The report given to Martin Hirsch, director of the AP-HP, on conflicts of interest recommends supervising the training, research and related activities of doctors.
Some of the 10,000 doctors from the Assistance Publique des Hospitals de Paris (AP-HP) are in a “risky situation” in the face of conflicts of interest that exist between the medical profession and the drug industry, according to the report. for the public institution. To prevent professionals from placing themselves, “voluntarily or in spite of themselves” in such situations, the authors wish to modify practices. Ancillary activities, conferences, medical representatives and funds intended for clinical trials are in particular in their sights.
The report rules out any attempt to isolate hospitals from industry, which would be an obstacle to their primary mission: “to contribute to medical progress, to its dissemination and to making it available to the greatest number”. Nevertheless, “it is no longer just a question of feeling in all conscience free from conflicts of interest, but also of convincing everyone that we are,” add the authors. From then on, old uses which could appear without risk must now be either banned or adapted ”.
“A university hospital center (CHU) has a triple mission: care, teaching and research”, we can still read. Each of them is a potential target for conflicts of interest. The report’s proposals emphasize three general points.
Monitor ancillary activities
AP-HP is also a producer of expertise. The case of Professor Michel Aubier has shown this recently. The head of the pneumology department at Bichat hospital in Paris, omnipresent in the media, was singled out for an undeclared ancillary activity at Total.
This accumulation must be more strictly supervised. The report stipulates that the time spent, the remuneration and the nature of the services performed must be compatible with the hospital practice and the interests of the AP-HP.
More precisely, these external activities must receive authorization from the university, which will define their nature: it will concern the doctor independently, or will be the subject of a direct agreement with the AP-HP. In the first case, the timetable must be respected (5 to 10 hours per week at most, for 41 half-days of absence per year).
Supervise research
In-depth work was carried out in the 2000s on the declaration of possible conflicts of interest of authors of scientific articles, but the influence of laboratories is still being felt on research, notably estimated the World Health Organization in a report of 2009.
Within the AP-HP, service associations are the Achilles heel. These small structures – whose number exceeds 400 according to Martin Hirsch, president of the AP-HP – receive funding from laboratories for clinical studies. Researchers can access it flexibly, for example to recruit research staff.
But the management of these funds can be a little hidden, say the authors of the report. They advise using the AP-HP hospital foundation, created at the end of last year to collect funding and reallocate it to research teams, in a more equitable and transparent manner. A transition should be made gradually, until the end of 2017, said Martin Hirsch.
Monitor training
There remains an important project, perhaps the most risky for doctors. Continuing education and information are undoubtedly the least controlled areas.
The report advises an overhaul of the system of medical representatives. It refers to a survey carried out among interns cardiology, two-thirds of whom said they were offered meals by medical laboratories at their workplaces several times a semester, and more than half of whom said they were regularly invited away from the service. In total, they saw an average of seven medical visitors per month.
“Spontaneous approaches to doctors, and more and more nurses, must stop,” said Martin Hirsch in an interview with the World. We are therefore going to modify the AP-HP regulations to better regulate them ”.
Medical information also relies on opinion leaders. Present in the media for information to the general public, but also in congresses and in specialized media, they have an enormous influence on the financial results of pharmaceutical companies. Their declarations of interests must be broadened, better supervised, and more rigorous.
Finally, continuing education, through medical congresses, exposes medical personnel to disguised gifts. “E98% of it is funded in France by the pharmaceutical industry (covering in particular the costs of conferences, travel, purchase of scientific documentation, e-learning, etc.). The details of this funding remain opaque, says the report. It would be in a range of 300 to 600 million euros.
For the AP-HP, the envelope would amount to 30 to 40 million euros per year. According to the report, a neutral third party should be introduced between manufacturers and practitioners, who would define “the profiles of the practitioners concerned by a congress and the terms of support”. The report also raises the question of partial financing on the part of professionals, and wishes to encourage the development of videoconferencing means.
.