Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-04-27T14:08:59.208Z Has data issue: false hasContentIssue false

Clinician Conflicts of Interest at the Cleveland Clinic: The Context and Functions of Disclosure Policy and What Remains Unknown

Published online by Cambridge University Press:  16 December 2024

Marc A. Rodwin*
Affiliation:
SUFFOLK UNIVERSITY, BOSTON, MASSACHUSETTS, USA

Extract

Due to their financial incentive, clinicians who earn income from a firm that markets medical devices, pharmaceuticals, tests, etc. might inappropriately prescribe their products or services. The Cleveland Clinic’s conflict of interest (CI) policy creates rules governing clinicians who accept compensation from outside firms that market products they prescribe or use in their practice (hereafter, covered financial relationships). The CI policy is implemented by the Innovation Management and Conflict of Interest Program (IM&COI) (hereafter the Committee).

Type
Commentary
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of American Society of Law, Medicine & Ethics

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Innovation Management and Conflict of Interest Program Policy VI – Conflicts of Interest in Clinical Practice, Cleveland Clinic, available at <https://my.clevelandclinic.org/about/overview/who-we-are/integrity-innovations> (last visited Jul. 12, 2024).+(last+visited+Jul.+12,+2024).>Google Scholar
Find a Doctor, Cleveland Clinic, available at <https://my.clevelandclinic.org/staff> (last visited Jul. 28, 2024).+(last+visited+Jul.+28,+2024).>Google Scholar
Derwin, K., Annand, C., Rose, S., et al., “Conflicts of Interest in Clinical Practice: Cleveland Clinic Policy and Experience,” Journal of Law, Medicine, & Ethics 52, no. 3 (2024): 732740.CrossRefGoogle Scholar
5. The web page includes standard text as a preface to all the individual information about a particular physician’s relationship. See, for e.g., Leonard Calabrese, D.O., available at <https://my.clevelandclinic.org/staff/337-leonard-calabrese#industry-content> (last visited September 19, 2024).+(last+visited+September+19,+2024).>Google Scholar
Liebrand, W.B., Messick, D.M., and Wolters, F.J., “Why We Are Fairer Than Others: A Cross-Cultural Replication and Extension,” Journal of Experimental Social Psychology 22, no. 6 (1986): 590604.CrossRefGoogle Scholar
Source: Cory Anand, Cleveland Clinic.Google Scholar
Milgram, S., Obedience to Authority (New York: Harper and Row, 1974); R.B. Caldini, Influence: Science and Practice (New York: Harper Collins, 1993).Google Scholar
Gibbons, R.V., Landry, F.J., Blouch, DL, et al., “A Comparison of Physicians’ and Patients’ Attitudes Toward Pharmaceutical Industry Gifts,” Journal of General Internal Medicine 13, no. 3 (1998): 151154.CrossRefGoogle ScholarPubMed
Wilson, T.D. and Brekke, N., “Mental Contamination and Mental Correction: Unwanted Influences on Judgements and Evaluations,” Psychological Bulletin 116, no. 1 (1994): 117142.CrossRefGoogle ScholarPubMed
Field, M.J. and Lo, B., eds., “Conflict of Interest in Medical Research, Education, and Practice,” (Washington DC: National Academies Press, 2009); American Association of Medical Colleges, In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making, AAMC Report of the Task Force on Financial Conflicts of Interest in Clinical Care (June, 2010).Google Scholar
Rose, S.L., Sah, S., Dweik, R., et al., “Patient Responses to Physician Disclosures of Industry Conflicts of Interest: A Randomized Field Experiment,” Organizational Behavior and Human Decision Process 166 (2021): 2738.CrossRefGoogle Scholar
R. Abelson and S. Saul, “Ties to Industry Cloud a Clinic’s Mission,” New York Times, December 17, 2005; R. Abelson and A. Pollack, “Patient Care vs. Corporate Connections,” New York Times, January 25, 2005; R. Abelson, “Cleveland Clinic Moves to Fight Conflicts of Interest,” New York Times, May 9, 2006; R. Abelson, “Cleveland Clinic Discloses Doctors’ Industry Ties,” New York Times, December 2, 2008.Google Scholar
D. Armstrong, “How a Famed Hospital Invests in Devics it Uses and Promotes,” Wall Street Journal, December 12, 2005.Google Scholar
B. McLeran, “A Bitter Pill for One Merck Critic,” Fortune Magazine, December 13, 2004.Google Scholar
See Abelson, “Cleveland Clinic Moves to Fight Conflicts of Interest,” supra note 12.Google Scholar
See Abelson and Pollack, supra note 12.Google Scholar
See Abelson and Saul, supra note 12.Google Scholar
See Cleveland Clinic, supra note 1.Google Scholar
Rodwin, M.A., “The Organized American Medical Profession’s Response to Financial Conflicts of Interest: 1890-1992,” The Milbank Quarterly (1992): 703741 .CrossRefGoogle ScholarPubMed
Relman, A.S., “The New Medical-Industrial Complex,” New England Journal of Medicine  303, no. 17 (1980): 963970 ; A.S. Relman, “Dealing with Conflicts of Interest,” New England Journal of Medicine 310, no. 18 (1984): 1182–1183.CrossRefGoogle ScholarPubMed
Moore v. Regents of University of California, 51 Cal. 3d 120 (1990); M.M. Mello, D.M. Studdert, and T.A. Brennan, “The Rise of Litigation in Human Subjects Research,” Annals of Internal Medicine 139, no. 1 (2003): 40–45.Google Scholar
