Question: I recommended a new glaucoma medicine to a patient who then looked at my CMS Open Payments data. He saw a $29 “food and beverage” payment from the glaucoma drug company from a sponsored seminar over a year ago. The patient claimed I was derelict in my duty to report a conflict of interest in recommending the drug. I don’t think one (bad) lunch buffet influenced my opinion. Also, the information I learned at the seminar was important for understanding the product fully, so that I could give the best advice and prescribe appropriately. Do I need to disclose every interaction I have with a manufacturer or drug company to every patient?
Answer: The AAO Code of Ethics Principle 7 states that we must act in the best interest of the patient, and it is clear on commercial relationships and conflicts of interest:
- Rule 11. Commercial Relationships. An ophthalmologist's clinical judgment and practice must not be affected by economic interest in, commitment to, or benefit from professionally related commerical interests.
- Rule 15. Conflict of Interest. A conflict of interest exists when professional judgment concerning the well-being of the patient has a reasonable chance of being influenced by other interests of the provider. Disclosure of a conflict of interest is requried in communications to patients, the public, and colleagues.
The question here becomes: was this lunch “an economic interest” or benefit to you, and did the company’s lunch have a reasonable chance of influencing your clinical decision making? There are no hard-and-fast rules as to the economic threshold by which payments to physicians cross those boundaries, and so reasonable judgement must apply. Most disinterested observers would assume a million-dollar payment from a drug manufacturer to a physician would influence their decision-making, while most would also assume that a 25 cent payment might not. However, there are data suggesting that small gifts, like drug-branded prescription pads, significantly influence prescribing habits, as do visits from pharmaceutical representatives.
Given the ambiguity regarding conflict of interest, a safe course is to proactively offer patients a full disclosure of any received gifts or payments. Make your disclosures publicly available (perhaps as a link on the practice website). It is also possible to attend corporate educational events while declining meals or gifts. If you do so, be sure to let the company know you are declining so you are not listed as a recipient. If you have erroneous payments on the Open Payments website, access the protocols for challenging and removing them.
Learn more at aao.org/clinical-education/redmond-ethics-center.
To submit a question, contact the Ethics Committee at ethics@aao.org.