SpineCare Medical Group, San Francisco Spine Institute, Daly City and San Francisco, California, USA.
Pain Med. 2011 Dec;12(12):1713-9. doi: 10.1111/j.1526-4637.2011.01282.x. Epub 2011 Dec 6.
Financial relationships among the biomedical industries, physicians, and professional medical associations (PMAs) can be professional, ethical, mutually beneficial, and, most importantly, can lead to improved medical care. However, such relationships, by their very nature, present conflicts of interest (COIs). One of the greatest concerns regarding COI is continuing medical education (CME), especially because currently industry funds 40-60% of CME. COIs have the potential to bias physicians in practice, educators, and those in leadership positions of PMAs and well as the staff of a PMA. These conflicts lead to the potential to bias the content and type of CME presentations and thereby influence physicians' practice patterns and patient care. Physicians are generally aware of the potential for bias when industry contributes funding for CME, but they are most often unable to detect the bias. This may because it is very subtle and/or the educators themselves may not realize that they have been influenced by their relationships with industry. Following Accreditation Council for Continuing Medical Education guidelines and mandating disclosure that is transparent and complete have become the fallback positions to manage COIs, but such disclosure does not really mitigate the conflict. The eventual and best solutions to ensure evidence-based education are complete divestment by educators and leaders of PMAs, minimal and highly controlled industry funding of PMAs, blind pooling of any industry contributions to PMAs and CME, strict verification of disclosures, clear separation of marketing from education at CME events, and strict oversight of presentations for the presence of bias.
生物医药产业、医生和专业医学协会（PMA）之间的财务关系可以是专业的、合乎道德的、互利的，最重要的是，可以改善医疗保健。然而，这些关系本身就存在利益冲突（COI）。COI 最令人担忧的问题之一是继续医学教育（CME），尤其是因为目前行业为 CME 提供了 40-60%的资金。COI 有可能使医生、教育者以及 PMA 的领导人和员工在实践中产生偏见，从而影响医生的实践模式和患者护理。医生通常意识到在 CME 中行业提供资金时存在偏见的可能性，但他们往往无法察觉这种偏见。这可能是因为它非常微妙，或者教育者自己可能没有意识到他们受到了与行业关系的影响。遵循继续医学教育认证委员会的指导方针，并要求透明和完整的披露，已成为管理 COI 的后备措施，但这种披露并不能真正减轻冲突。确保基于证据的教育的最终和最佳解决方案是教育者和 PMA 领导者完全放弃投资、PMAs 和 CME 受到最小和高度控制的行业资金、将任何行业对 PMA 和 CME 的捐款进行盲池、严格验证披露、在 CME 活动中严格区分营销和教育以及严格监督演示文稿以防止出现偏见。
