An 11-member group of researchers, academicians, and leaders of
professional medical associations (PMAs)—including APA Medical Director
James H. Scully Jr., M.D.—have called on those associations to work
toward eliminating pharmaceutical and medical-device industry funding of
educational and other activities.
The group—whose members were invited to participate as individuals,
not as representatives of their organizations—issued a set of remarkably
stringent recommendations involving 10 areas of industry-PMA relations (see
Proposals to Reduce Industry
Dependence). The recommendations appear in an
article "Professional Medical Associations and Their Relationships With
Industry: A Proposal for Controlling Conflicts of Interest" in the April
1 Journal of the American Medical Association.
"The recommendations are rigorous and would require many PMAs to
transform their mode of operation and, perhaps, to forgo valuable
activities," the authors stated in the paper. "To maintain
integrity, sacrifice may be required. Nevertheless, these changes are in the
best interest of the PMAs, the profession, their members, and the larger
The 10 areas addressed include general budget support from industry; annual
conferences and periodic regional meetings; industry funds for research by
PMAs and their members; industry funds for fellowships and training programs;
committees that formulate practice guidelines and outcome measures; industry
support of PMAs' publications; product endorsements; affiliated foundations;
conflicts of interest among PMAs, presidents, officers, and board members; and
guidance for PMA members.
In an interview with Psychiatric News, Scully said the
recommendations are important to maintain public trust and the right of
organized medicine to regulate its own activities.
APA Medical Director James H. Scully Jr., M.D.
"The educational and other programs of medical associations are under
assault," Scully said. "This is a problem area, and the public
trust is critical. Also at risk is our ability to self-regulate. Congress is
looking at this area [of medicine-industry relationships], so if we want to
maintain our ability to self-regulate, we have to make sure we do even more
[to eliminate conflicts of interest and maintain transparency] than we might
have otherwise done."
Most crucial, Scully said, is the need for PMAs to separate medical
education programs from industry funding.
"Probably the most important recommendation is a step that APA has
taken, which is to separate out marketing from medical education," he
said. "It's our mission to make sure our members have the best
information so they can practice the highest-quality medicine. And any
allegation or appearance [that that mission is being compromised by industry
influence] needs to be addressed.
"APA has had very high standards in this regard, and those standards
have even exceeded the rules. But we need to have a heightened awareness of
the perception of conflict of interest and continue to improve."
Just days prior to the appearance of the JAMA article, the APA
Board of Trustees voted to phase out industry-supported symposia along with
industry-supplied meals at its annual meetings (Psychiatric News,
Scully also underscored a recommendation that professional medical
associations not be perceived in any way to be endorsing the products of
pharmaceutical or device-manufacturing companies that may be supporting their
"It is not the business of professional medical societies to be
helping market drugs or devices," Scully said. "We need to be very
clear about that."
He said that the rule applies to practice guidelines that a PMA may
produce. "When we say, 'Use treatment x or y,' it needs to be very clear
that there is no third-party involvement—that it is based on the best
available scientific consensus."
That too goes for diagnostic manuals, such as the new edition of
DSM that APA is currently developing, Scully said.
The JAMA article is the result of a grant by the Pew Foundation to
the Institute on Medicine as a Profession (IMAP) at Columbia University
College of Physicians and Surgeons to look at issues of conflict of interest
and transparency in medicine. The lead author and drafter of the document was
David Rothman, Ph.D., president of IMAP.
In addition to Rothman and Scully, the 11-member panel included Catherine
DeAngelis, M.D., Ph.D., the editor of JAMA; Susan Chimonas, Ph.D., a
research scholar at IMAP; David Wofsy, M.D., a professor of medicine at the
University of California, San Francisco; Walter J. McDonald, M.D., past CEO of
the Council of Medical Specialty Societies; Carol Berkowitz, M.D., past
president of the American Academy of Pediatrics; Ralph Hale, M.D., executive
vice president of the American College of Obstetricians and Gynecologists;
Steven Nissen, M.D., past president of the American College of Cardiology;
June Osborn, M.D., past president of the Josiah Macy Jr. Foundation; and
Gerald E. Thomson, M.D., past president of the American College of
Discussions were held over a two-year period, and several drafts of the
document were reviewed before the final version was published.
The stringency of much of the language is striking—the authors
acknowledged in the paper that the "proposals are likely to generate
controversy and claims that they are too restrictive."
"We will continue to provide our members and others who attend our
meetings the highest quality educational programs with world experts who will
be presenting these without any question that there is any bias," he
said. "We are not going to stop doing educational programs—we are
going to do them better." ▪