President's Perspective July 2012

Michelle ButterworthConflict of Interest: A Perceived and Real Perspective
By Michelle L. Butterworth, DPM, FACFAS, President

Conflict of interest (COI) is a phrase that has recently become mainstream in many industries and professions, but no more so than the medical profession. One definition of medical conflicts of interest comes from the Institute on Medicine as a Profession, which states, “Conflicts of interest (COI) in medicine arise when ‘the responsibilities of individuals or organizations are, or have the potential to be, compromised by other, external obligations. The failure of fiduciary responsibility is the key concept in defining conflict of interest situations. Conflicts occur when the public expects that professionals will further the interests of their clients/ patients, not their own personal interest.’ ”
As medical research and healthcare have become vastly more complex and expensive, the task of managing COIs has also become more difficult and poses challenges to both physicians and medical associations. For the physician, COIs raise concerns about treatment decisions, product selection, and what’s in the best interests of the patient. For medical associations, COIs raise concerns about the objectivity and trustworthiness of research, education, training, and scientific journals.
In recent years, medical COIs have become the subject of Congressional and Justice Department investigations, new CMS regulations, significant scrutiny by CME creditors, and the media. The complexity and cost of compliance of this and many other regulations have created huge “Compliance Departments” in industry and increasingly in medical associations.
The allopathic CME accreditor, the American Council on Continuing Medical Education (ACCME) has different COI and industry grant rules than does the podiatric accreditor, the Council of Podiatric Medical Education (CPME). ACFAS adheres to most of ACCME’s rules and all of CPMEs, and we hope that when CPME rewrites its CME accreditation criteria next year they will emulate more of ACCME’s rules as one more step in our march toward parity.
Since the College’s primary mission is to enhance education and research, we are quite serious about COIs in our governance, programs, research, and publications. The existence of a COI is not, in and of itself, evidence of wrongdoing IF, in most cases, the conflicts are openly disclosed. ACFAS officers, staff, committee members, speakers and authors must disclose their conflicts through written documentation. COI disclosures are reviewed and updated at every meeting. The Conflict of Interest Committee reviews upcoming agendas and all COI disclosures. If there are any real or perceived conflicts, in most cases the individual must recuse themselves from the discussion and abstain from voting.
COIs for speakers are published in materials and speakers are given detailed instructions on what they can and cannot discuss during presentations. Additionally, each session evaluation form asks attendees if they sensed any commercial bias by speakers. Under a new policy, if attendees complaints are corroborated, the speaker(s) who interjects commercial bias will be advised of the infraction and vigorously reminded of the College’s COI policies. If the speaker continues to violate College policy, they will be banned from all future speaking roles.
ACFAS is serious about the full disclosureof conflicts and commercial bias and is constantly updating our policies to ensure compliance. We challenge all podiatric CME providers, publishers, and researchers to do the same to ensure that our entire profession enhances its image and reputation in the eyes of not only its own members, but more importantly, in the eyes of government, the media, and our patients.
Questions for Dr. Butterworth? Write her at

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