Counterpoint - Physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed

Study Design. Review of the nature of conflicts of interest in physician-industry relationships, with a focus on the efforts to ethically manage physician-industry relationships. Objective. To illustrate the perspective that physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed. Summary of Background Data. The interest in considering the appropriateness of physician-industry relationships has recently become focused on spine surgery. Many of the conflicts of interest inherent to these relationships have been interpreted as problematic, and have been scrutinized by the media, industry, medical and legal professions, and Federal government. Methods. The basis for conflicts of interest, manner in which bias may be introduced, and methods to reduce bias are presented. The potential risks and benefits to patients that are inherent to physician-industry relationships are considered. A framework, developed by medical ethicists, is provided to guide analysis of conflicts of interest in physician-industry relationships. Results. Collaboration between spine surgeons and industry is necessary to improve patient care. The conflicts of interest that often arise in physician-industry relationships must be recognized, and keenly managed in order to eliminate the risk and maximize the benefit to the patient. Ethical management of conflicts must include disclosure. To preserve patient autonomy, management should also include a discussion of the quality of the medical evidence on which treatment recommendations are made. Guidelines from industry and medical professional organizations, including the "Standards of Professionalism" currently under development by the American Academy of Orthopedic Surgery, are also expected to aid in the ethical establishment and management of conflicts of interest. Conclusions. Careful consideration of conflicts of interest in physician-industry relationships has provided an opportunity to review our goals as physicians in society, and to continue collaborative advancement of our field for the benefit of our patients.