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zoom RSS 医師は企業との金銭的繋がりを断つように/米国医療事情

<<   作成日時 : 2009/04/06 00:17   >>

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 医療専門家が企業の支援から離れ、記念品のペン・バッグや臨床的に重要なガイドラインや研修プログラムの後援などの完全禁止へと早急に動くようにと、有名な医師・研究者のグループが水曜日に迫った。
 主要なメディカルセンターでは既に厳格な方針を定めている。
画像 JAMA 4月1日号で、学会の指導的立場にあり一定の有力な委員会メンバーとなっているものにたいしては企業との金銭的な繋がりを禁止し、医学専門家の学会が厳密な利害不一致のガイドラインを採用するように勧めている。治療ガイドラインの作成のために企業の資金を受け入れたり、作成委員会に企業と金銭的な繋がりがあるメンバーが入れないようにすべきであると強く主張している。
 米国心臓学会のDr. Steven E. Nissenは「0ドル」方針を支持し、医学会は企業からの資金提供を一切受けないつもりである。
 企業スポンサーが医学会と隣接したホールのブースで医学雑誌広告を買うことは可能である。
 しかし、研究の大部分は製薬会社によって出資されている。経験が全くない若手により治療ガイドラインの重要な決定がなされるようになるかもしれない。
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ハーバード・メディカル・スクールの倫理的苦境/米国医療事情
http://kurie.at.webry.info/200903/article_8.html
医師へのマグカップやボールペンの提供も自粛/米国医療事情 No Free Lunch
http://kurie.at.webry.info/200901/article_1.html
製薬企業と研究センターの関係/米国医療事情 小児精神医療
http://kurie.at.webry.info/200811/article_54.html
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Doctors Urge End to Corporate Ties
http://www.nytimes.com/2009/04/02/health/policy/02journal.html
By RONI CARYN RABIN
Published: April 1, 2009

A group of prominent physicians and researchers on Wednesday urged professional medical groups to “wean” themselves from industry support and move toward a complete ban on corporate money for things like souvenir pens, tote bags and the sponsorships of committees that develop clinically important guidelines and training programs.

The recommendations are not binding and would have to be put in place by individual professional associations. Still, concern over industry support has been increasing among scientists, and several leading academic medical centers already are putting stringent policies in place.

In a paper in the April 1 issue of The Journal of the American Medical Association, the doctors’ group recommends that medical professional associations adopt stricter conflict-of-interest guidelines, not simply requiring the disclosure of financial ties to drug and medical device companies but also barring members with financial ties from serving in leadership positions and on certain influential committees within the association.

The authors are particularly adamant that professional medical associations should neither accept corporate money to underwrite the development of practice guidelines nor allow members with financial ties to industry to serve on committees that develop the guidelines, which are usually widely adopted as the gold standard for medical practice.

The authors acknowledged that while it would be difficult, even painful, to carry out the reforms, they were essential if physician associations are to maintain their scientific integrity and the trust of their patients.

“When we write a practice guideline, we are telling our colleagues how they should care for their patients,” said Dr. Steven E. Nissen, one of the authors of the paper and a past president of the American College of Cardiology, who supports what he calls a “zero dollar” policy, under which medical associations would not take any money from industry. “If you are one of those patients, you are counting on that guideline to be of the highest caliber, free of any influence.”

The recommendations would allow corporate sponsors to buy advertisements in medical journals and booths in halls adjacent to medical conferences.

“The consensus here was quite clear: You do not want the piper calling the tune,” said David J. Rothman, a professor of social medicine at Columbia University. “We ask that these groups make every effort to get to zero percent and, knowing that it is very difficult to do that, that they move as rapidly as possible to no more than 25 percent,” referring to how much of their support should come from industry.

Marjorie Powell, senior assistant general counsel for Pharmaceutical Research and Manufacturers of America, a drug industry trade group, said the proposals could deprive the medical community of the expertise of some of its most experienced doctors, who are often deeply involved in industry-financed research.

“The vast majority of the research is funded by pharmaceutical companies,” Ms. Powell said. Important decisions regarding practice guidelines might be made, she said, by “very junior people who have no experience.”

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Professional Medical Associations and Their Relationships With Industry
A Proposal for Controlling Conflict of Interest
http://jama.ama-assn.org/cgi/content/short/301/13/1367
David J. Rothman, PhD; Walter J. McDonald, MD; Carol D. Berkowitz, MD; Susan C. Chimonas, PhD; Catherine D. DeAngelis, MD, MPH; Ralph W. Hale, MD; Steven E. Nissen, MD; June E. Osborn, MD; James H. Scully Jr, MD; Gerald E. Thomson, MD; David Wofsy, MD

JAMA. 2009;301(13):1367-1372.

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. Any threat to the integrity of PMAs must be thoroughly and effectively resolved. Current PMA policies, however, are not uniform and often lack stringency. To address this situation, the authors first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs. The authors then went on to formulate guidelines, both short-term and long-term, to prevent the appearance or reality of undue industry influence. The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.


Author Affiliations: David J. Rothman, PhD, president, Institute on Medicine as a Profession, and Bernard Schoenberg Professor of Social Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Walter J. McDonald, MD, past CEO, Council of Medical Specialty Societies, Chicago, Illinois; Carol D. Berkowitz, MD, past president, American Academy of Pediatrics, Elk Grove Village, Illinois; Susan C. Chimonas, PhD, research scholar, Center on Medicine as a Profession, College of Physicians and Surgeons, Columbia University, New York, New York; Catherine D. DeAngelis, MD, MPH, editor in chief, JAMA, Chicago, Illinois; Ralph W. Hale, MD, executive vice president, American College of Obstetricians and Gynecologists, Washington, DC; Steven E. Nissen, MD, past president, American College of Cardiology, Washington, DC; June E. Osborn, MD, past president, Josiah Macy, Jr Foundation, New York, New York; James H. Scully Jr, MD, medical director and CEO, American Psychiatric Association, Arlington, Virginia; Gerald E. Thomson, MD, past president, American College of Physicians, Philadelphia, Pennsylvania, and chairman of the board of directors, Institute on Medicine as a Profession, College of Physicians and Surgeons, Columbia University, New York, New York; and David Wofsy, MD, professor of medicine, University of California, San Francisco.

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医師は企業との金銭的繋がりを断つように/米国医療事情 医師の一分/BIGLOBEウェブリブログ
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