is marketing masked as education.”
Guiding academic physicians, medical students on ethical issues
In addition to ensuring high ethical standards in industry support of CME, the AMA also is working to ensure that medical students are made aware of the Sunshine Act and its implications for their future practice.
Further, AMA policy encourages all medical school faculty to “model professional behavior to students by disclosing the existence of financial ties with industry, in accordance with existing disclosure policies at each respective medical school.” A new report from the Pew Charitable Trusts provides guidance to academic medical centers in this regard; it contains 15 recommendations intended to protect the integrity of education and training and the practice of medicine within the academic medical center while not impeding research and scientific inquiry.
The AMA has been a pioneer in turning physicians’ attention to the ethical concerns posed by gifts from industry. Today, it remains proactive in addressing these concerns and ensuring that ethics, not external regulation, is the bedrock upon which physician professionalism is built.
