Inadequate conflict of interest policies at most French teaching hospitals: A survey and website analysis

English version

Autoři: Christian Guy-Coichard ^aff001; Gabriel Perraud ^aff002; Anne Chailleu ^aff003; Véronique Gaillac ^aff004; Paul Scheffer ^aff005; Barbara Mintzes ^aff006
Působiště autorů: AP-HP St Antoine Hospital, Paris, France ^aff001; Faculty of Medicine, Brest, France ^aff002; Chair of Formindep, Paris, France ^aff003; Hôpital Sainte-Anne, Paris, France ^aff004; Sciences of Education Department, Paris 8 University, Saint-Denis, France ^aff005; Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, Australia ^aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224193

Souhrn

Background

There are 32 teaching hospitals in France, including 30 University hospitals and two Regional teaching hospitals. Teaching hospitals have three roles: health care provision, training of healthcare professionals, and medical research. These roles lead to frequent interactions with pharmaceutical and medical device companies, inevitably raising risks of conflicts of interests. Therefore, policies to manage conflict of interests (COI) are crucial. This study aims to examine COI policies in French teaching hospitals.

Methods

All French teaching hospitals (n = 32) were included in this study. All hospitals websites were screened for institutional COI policies and curriculum on COI, using standardized keyword searches. More data were collected through a questionnaire addressed to each chief executive officer (CEO) of the teaching hospital. We used predefined criteria (n = 20) inspired by similar surveys on COI policies in French, US and Canadian medical schools, with some additions to reflect the local hospital context. A global score for each hospital, ranging from 0 to 60 (higher scores denoting stronger policies) was calculated by summing points obtained for each criterion.

Results

All 32 hospitals had websites; 21 hospitals listed policies or regulations on their websites or provided them on request. In December 2017, 17 (53.1%) had rules and regulations for some items only, four of which (12.5%) have considered implementing a policy, and only two (6.3%) have begun implementation. 15 (46.9%) had no evidence of COI policies and a null score. The maximum score was 24 out of 60.

Conclusion

This is the first systematic assessment of COI policies in teaching hospitals in France. Such policies are needed to protect patients, clinicians and students from undue commercial influence. Despite public and political pressure for better management of COI, few teaching hospitals have implemented comprehensive and protective policies, and some hospitals lacked policies altogether. These results highlight the need for greater attention to management of COI within teaching hospitals. One potential solution would be to integrate COI policies into hospital accreditation procedures, in order to ensure a baseline of management at all teaching hospitals.

Klíčová slova:

Medicine and health sciences – Health economics – Health care policy – Medical devices and equipment – Public policy – Medical education – France – Procurement

Zdroje

1. Cour des Comptes, 2017. Rôle des CHU dans l’enseignement et la recherche médicale. https://www.ccomptes.fr/sites/default/files/2018-01/20180117-role-des-CHU.pdf (French General Accounting Office, communication to the Senate Social Affairs committee: Role of teaching hospitals in education and medical research). Checked on December 15, 2017.

2. Vororn J, Chen M, Hartley R. 1982. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med. 1982, Vol. 73, pp. 4–8.

3. Jukti Kumar K. 2016. Hospital to retail spillover analysis and its impact on commercial decision making, presentation at Lifesciences Commercial data insight conference, http://www.cbinet.com/sites/default/files/files/Kalita_Jukti_pres.pdf. Checked on December 15, 2017.

4. Spurling GK. Information from pharmaceutical companies and the quality, quantity and cost of physician’s prescribing: a systematic review. PLoS Med 2010; 7(10); e1000352. doi: 10.1371/journal.pmed.1000352 20976098

5. Wood SF, Podrasky J, McMonagle MA, Raveendran J, Bysshe T, Hogenmiller A, https://www.ncbi.nlm.nih.gov/pubmed/?term=Fugh-Berman%20A%5BAuthor%5D&cauthor=true&cauthor_uid=29069085etal. Influence of pharmaceutical marketing on Medicare prescriptions in the district of Columbia. PLoS Med 2017; 10:1371–83.

