Say you need a hip replacement. If your doctor at the large, well-reputed university hospital recommends a particular brand of artificial hip that he happened to invent, and therefore might be collecting royalties on, should he be required to tell you? The Association of American Medical Colleges (AAMC) thinks so. In late June, the AAMC issued a report recommending that teaching hospitals establish mechanisms to disclose any ties to industry that their physicians have that could potentially have an impact on their clinical practice.

“Many medical centers have conflict-of-interest policies that govern research and corporate relations; however, less than one percent have adopted policies that define conflict of interest in clinical care,” AAMC chief medical officer Joanne Conroy said in a 30 June teleconference with members of the press.

One of the members of that one percent is the Washington University School of Medicine (WUSM) in St. Louis, which adopted a stringent clinical conflict-of-interest policy in 2006. Under these rules, doctors must disclose potential financial conflicts of interest to the university, which publishes information on any industry relationship that nets a physician more than $10,000 annually on its medical practice website.

Before recommending the use of an implantable medical device, physicians have to inform the patient if they have a relationship to the manufacturer. In some cases, ties to pharmaceuticals or other products must also be disclosed. Furthermore, doctors at WUSM cannot receive any royalties from devices, drugs or any other medical care product used on WUSM patients (even if the device is recommended by another doctor). Those that fail to comply with the policy can have their clinical privileges suspended, professional liability insurance coverage withdrawn and salary or bonus reduced.

“Academic institutions should be leaders in ensuring professional integrity and preserving public trust,” says WUSM vice chancellor James Crane, the architect of the clinical conflict of interest policy. “We are also entrusted with educating future generations of physicians, and it is important that our faculty serve as role models for those we train.”

The AAMC's guidelines don't go so far as to recommend prohibiting the collection of royalties but suggest that hospitals make good faith efforts to let patients know their doctor could benefit financially from prescribing a particular method of care. It's up to the institution to decide how to handle disclosure. That could mean publishing the information on a website or disclosing the information to the patient when they register at the hospital. But the guidelines do not aim to discourage doctors from working with commercial health care companies.

“Partnerships between academic medical centers and industry are essential to medical innovation and create powerful collaborations that benefit patients,” Conroy said. “It's not the conflict itself; it's really the management of that conflict.”