Udayan K. Shah, MD

Academy members are facing increasing pressure as they balance interactions with device and drug manufacturers, maintain corporate funding sources to support research and educational efforts, and experience greater public scrutiny.

The effects of this pressure and ways to effectively deal with it were the topics of "Walking the Line: Ethical Engagement with Industry."

Udayan K. Shah, MD, chair of the AAO-HNSF medical devices and drugs committee, said there is plenty of literature supporting the real and perceived bias associated with gifts.

Eric Campbell, PhD, associate professor of medicine at Harvard Medical School, conducted a study in 2007 that found that 94 percent of doctors reported some type of relationship with the pharmaceutical industry, whether it was drug samples to CME support.

"In my personal opinion, we are otolaryngologists, but we're still human," Dr. Shah said. "We have to be very cautious and honest with ourselves and to each other."

The interactive course shared information and prior cases with physicians considering or already involved with industry relationships, such as non-disclosure agreements, product development, and speakers bureaus.

Attendees also heard recommendations that maximize patient benefit from new products, minimize legal risk, and optimize physician involvement and compensation. They learned about the concept of "risk tolerance" and the proper process for safe and ethical evaluation of devices and drugs.

"Why does this matter?" Dr. Shah said. "It affects patient perception when grandma cannot afford Cardizem and the doctor is walking around with a Cardizem briefcase, or in our case. Your reputation is at risk. There are industry-wide costs, which are huge. Most worrisome . . . we're in big trouble if Standard and Poor's rates us poorly and our endowment—meaning our salaries—goes away. You can go to jail, you can be excluded for healthcare coverage, you could lose your license, and you can have other penalties as well."

Attendees were given a number of scenarios that tested their ethical stance. They were able to select the most ethical response with a handheld "clicker" from their chair.

Gordon J. Siegel, MD, put the topic in another perspective—that of the "free lunch."

"In the United States there are approximately 850,000 physicians," he said. "If each one of those physicians were to accept one lunch for $10 per week that would be $8.5 million dollars a week spent on free lunch. If you look at that in terms of a year that's $442 million a year in free lunch—money that could be going to patients who can't afford medication, people who can't afford food. And if a physician wants to be really generous, he'll feed his staff, too. Now we're up to $2.2 billion for the cost of free lunch."

He then cited various sources explaining how the country's middle class is increasingly having to put other needs before prescription medication.

"People are having to choose between gas, meals and medication," Dr. Siegel said. "Do we really want our free lunch?"