The Downside of the Informed Consent Juggernaut

This Academy should have no interactions with the pharmaceutical industry.” This statement paraphrases a speaker at the American Academy of Pain Medicine annual 2010 meeting. Such hubris and arrogance I have come to expect from academics, especially when we are dealing with notions of conflict of interest. It is such speakers who have caused the rush to limit Health Care Professionals (HCP) interactions with the pharmaceutical industry, apparently ignoring all other potential sources of conflict of interest—e.g., sexual orientation, political commitments, professional reputation, and religious affiliation–and arguing instead that all financial conflicts of interest should be eliminated. When presented with the story that follows the speaker above had little to say. But it was obvious he hadn’t anticipated, or didn’t care about, the negative consequences of such policies.

In January of 2002 a small group of HCPs met and formed an organization dedicated to a multidisciplinary approach to the treatment of chronic pain. This group had a desire for pain treatment education but also a drive to develop a distinctive format, multidisciplinary and interactive. The Iowa Pain Institute (IPI), a nonprofit educational organization, was born out of this desire and drive. I was one of a small group of individuals who founded the Iowa Pain Institute. Never wanting it to be “my group,” I declined to accept the presidency. I, and the other founders, wanted this group to be autonomous of its founders, something that would continue without our input and help, a goal almost achieved. Further, although some of us were academically affiliated (I consider myself a “recovering academic”) we wanted the group to be free of the conflicts of interest involved in such an affiliation.

The group and its events grew way beyond the expectations of its founders. For eight years this group operated monthly with a regular attendance of over 50 individuals. The group’s goals and mission were to develop a multidisciplinary interactive setting for education and investigation into the treatment of chronic pain. Chiropractors, nutritionist, physicians, nurse practitioners, physical therapist, nurses, physician assistants and others attended. The physician group was a mix as well–neurologists, pain physicians, anesthesiologists, surgeons, physical medicine and rehabilitation physicians, internal medicine physicians, family practitioners and others. The format for the monthly meetings consisted of a formal presentation on a disease state with case studies. These were interspersed with a journal club format.

The pharmaceutical industry funded these meetings; however, it was made clear that the content was the sole responsibility of IPI and its leadership. Not once in our eight–year history was there any pressure or pushback on content from the industry representatives who so generously sponsored our events. The industry proved generous, compliant with our group’s policies and more than willing to help our group with its goals and mission. As an example, a meeting might focus on osteoarthritis. The speaker would present an overview of the disease of osteoarthritis, then present one or more cases including x–rays. An in depth discussion would ensue suggesting different approaches, pharmaceutical and well as non–pharmaceutical.

The members would meet at a local restaurant at 6 P.M. for networking time followed by the meeting at 7 P.M. The meeting would last roughly 2–hours. There was a membership fee of $25 per–year, which allowed the members free attendance to each sponsored event. Unsponsored meetings did occur on occasion. The topics during these non–sponsored meetings were usually non–pharmacologic, e.g., the physiology behind Chiropractic Medicine. The leadership was voluntary, consisting of a President, Vice–President, Secretary and Treasurer. During the hours before the actual meeting, members were able to discuss with health care professionals with whom they might have little, if any, interaction during their work day. Cases were discussed; treatment efficacies and new treatments were reviewed during these informal discussions. The members would then sit and the meeting would begin. The meeting was focused on education, not on organizational bureaucracy. A speaker would present an overview of a disease state. This would include epidemiology, etiology, diagnosis and treatment. On occasion there would be demonstrations of diagnostic...