For the good of my patients

In every house where I come, I will enter only for the good of my patients.   – The Hippocratic Oath.

At first blush, this moral imperative would appear to be a truism.   And yet every day, it is violated with complete impunity.  

 Whenever, in my capacity as a physician, I encounter my patient – “enter his house,” so to speak – do I really interact with him only in his own best interests, or do I also carry with me a number of ulterior, and hidden, motives? My patient presumes that I am acting exclusively in his interests.   That is why he trusts me.   He trusts me with his health, his well-being, his very life.   He trusts me.   And that is why I should regard that trust as a sacred thing, and do whatever I can to protect it and preserve it.

Yet we are constantly reminded at every turn that all too often the well-being of the patient is not the only concern that preoccupies physicians.   In the world of contemporary medicine, commercial interests have encroached upon every aspect of professional activity, not only in the domain of clinical practice, but in those of research and education, as well.   Unfettered and unregulated, such a pervasive influence of industry threatens to undermine the very sanctity of the physician-patient relationship upon which sound and ethical medical practice is based.

Recognizing this danger, the Council of Medical Specialty Societies recently drew up a document entitled the Code for Interactions with Companies.   The CMSS task force responsible for creating this Code has proposed ethical guidelines which should govern the activities of professional health societies wherever they interface with commerce.   For example, there should be no quid pro quo in accepting charitable contributions or educational grants from commercial interests, nor should these interests have any voice in determining the contents of the presentations given at society meetings.   Research topics will be decided by the society independently of any company which offers to provide financial support.   Companies that provide research grants will have no control over manuscript contents, and they will not be permitted to claim property rights over them.   No direct commercial support for clinical practice guidelines will be allowed.  

Transparency plays a central role in the CMSS Code.   “Key leaders” of a society should be required to disclose to the members of the society and to the general public any relationships they may have with industry.   In like manner, all contributions made by industry in any capacity to support the activities of the society must be disclosed.   Written policies and procedures should be put in place for managing any real or perceived conflict of interests encountered in the course of society activities.  

The board of directors of the Academy of Breastfeeding Medicine has voted to endorse the CMSS Code, which will soon be posted on the ABM website.   The ABM ethics committee has been working for more than a year to develop policies and procedures whereby the integrity of the Academy can be protected vis a vis its transactions with industry.   These procedures will be entirely consonant with the principles enumerated in the CMSS Code.   In addition, the ethics committee statement will highlight the special importance of the WHO Code of Marketing of Breast-milk Substitutes in protecting medical education and research from the influence of the infant formula industry.

The CMSS Code represents a momentous step forward in preserving the independence of medical practice, education and research.   The Academy of Breastfeeding Medicine endorses this statement enthusiastically.   Our patients should expect no less from us.

Jerry Calnen, MD, is a pediatrician and is president of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.