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Are there any other situations not captured in this survey that raise serious concerns about conflicts of interest? Please describe these in the space provided.
#Response DateComment
1.Tue, 3/13/07 11:17 PMFor me the bottom line in any of these situations is the people involved. Even when a strong conflict of interest is clearly present, an ethical person will act ethically regardless.
2.Tue, 3/13/07 11:58 PMDr. X is a member of a very large cardiology group. He is also chair of a credentialling committee and routine vetoes any applications from competitors.
3.Wed, 3/14/07 12:06 AMI find this survey very interesting in light of reading Dr Brody's new book. I think CHM should give a copy to all med students and make them read it.
4.Wed, 3/14/07 12:30 AMa small group of private individuals investing a significant amount of money in a medical school... how could one say that that small group of individuals won't have a very large impact on the path that the medical school takes?
5.Wed, 3/14/07 12:33 AMCompany "X" educates CHM Medical students or CHM residents on a drug/device and pays for "Y" Y= average lunch Y= pens/trinkets Y= expensive dinner Y= formal dinner and dance
6.Wed, 3/14/07 12:40 AMpublishing journal articles in journals supported by ads of big pharma. Research that is only done on meds or devices that have a patent have a COI
7.Wed, 3/14/07 12:48 AMHow about students getting into med school or getting scholarships based on knowing or having a family member at the School of MED? or on race???
8.Wed, 3/14/07 1:06 AMAt some other schools, medical supply companies provide students with medical equipment at no charge so long as they are formally acknowledged of the gift.
10.Wed, 3/14/07 2:19 AMI would just like to say that I am new to thinking about this and don't really know a lot of these answers, but they are interesting and important questions.
11.Wed, 3/14/07 3:10 AMThe cost of education, research, training and expansion almost mandates conflicts of interests, especially since medicine is the US's largest industry. It is our professional duty as present and future physicians to be both introspective and proactive to maintain at the height of our priorities the patients whom we serve, and to set into place fail safe nets (boards, committees, and peer evaluations) to catch us should we fail.
12.Wed, 3/14/07 3:28 AMI think there are more teaching scenarios and student evalautions where COI can arise. Ex: a student who is known to be an offspring of a well known faculty member may well get favourable treatment.
13.Wed, 3/14/07 3:50 AMFaculty grading based on the student's future specialty of interest, I have seen this alot. (eg. Faculty from pediatrics grading students with interest in peds higher for same quality/participation/paper/etc.)
14.Wed, 3/14/07 1:24 PMI think any interaction/business partnership between medical schools and pharmaceutical companies is a huge conflict of interest and trains medical students to take handouts from these companies when they are physicians. I would be very upset if as a medical student I was required to attend a pharmaceutical lecture.
15.Wed, 3/14/07 2:41 PMPurchasing of medical equipment, including kickbacks to faculty recommending which product (eg radiologic) will be purchased. Pharmaceutical funding for the education of our adult cardiology fellows.
16.Wed, 3/14/07 2:43 PMnone
17.Wed, 3/14/07 2:49 PMThere is always a concern about conflicts of interest when a teacher, physician or other professional benefits at the expense of either the institution, students and/or patients. Collaboration with drug companies, publishing companies, private industry and other groups is encouraged as an expression of academic freedom, as long as benefits are not exclusively those of the participating individual.
18.Wed, 3/14/07 3:17 PMA physician has a clinical practice supported by a regional health care system and also has an appointment as faculty at the university. The physican has access to university operations information that would allow the health care system to exploit gain increased market share in the area of the doctor's clinical practice. I think COI situation has been not been adequately described in this survey whereby a physician uses a university position to divert opportunities for private gain... (similar to the situation presented in one of the scenarios where 1 of 2 procedures was advanced based amount of reimbursement. Sometimes work can be diverted that will maximize private benefit over university benefit... don't have enough time to perfectly word this)
19.Wed, 3/14/07 5:22 PM.
20.Wed, 3/14/07 5:25 PMHow about prevention efforts? Is there a conflict of interest when a medical facility ior provider fails to provide prevention services when the potential decrease in disease incidence will affect the income from treating the disease?
21.Wed, 3/14/07 10:16 PMMaybe the promotion of guidelines which lead to more tests/procedures done by a doctor or department. ie CT scans for coronary calcification scores being promoted to the public for self-referral, generating radiology income but perhaps not shown by evidence to be truly rationally evaluated in a favorable way.
22.Wed, 3/14/07 10:31 PMSeminars and CME print material put out by a "research/educational" company do not disclose funding sources. The experts recommend a particular treatment which happens to be the drug marketed by one of the major sponsors of the educational company. The experts recieve $2000 for every version of the print material and $5000 for every CME seminar, but these are "educational grants".
23.Thu, 3/15/07 2:42 PMCOntinuing to work at a medical school where priorities of the institution and the college do not fit the needs of the community and the nation.
24.Fri, 3/16/07 11:43 AMI think it is important to try to evaluate whether the exchange allows research and or eduacation that won't get funded without drug co money and whether a true evaluation of the drug etc is possible. My first priority is my patients care and I don't like the idea that I would compromise that because of a drug rep or a coffee cup. The end point always should be to improve patient care.