6. Steinbrook R. Physicians, Industry payments for food and beverage, and drug prescribing. JAMA 2017; 317(17):1753–54. doi: 10.1001/jama.2017.2477 28464155

7. Austad KE, Avorn J, Franklin JM, Kowal MK, Campbell EG, Kesselheim AS. 2013. Changing interactions between physician trainees and the pharmaceutical industry: a national survey. J Gen Intern Med. 2013, Vol. 28, 8, pp. 1064–1071. doi: 10.1007/s11606-013-2361-0 23444007

8. Austad KE, Avorn J, Kesselheim AS. 2011. Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS Medicine. 2018(5): e10011037

9. Brodkey A C. 2005. The role of industry in teaching psychopharmacology: a growing problem. Acad Psychiatry. 29, 2005, pp. 222–229. doi: 10.1176/appi.ap.29.2.222 15937271

10. Hodges LE, Arora VM, Humphrey HJ, Reddy ST. 2013. Premedical students´ exposure to the pharmaceutical industry´s marketing practices. Acad Med. 2013, Vol. 88, 2, pp. 265–268. doi: 10.1097/ACM.0b013e31827bfbce 23269292

11. Hyman PL, Hochman ME, Shaw JG, Steinman MA. 2007. Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry. Acad Med. 2007, Vol. 82, pp. 94–99. doi: 10.1097/01.ACM.0000249907.88740.ef 17198299

12. Lea D, Spigset O, Slørdal L. 2010. Norwegian medical students’ attitudes towards the pharmaceutical industry. Eur J Clin Pharmacol. 2010, Vol. 66, pp. 727–733. doi: 10.1007/s00228-010-0805-6 20300742

13. Sandberg WS, Carlos R, Sandberg EH, Roizen MF. 1997. The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or products. Acad Med. 1997, Vol. 72, pp. 916–918. 9347716

14. Sierles FS, Brodkey AC, Cleary LM, McCurdy FA, Mintz M, Frank J, et al. Medical students' exposure to and attitudes about drug company interactions. JAMA. 2005, Vol. 294, pp. 1034–1042. doi: 10.1001/jama.294.9.1034 16145023

15. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000; 283:373±380. doi: 10.1001/jama.283.3.373 10647801

16. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003; 290(2): 252–255. doi: 10.1001/jama.290.2.252 12851281

17. Katz D, Caplan AL, Merz JF. All gifts large and small–toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioeth 2003; 3(3):39–45. doi: 10.1162/15265160360706552 14594489

18. Base de données publique Transparence Santé (public database Health Transparency): www.transparence.sante.gouv.fr. Accessed February 18, 2018. Analysis by Alterantives Economiques, January 2018: https://www.alternatives-economiques.fr/lhopital-objet-de-convoitises-labos/00082527

19. Rapport d’information du Sénat n° 513, Commission des affaires sociales, sur l’enquête de la Cour des Comptes sur la prévention des conflits d’intérêts en matière d’expertise sanitaire, (2016) [information report of the Senate No. 513, Social Affairs Committee, on the Court of Auditors' investigation into the prevention of conflicts of interest in health expertise]. https://www.senat.fr/rap/r15-513/r15-5131.pdf. Accessed December 15,2017

20. Kao AC, Braddock C 3rd, Clay M, Elliott D, Epstein SK, Filstead W, et al. Effect of educational interventions and medical school policies on medical students’ attitudes toward pharmaceutical marketing practices: a multi-institutional study. Acad Med. 2011, Vol. 86, pp. 1454–1462. doi: 10.1097/ACM.0b013e3182303895 21952057

21. Kim A, Mumm LA, Korenstein D. 212. Routine conflict of interest disclosure by preclinical lecturers and medical students’ attitudes toward the pharmaceutical and device industries. JAMA. 212, Vol. 308, pp. 2187–2189. doi: 10.1001/jama.2012.25315 23212492

