Howard Brody. Professional medical organizations and commercial conflicts of interest: ethical issues. Annals of Family Medicine, 2010 Jul-Aug; 8(4): 354-8.

Financial arrangements between healthcare providers, or their professional organisations, and industry have long been a matter for ethical concern. Howard Brody, a member of the American Academy of Family Physicians (AAFP) himself, has argued strongly against the controversial financial arrangement between AAFP and the Coca-Cola (CC) Corporation. AAFP accepted funding in the name of developing patient education material on obesity from CC, a major producer of sweetened drinks that are considered to be a significant cause of obesity. The concern is whether the arrangement would create a conflict between the AAFP’s financial interest and its interest in serving public health objectives.

Brody sets out to examine the arguments by AAFP leaders in defence of their arrangement with CC, in order to separate ethical arguments from rationalisations. In the author’s opinion, the leadership of professional medical organisations is such that more such alliances, posing worrisome conflict of interest issues, are likely to take place, and these may not be easy to resolve.

Brody states that medical professional bodies must provide ethical guidelines to their members. Further, for doctors to abide by the guiding principles of their profession, the individuals managing these professional bodies must practise the highest level of professional and ethical conduct. In addition, these organisations are also the “face of the profession, and how they behave will determine to a considerable extent the degree of trust and respect that medicine earns from the general public and societal leaders”. Controversies like the one under discussion can destroy the overall credibility of medical professionals who are committed to patient and public health.

Premature accusation?

AAFP has provided counter arguments in public statements and communications with its members to justify its position. AAFP suggests that the accusation is premature to begin with. It believes that until the patient-education materials prepared are critically analysed by the public and professionals, it would be wrong to charge the organisation with conflict of interest. Brody refers to the definition of “conflict of interest” in response to this counter argument: a “… reasonable presumption that they will be tempted to put aside the primary interests in favor of a secondary set of interests”. This means that a conflict has occurred once an arrangement in favour of a “secondary interest” is made. Measures need to be taken to resolve the conflict before the public or patients are harmed.

The other party is not evil

Second, AAFP states that CC, whose “product may contribute to obesity” should not be considered as “evil” just because it is willing to fund a public awareness programme against obesity. Brody’s response is that it is not a matter of being good or evil. The basic difference in the objectives of the medical professional body (the well being of public health) and CC (selling their product) is what indicates that the arrangement has conflicting interests.

Wrong not to engage

Third, AAFP has suggested that relationships like the one between it and CC are “opportunities to change the company’s behavior for the better”. Therefore, it would be wrong to avoid such an alliance, to not engage with them. Brody is sceptical of this argument because of the large amounts of money involved. Arrangements can exist between medical organisations and corporations only if any conflict of interest is eliminated and the end result is primarily “improved public health”.

CC vs Sunbeam

Finally, AAFP has compared its case with a multimillion dollar scandal involving the American Medical Association (AMA) and Sunbeam and argued that it has taken care of the “traps” that caused AMA embarrassment. Brody rejects this argument and points out that AAFP’s consideration in this respect is to avoid the legal and public relations mistakes that AMA made, rather than “learning the key ethical lesson”.

Finally, Brody states that AAFP has made certain ethical counterarguments that support such alliances. One is based on the definition of “conflict of interest”. In AAFP’s view, proven conflicts of interest are potentially harmful, and “apparent” conflicts are not worrisome. AAFP supports a “management strategy” which calls for disclosure of conflict and managing it by establishing procedures to prevent “ill effects”. He argues that even an apparent conflict affects the public’s trust in the profession. Hence, AAFP’s line of thinking is unacceptable for organisations “that aspire to higher ethical standards of conduct”.

Brody concludes that discussions on conflict of interest must separate rationalisation from ethical arguments. The AAFP president, when announcing CC funding, called the arrangement a “consumer alliance program”. Brody describes it as a “corporate alliance program” because such plans are made primarily to look after the interests of the corporation. He states that medical organisations that enter into corporate deals are benefiting their leaders and office bearers. Such alliances harm the public health and affect public trust in medical professionals. Any organisation that makes an effort to rationalise the loss of public trust and health cannot be functioning ethically.