Personal relationships, conflict of interest and ethics

The Pittsburgh-Tribune Review reported recently on The University of Pittsburgh Medical Center’s April 1st ban on the delivery of drug samples to physicians and and offices by drug reps.

Here is the story from the Pittsburgh-Tribune Review: UPMC to stop reps’ delivery of drug samples

The policy is meant to eliminate perceived or actual conflicts of interest between UPMC providers and drug companies. UPMC banned gifts and meals to hospital personnel by health care companies more than a year ago.

“There is a concern that personal relationships can influence decision-making,” said Dr. Barbara E. Barnes, associate vice chancellor of the University of Pittsburgh.

A computerized system run by a private firm, MedManage Systems, will replace sales reps’ visits. It allows doctors to order samples that would be shipped to physicians’ offices.

So, to be clear, this isn’t about the ethics of providing free drug samples. Nor is it about drug swag or free lunches. This is about relationships between people, specifically drug reps and physicians. In this context, the term “relationship” doesn’t have to imply a friendship or a sexual relationship. It merely refers to the establishment of an ongoing connection. The Pittsburgh ban doesn’t end the actual delivery of drug samples and vouchers to physicians’ offices. Nor does it end the delivery of information about the drugs to physicians’ offices. It only ends the personal delivery of any of this by drug reps.

Drug reps are, from my own clinical experience, usually very smart, young professionals who not only know a lot about the drugs and products that they are promoting, but probably a heck of a lot about human interaction, how to connect effectively with people and most of all, how to sell their products. They work hard at developing good relationships with physicians and their office staff and promote the product that they represent, through personal interaction, free samples and a high level of friendly service.

So what’s the point here and where is the connection to research ethics? Well, clearly, in all contexts, relationships matter. Relationships between people are an obvious source of conflict of interest. While often the source of conflicts of interest in research lies in personal gain — for example, a researcher who stands to make a profit from the research or get an academic promotion — the source could instead be a personal relationship and how that relationship and the obligations implied by such a relationship might alter the researcher’s ability to make a sound decision in a professional context.

In the present case, The University of Pittsburgh Medical Center’s ban on drug reps implies concern about the effect of personal relationships on prescribing practices. Arguably, personal relationships might also influence other kinds of related activities including research and the reporting of research findings. While most ethics review boards ask researchers to note any real or potential conflicts of interest, most researchers report things like financial interests, or having a stake in a patent or copyright. I doubt that many Board members have read a research ethics application listing a personal relationship that might have a potential effect on how a researcher is able to conduct research or report findings. It’s clear that the University of Pittsburgh is taking an unparalleled first step in acknowledging that personal relationships and subsequent obligations may well alter good judgment and sound practices.

~ by Nancy Walton on March 25, 2009.

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