ETHICS AND PROFESSIONALISM: WHERE THE RUBBER MEETS THE ROAD

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ETHICS AND PROFESSIONALISM WHERE THE RUBBER
MEETS THE ROAD

• SOCIETY OF PROFESSORS OF CHILD AND ADOLESCENT
  PSYCHIATRY
• April 3, 2008

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DISCLOSURES

• Personal travel and expenses to SPCAP meeting
  supported by UC Davis
• No industry support
• Past-president of AACAP may (but should not)
  enhance sphere of influence

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http//www.pbs.org/wgbh/pages/frontline/medicatedc
hild/
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Campbell, E., Regan, S., Gruen, R., Ferris, T.,
Sowmya, R., Cleary, P., and Blumenthal, D.
Professionalism in Medicine Results of a
National Survey of Physicians. Annals of Internal
Medicine, 147795-802, 2007.
Medical Professionalism Project. Medical
professionalism in the new millennium a
physicians charter. Lancet, 359520-522, 2002.
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2008 MATCH-USMG
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NRMP MATCH DATA
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CHOOSING A SPECIALTY
NYT 3/19/2008
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CHOOSING A SPECIALTY
NYT 3/19/2008
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CHOOSING A SPECIALTY
NYT 3/19/2008
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AN HISTORIC NOTE ON PROFESSIONALISM
Medieval European craft guilds are the
antecedents of todays professions. Guilds became
powerful because

• Guilds provided an important public service
• Members made high quality products
• High quality was guaranteed by limited
  production and long apprenticeships
• Guilds paid taxes (dues) and enjoyed
  protection

Guilds have not survived. Businesses employed
apprentices, paid higher wages and made products
faster and cheaper. Todays rising high health
care costs have become a serious problem for both
government and business
Harold Sox, Editorial, Ann. Int. Med. 147,809,2007
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PROFESSIONALISM IS THE BASIS OF MEDICINES
CONTRACT WITH SOCIETY

• IT DEMANDS
• Placing the interests of the patients above those
  of the physician
• Setting and maintaining standards of competence
  and integrity
• Providing expert advice to society on matters of
  health

Ann. Int. Med. 136243-246, 2002
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CHARTER ON PROFESSIONALISM

• PRIMACY OF PATIENT WELFARE
• Altruism toward patient
• No compromise with market forces, societal
  pressures and administrative exigencies
• PATIENT AUTONOMY
• Honesty with patients
• Empowering patients for informed decisions in
  keeping with principles of ethical practice
• SOCIAL JUSTICE
• Equitable distribution of health care resources
• Elimination of discrimination

Ann. Int. Med. 136243-246, 2002
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TEN PROFESSIONAL COMMITMENTS

• Professional competence
• Honesty with patients
• Patient confidentiality
• Appropriate relations with patients
• Quality improvement
• Improving access
• Just distribution of finite resources
• Scientific knowledge
• Maintaining trust by managing conflicts of
  interest
• Professional self regulation

Ann. Int. Med. 136243-246, 2002
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Campell, E. et al Ann. Int. Med. 147795-803,2007
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PUBLIC PERCEPTION

• Medicine and Industry

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Sandeep Jauhar, M.D. NYT Science Section,
3/11/2008
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NYT, 3/11/2008
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IN SHORT, MARKETING WORKSMelissa Healy, LA
Times, August 6, 2007

• INDUSTRYS VIEWPOINT
• Promotional spending is a service to science,
  physicians and patients.
• Direct advertising to consumers helps motivate
  them to improve their health.
• Detailing doctors keeps them abreast of new
  therapies and scientific advances.

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THE DATA

• As marketing budgets climbed toward a 2006 high
  of 28 billion, the number of individual
  prescriptions filled in the United States rose
  from 2.9 billion in 1999 to 3.7 billion in 2006.
• Of more than 10,000 drugs on the U.S.
  pharmaceutical market, half of the marketing
  budgets are used for 50 brand-name medications.
  Those 50 are the ones that sell the best.

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• "These are large and sophisticated organizations.
  . . . They would not be spending that money if it
  didn't work."
• Dr. Martin Shapiro, past president of the
  Society of General Internal Medicine (UCLA)

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A PROBLEM FOR TRAINING??
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JAMA, 29815, Oct. 2007
NPR, Science Friday, 10/19/2007
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SOME BEGINNING SOLUTIONS
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AAMC
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AACAPs EFFORTS

• Conflict of Interest disclosures
• All Committee meetings
• All Program submissions/presentations
• All Journal submissions/publications
• All Practice Parameters
• Code of Ethics for members
• Registration of clinical trials for JAACAP
  consideration
• Operating principles for extramural support of
  AACAP meetings and related activities including
  an annual meeting with industry representatives
• Task Force on Policies and Procedures
• Town Hall discussions, Newsletter columns

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AACAP BUDGET FACTS
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SUMMARY

• Conflicts can not be eliminated
• Influence needs to be managed
• Transparency and full disclosure
• Education of members and the public
• Regular communication and dialogue among all
  parties

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WHERE TO FROM HERE?

• AACAP has done enough and as a professional
  organization we are fine
• AACAP has done too much
• AACAP should do more
• The issues are blown out of proportion by the
  media---They will go away