22. Monaghan MS, Galt KA, Turner PD, Houghton BL, Rich EC, Markert RJ, et al. Student understanding of the relationship between the health professions and the pharmaceutical industry. Teach Learn Med. 2003, Vol. 15, pp. 14–20. doi: 10.1207/S15328015TLM1501_04 12632703

23. Sigworth SK, Cohen GM. 2001. Pharmaceutical branding of resident physicians. JAMA. 2001, Vol. 286, pp. 1024–1025.

24. Varley CK, Jibson MD, McCarthy M, Benjamin S. A survey of the interactions between psychiatry residency programs and the pharmaceutical industry. Acad Psychiatry. 2005, Vol. 29, pp. 40–46. doi: 10.1176/appi.ap.29.1.40 15772403

25. Act No. 2016–483 of 20 April 2016 on the ethics and rights and obligations of civil servants. https://www.legifrance.gouv.fr/ Accessed February 18, 2018.

26. Benkimoun P (2011) New law introduces tougher rules on drug regulation in France. BMJ 343: d8309. doi: 10.1136/bmj.d8309 22194407

27. Laws 93–121 of 27/01/1993 ("Loi anti-cadeaux”, Anti-gifts Law), 2011–2012 of 29/12/2011 (Bertrand Law), 2016–41 of 26/01/2016 ("Loi de modernisation du système de santé”, Health System Modernization Law), the Public Health Code and the Medical Code of Ethics.; available on https://www.legifrance.gouv.fr/

28. Mullard A (2011) Mediator scandal rocks French medical community. Lancet, 377: 890±892. doi: 10.1016/s0140-6736(11)60334-6 21409784

29. Charte de l’information par démarchage ou prospection visant à la promotion des médicaments; Les entreprises du médicament (LEEM)/Comité Economique des Produits de Santé, (2014). [Charter ofmedical detailing; Union of Companies / Economic Committee for Health Products]. Accessed December 15, 2017.

30. Scheffer P, Guy-Coichard C, Outh-Gauer D, Calet-Froissart Z, Boursier M, Mintzes B,. (2017). Conflict of Interest Policies at FrenchMedical Schools: Starting from the Bottom. PLoSONE 12(1): e0168258. doi: 10.1371/journal.pone.0168258 28068362

31. Mason PR, Tattersall MHN (2011) Conflicts of interest: a review of institutional policy in Australian medicalschools. MJA 194: 121±125 21299485

32. Shnier A, Lexchin J, Mintzes B, Jutel A, Holloway K (2013) Too Few, Too Weak: Conflict of Interest Policies at Canadian Medical Schools. PLoS ONE 8(7): e68633. doi: 10.1371/journal.pone.0068633 23861928

33. Etain B, Guittet L, Weiss N, Gajdos V, Katsahian S (2014) Attitudes of Medical Students towards Conflict of Interest: A National Survey in France. PloS ONE 9(3): e92858. doi: 10.1371/journal.pone.0092858 24671179

34. Charter of the conference of deans of French medical schools. Available at http://unice.fr/faculte-de-medecine/contenus-riches/documents-telechargeables/doc_faculte/V3_Charte_facultes_medecine_odontologie_2017.pdf. Checked on February 2, 2018.

35. Managing Conflicts of Interest in the NHS. Model Policy Content for Organisation, National Health Service (NHS) (2017) https://www.england.nhs.uk/publication/managing-conflicts-of-interest-model-policy-content-for-organisations/. Accessed December 15,2017

36. AMSA: American Medical Student Association (2015) AMSA JustMedicine Scorecard 2015. https://amsascorecard.org/. Checked February 2, 2018.