Kolber, M.J., “Stark Regulation: A Historical and Current Review of the Self-Referral Laws,” HealthCare and Ethics Committee Fourm  18 , no. 1 (2006): 6184.Google ScholarPubMed
Kusserow, R.P., “The Medicare & Medicaid Anti-Kickback Statute and the Safe Harbor Regulations - What’s Next?” Health Matrix  2 , no. 1 (1992): 4970.Google ScholarPubMed
United States v. Greber, 760 F.2d 68 (3rd Cir. 1985).Google Scholar
American Medical Association Council on Ethical and Judicial Affairs, Conflicts of Interest, Report A (1-86) (December, 1986); American Medical Association Council on Ethical and Judicial Affairs, Current Opinions, sections 4.05, 8.03, and 8.12 (October, 1986).Google Scholar
Id.; Pharmaceutical Research and Manufacturer’s Association, Code on Interactions with Health Care Professionals (August 6, 2021), available at <https://phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/P-R/PhRMA-Code---Final.pdf> (last visited Jul. 28, 2024).+(last+visited+Jul.+28,+2024).>Google Scholar
Department of Health and Human Services Office of Inspector General Compliance Program Guidance for Pharmaceutical Manufacturers, 68 Fed. Reg. 23,731 (May 5, 2003).Google Scholar
U.S. Senten’g Guidelines Manual ch. 8, cmt. n.1 (U.S. Sent’g Comm’n 2004).Google Scholar
Moore v. Regents of University of California, 51 Cal. 3d 120 (1990).Google Scholar
Moore, op. cit., p. 131–32.Google Scholar
Studdert, D.M., Mello, M.M., Brennan, T.A., “Financial Conflicts of Interest in Physicians’ Relationships with the Pharmaceutical Industry—Self Regulation in the Shadow of Federal Prosecution,” New England Journal of Medicine. 315, no.18 (2004): 18911900.CrossRefGoogle Scholar
Emanuel, E.J. and Steiner, D., “Institutional Conflict of Interest,” New England Journal of Medicine  332, no. 4 (1995): 262268 . CrossRefGoogle ScholarPubMed
Rodwin, M.A., Medicine, Money, and Morals: Physicians’ Conflicts of Interest (USA: Oxford University Press, 1995): at 821.Google Scholar
Rodwin, M.A., Conflicts of Interest and the Future of Medicine: The United States, France, and Japan (USA: Oxford University Press, 2011): at 8–11; M.A. Rodwin, “Conflict of Interest in the Pharmaceutical Sector: A Guide for Public Management,” DePaul Journal of Health Care Law 21, no. 1 (2019). CrossRefGoogle Scholar
Grunder, T.M., “On the Readability of Surgical Consent Forms,” New England Journal of Medicine, 302, no. 16 (1980): 900902.CrossRefGoogle Scholar
Rodwin, M.A., “Physicians’ Conflicts of Interest: The Limitations of Disclosure,” New England Journal of Medicine 321, no. 20 (1989): 14051408; See Rodwin, supra note 36 at 213-219; See Rodwin, Conflicts of Interest and the Future of Medicine: The United States, France, and Japan, supra note 38, at 215–219.CrossRefGoogle ScholarPubMed
Moore, D.A., Cain, D.M, Lowenstein, G. et al, Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy (Cambridge: Cambridge University Press, 2005); D.M. Cain, G. Lowenstein, D.A. Moore, “The Dirt on Coming Clean: Perverse Effects of Disclosing Conflicts of Interest,” Journal of Legal Studies 34, no. 1 (2005): 1–25.CrossRefGoogle Scholar
Olson, S., Berger, A.C., Beachy, S.H. et al., Conflicts of Interest and Medical Innovation: Ensuring Integrity While Facilitating Innovation in Medical Research (Washington, DC: National Academies Press, 2014).Google Scholar
Olson, op. cit., p. 48.Google Scholar
Olson, op. cit., p. 3.Google Scholar
Olson, op. cit., p. 6.Google Scholar
See Rodwin, Conflicts of Interest and the Future of Medicine: The United States, France, and Japan, supra note 38, at 151–53; See Rodwin, supra note 36, at 130–34.Google Scholar
See Olson, supra note 46, at 44.Google Scholar
See Rodwin, supra note 40, at 106.Google Scholar
Charles, M.D., “Selling Drugs by ‘Educating’ Physicians,” Journal of Medical Education 36, no. 1 (1961): 123.Google Scholar
Relman, A.S., “Separating Continuing Medical Education from Pharmaceutical Marketing,” JAMA 285, no. 15 (2001): 20092012.CrossRefGoogle ScholarPubMed
Steinman, M.A., Bero, L.A., Chren, M., et al., “Narrative Review: The Promotion of Gabapentin: An Analysis of Internal Industry Documents,” Annals of Internal Medicine 145, no. 4 (2006): 284293; S. Sismondo, “Key Opinion Leaders and the Corruption of Medical Knowledge: What the Sunshine Act Will and Won’t Cast Light On,” The Journal of Law, Medicine & Ethics 41, no. 3 (2013): 635–640; US Department of Justice Office of Public Affairs, Press Release, GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data (July 2, 2012), available at <https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-and-pay-3-billion-resolve-fraud-allegations-and-failure-report> (last visited July 28, 2024); US Department of Justice Office of Public Affairs, “Opioid Manufacturer Insys Therapeutics Agrees to Enter $225 Million Global Resolution of Criminal and Civil Investigations,” June, 5, 2019, available at <https://www.justice.gov/opa/pr/opioid-manufacturer-insys-therapeutics-agrees-enter-225-million-global-resolution-criminal> (last visited July 28, 2024).CrossRefGoogle ScholarPubMed
Mitchell, AP., Trivedi, N.U., Gennarelli, R.L., et al., “Are Financial Payments from the Pharmaceutical Industry Associated with Physician Prescribing? A Systematic Review,” Annals of Internal Medicine 174, no. 3 (2021): 353361.CrossRefGoogle ScholarPubMed