26.Sun, 3/18/07 3:23 PMThe greatest flaw right now in community-based medical education is pharmaceutical/medical device companies driving research. 100% of the research done in Grand Rapids is driven by these entities, and to be honest, it drastically alters how medicine is practiced in comparison to the remainder of the country. Its very obvious to see as a student, especially after having visited other medical institutions on away-electives.
27.Mon, 3/19/07 12:25 AM Almost all the questions have to be answered "It depends " The devil is in the details
28.Mon, 3/19/07 4:47 AMThe number of students at MSU-CHM who are allowed to continue through their pre-clinical and clinical years without obtaining the adequate excellence (as reflected by failed clerkships, recurrent extensions, and repeated unprofessional marks) is shocking. Students are allowed to apply for residencies while still taking basic, 3rd-year clerkships (eg. Ob/Gyn), and graduate on time, suggesting that these students were allowed to complete elective prior to completing required clerkships. Meanwhile, other students who have repeatedly failed are continually pushed through the system. In the end, this serves only to undermine MSU-CHM's already tepid reputation nationally, as sub-par students and residents go forth and represent the type of education obtained at this school. It does nothing for CHM to have such students pushed through by some sort of administrative focus on graduating classes with a politically correct demographic, instead of a consistent, demonstrated level of competence.
29.Mon, 3/19/07 1:55 PMAlong with requiring students/residents to participate in pregnancy terminations, require them to perform circumcisions on infants, which many consider to be unethical (violates the Do No Harm part of the Hippocratic Oath). I have been stunned by how the students are brainwashed by their third-year on how evil it is for the drug companies to provide lunch and talk about their product. Once in practice a lot of information about pharmaceutical comes from their representatives. No one make you prescribe their medication but you. Information is good. Shutting off a source of information is not good.
30.Mon, 3/19/07 4:28 PMLarge donations are offered to a medical school from a world-wide nutriceutical company.To receive the funds, the medical school must participate in the clinical investigation and eventual marketing of the company products.
31.Mon, 3/19/07 5:38 PMWe all have conflicts of interest. The question of concern is our behavior. Are we corrupted?
32.Mon, 3/19/07 8:58 PMNext time you construct a survey like this, you should provide an opportunity for comment WITHOUT having to select option 5 ("It Depends").
33.Wed, 3/21/07 2:41 PMA medical student has a problem (conflict, harassment, etc...) with the resident supervision him/her... however the attending in charge of the residents (in a 3-4or5 year program) is the SAME attending in charge of the medical students (who only have a month to two month clerkship). Furthermore the attending in charge of the department is related to that person or the person in charge of the department (and its faculty) is the SAME person as the person in charge of the residents (and there is a conflict or situation of harassment between a resident (transient employee) and a faculty member (tenure).
34.Mon, 4/23/07 1:23 PMI would be concerned about faculty who have heavy industry support and sit on the IRB.
35.Tue, 4/24/07 10:15 PMJust because a drug is marketed does not mean it is not the most appropriate drug to use, irregardless of cost. Trying to minimize cost, irrelevent of the quality of the drug therapy, can also be a conflict of interest of those representing hospitals and there costs by trying prevent pharmaceutical companies from having resonable contact with medical providers. I think there are extremes of both sides of the conflict of interest spectrum, from the anti-drug pens lobby to those physicians accepting extravagant, irrelevent junkets in the past. One more point, medicine is a business too- if you don't pay your bills/staff, you won't be able to provide patient care for long. Just because physician get reimbursed for their medical expertise does not mean there is necesarily a conflict of interst. I look forward to see the results of the survey and how the results are interpretted. I hope you email all of us with the information. Thanks!
36.Wed, 4/25/07 1:40 PM1. You are submitting an intramural grant proposal. You are asked to serve as a reviewer of a competitor's grant that has been submitted for the same cycle (IRGP). Serious COI. 2. You are asked to serve as a reviewer of an intramural grant submitted by a person who is a frequent/longtime collaborator of yours, and/or a personal friend. Serious COI.
37.Wed, 4/25/07 6:18 PM I WILL LIKE YOU ALL TO REMEMBER THAT "COI" IS A MORAL ISSUE AND MORALS ARE NOT ABSOLUTE. TO ME, THE BIGGEST DETERMINANT OF CONFLICT OF INTEREST IS "INTENT", WHICH IS VERY DIFFICULT TO DETERMINE.
39.Sun, 4/29/07 9:32 PMIt would be interesting to see if responses were different to physicians getting training in multiple procedures in order to increase their rate of reimbursement vs the x-ray question. Ideally, there should be no connection between a physician's decision regarding best treatment for their patient and the physician's reimbursement.
40.Mon, 4/30/07 2:20 AMOther examples of self referral involving, as an example, medical imaging, where the technical and professional fees generated go directly to the referring physician (Stark loophole)
42.Mon, 5/14/07 1:29 AMI have heard from some female pharmaceutical reps that they are treated inappropriately from merely suggestive talk to actually being propositioned.