or indirect ownership shares in the facility (MedPAC, 2009; see further discussion in Chapter 6). The provision of recommendations on conflicts of interest arising from physician ownership of facilities was outside this committee’s charge. The reporting program proposed by MedPAC would make considerable additional information available to researchers, patients, and others.

A discussion of the pros and cons of establishing a broader system of disclosure is presented in Appendix F.

Recommendations in the Following Chapters

The recommendations in this chapter call for institutions to adopt conflict of interest policies consistent with the recommendations in this report and for individual and cooperative institutional efforts and legislative actions to strengthen policies on the disclosure of individual and institutional financial relationships with industry. The next four chapters of this report offer additional recommendations related to policies and practices in the specific areas of medical research, medical education, patient care, and the development of clinical practice guidelines. Chapter 4 calls for institutions to generally bar researchers with a conflict of interest from conducting research with human participants except when the investigator’s expertise is essential to the safe and rigorous conduct of the research. Chapters 5 and 6, among other recommendations, call for physicians and researchers to forgo and institutions to prohibit or end certain relationships with industry that present unacceptable risks of undue influence over professional decision making or a loss of public trust.

Chapter 7 includes recommendations for reducing industry influence in the development of clinical practice guidelines and increasing the levels of disclosure of organizational and individual financial relationships. Chapter 8 recommends that institutions establish policies at the board level to identify, limit, and manage institution-level conflicts of interest. The final chapter calls for a range of organizations to develop incentives to promote the institutional adoption and implementation of the policies recommended here. It also calls for the development of a research agenda to evaluate and guide improvements in conflict of interest policies and procedures.

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