The term “conflict of interest” means many things to many people but, in the context of an orthopaedic department in an academic medical center, the term applies to the relationship we have with companies in the pharmaceutical and orthopaedic device industries. These companies do business with us and our hospitals (we buy, use, or prescribe their products) and, as in any sales industry, their representatives want to treat us – their customers – well.  Sounds like good customer service, right?

The problem is that the medical profession (physicians and hospitals in particular) is being held to a higher standard regarding conflict of interest than most other professions or industries. Governmental agencies, consumer groups, patients, and law enforcement agencies are increasingly concerned with assuring that those providing healthcare services to patients are not being unduly influenced by the pharmaceutical or device industries. In almost no industry is it legal to accept a monetary “kick-back” for using or buying a specific company’s products, but in healthcare it is even being questioned whether seemingly insignificant gifts – such as pens, lunches, or notepads – might unduly influence the prescribing/ordering habits of a physician providing care for a patient.

We may each have our own opinion as to whether this is fair or unfair. We may each agree or disagree with the research done on the topic indicating that even small gifts can influence a buyer’s attitude towards a seller. We cannot, however, deny that this topic is getting a lot of national attention right now. The US Department of Justice has raised it to the “top of our minds” with allegations against companies for making – and physicians for accepting – improper payments. The American Association of Medical Colleges, the American Medical Association, and just about every other national medical association and industry group have gone on record stating that conflict of interest is an important topic that should be watched and managed carefully. Some academic institutions have gone so far as to ban ALL gifts from their campuses; for example, Yale University School of Medicine prohibits any pens, notepads, lunches, or any other gift in its medical center. Stanford University has taken it one step further, announcing last month it would not allow industry support for any educational activities conducted within its medical school or healthcare system.

So, what does this mean for us in our daily professional lives? Where will it end? Will CME as we know it disappear due to loss of industry support? I don’t know the answer to these questions, but I do know that we all need to acknowledge and understand that conflict of interest is an important issue that many of our patients will be in tune with.  We should be cautious about having, in patient care areas, items that clearly show a manufacturer’s name or logo, as some patients will interpret this as a conflict of interest.  Calendars, notepads, pens, scissors, models – anything that has a company’s name on it, should not be openly displayed in patient care areas. If a patient sees and asks about such items, we should not remark glibly that “they give those to us all the time”, but remind the patient that some items are important to carrying out patient care (such as models, notepads, scissors, etc).

I’m afraid that conflict of interest is a topic we can no longer ignore – it won’t go away. It is a train on a track and is headed right for us. Most medical schools, most medical associations, and most medical companies in the United States are in the process of revising their policies on conflict of interest. While this may be frightening because it may change daily professional life for us, it is probably wise that the “House of Medicine” tackle this issue in a proactive way.  If our own profession does not take an active role in providing a satisfactory response to this issue, then is it likely the federal government will define policies on conflict of interest for us. The only thing worse than having to do things a bit differently would be having the government dictate to us how to do them differently.

Dr. Douglas R. Dirschl is Frank C. Wilson Distinguished Professor and Chair of Orthopaedics at UNC School of Medicine. He also serves on the Own the Bone Steering Committee and chairs the Critical Issues Committee for the American Orthopaedic Association.