37. https://web.archive.org/web/20141005205156/ http://teaching-hospitals.amsascorecard.org:80/ https://www.amsa.org/about/amsa-press-room/press-release-grading-teaching-hospitals/ Accessed December 15,2017

38. AllTrials trials tracker: https://trialstracker.ebmdatalab.net/#/ checked on February 26, 2018

39. Petition by 800 French clinical trial investigators to maintain ‘associations de service’: http://codirc.fr/wp-content/uploads/2015/05/Lettre-%C3%A0-la-Ministre-de-la-Sant%C3%A9-2.pdf. Checked on December 15, 2017.

40. Petition by the CRO union, Biotech union to maintain ‘associations de service’ http://codirc.fr/wp-content/uploads/2015/05/Lettre-ouverte-%C3%A0-Madame-la-Ministre-de-la-Sant%C3%A9_France-Biotech-1.pdf. Checked on December 15, 2017.

41. Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas SC, Cohen JJ, et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006, Vol. 295, pp. 429–433. doi: 10.1001/jama.295.4.429 16434633

42. Hafferty FW. 1998. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998, Vol. 73, pp. 403–407. doi: 10.1097/00001888-199804000-00013 9580717

43. Geppert CMA. 2007. Medical education and the pharmaceutical industry: a review of ethical guidelines and their implications for psychiatric training. Acad Psychiatry. 2007, Vol. 31, pp. 32–39. doi: 10.1176/appi.ap.31.1.32 17242050

44. Lo B, Field MJ. 2009. Conflicts of Interest in Research, Education and Practice. Institute of Medicine of the National Academies. Washington, DC: National Academies Press, 2009.

45. Sears J. 2008. Implementing the Recommendations of the AAMC Task Force on Industry Funding of Medical Education: A Selected Policy Language Compendium. Association of American Medical Colleges. Washington, DC,: s.n., 2008.

46. Rapport sur la pharmacovigilance et gouvernance de la chaîne du médicament, de l’Inspection Générale des Affaires Sociales (IGAS), [Report on pharmacovigilance and governance of the drug chain ", by the General Inspectorate of Social Affairs ] http://www.ladocumentationfrancaise.fr/rapports-publics/114000331/index.shtml. Accessed December 1515,2017

47. Guide “Comprendre la promotion pharmaceutique et y répondre”, Organisation Mondiale de la Santé, traduction française par la Haute Autorité de Santé (2013). [Understanding and Responding to Pharmaceutical Promotion, World Health Organization, http://www.has-sante.fr/portail/upload/docs/application/pdf/2013-04/comprendre_la_promotion_pharmaceutique_et_y_repondre_-_un_manuel_pratique.pdf. Accessed December 15,2017

48. Recommendations of the American Board of Internal Medicine (2006), Association of American Medical College (2008), Institute of Medicine (2009) cited in: Chimonas et al, Managing conflicts of interest in clinical care: a national survey of policies at US medical schools, Acad.Med. 2011;86:293–99.

49. Conflict of interest prevention policy implemented by Stanford University (USA), Western University (Canada). accessed December 15,2017

50. Référentiel de la Haute Autorité de Santé (HAS) de certification de la Visite Médicale (2016) [Referential of the High Authority of Health for certification of the medical companies representatives]: https://www.has-sante.fr/portail/upload/docs/application/pdf/2016-03/referentiel_de_certification_ip_mars_2016.pdf. Accessed December 15,2017

51. Dean J, Loh E, Coleman JJ.Pharmaceutical industry exposure in our hospitals: the final frontier. MJA 204(1): 20–22. doi: 10.5694/mja15.00734 26763810

52. Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas SC, Cohen JJ,Health industry practices that create conflicts of interest. A policy proposal for academic medical centers. JAMA 295;4:429–33.

53. American Medical Student Association. 2007. AMSA PharmFree Scorecard. 2007.—. 2009. AMSA PharmFree Scorecard, Conflict of interest policies at academic medical centers. Available at www2.amsascorecard.org. 2009.

54. Association of American Medical Colleges. New AAMC task force to examine industry influence on medical education. 2009.https://www.aamc.org/newsroom/newsreleases/2008/82614/080619.html. Accessed February 2, 2018.