Guidelines for Corporate Relationships
Principles to guide AMA's relationships with corporate America were adopted by the AMA House of Delegates at its December 1997 meeting and slightly modified at its June meeting. Subsequently, they have been edited to reflect the recommendations from the Task Force on Association/Corporate Relations, including among its members experts external to the AMA. The following principles are based on the premise that in certain circumstances, the AMA should participate in corporate arrangements when guidelines are met, which can further the AMA's core purpose, retain AMA's independence, avoid conflicts of interest, and guard our professional values. The AMA House of Delegates adopted these revised principles at its June 1999 meeting. The following updated principles were adopted at the June 2002 meeting.
Overview of Principles
The American Medical Association's principles to guide corporate relationships have been organized into the following categories: General Principles that apply to most situations; Special Guidelines that deal with specific issues and concerns; Organizational Review that outlines the roles and responsibilities of the Board of Trustees, Executive Vice President, the Corporate Review Team and other staff units; and Operational Issues that outline the annual reports to the Board of Trustees (BOT) and House of Delegates (HOD). These guidelines should be reviewed over time to assure their continued relevance to the policies and operations of the AMA and to our business environment. The principles should serve as a starting point for anyone reviewing or developing AMA's relationships with outside groups.
General Principles
The AMA's vision and values statement should provide guidance for externally funded relationships. Relations that are not motivated by the association's mission threaten the AMA's ability to provide representation and leadership for the profession.
1. The AMA's vision and values must drive the proposed activity.
The AMA's vision and values ultimately must determine whether a proposed relationship is appropriate for the AMA. The AMA should not have relationships with organizations or industries whose principles, policies or actions obviously conflict with the AMA's vision and values. For example, relationships with producers of products that harm the public health (e.g., tobacco) are not appropriate for the AMA. In general, rather than responding to others, the AMA will proactively choose its priorities for external relationships and participate in those that fulfill these priorities.
2. The relationship must preserve or promote trust in the AMA and the medical profession.
To be effective, medical professionalism requires the public's trust. Corporate relationships that could undermine the public's trust in the AMA or the profession are not acceptable. For example, no relationship should raise questions about the scientific content of the AMA's health information publications, AMA's advocacy on public health issues, or the truthfulness of its public statements.
3. The relationship must maintain the AMA's objectivity with respect to health issues.
The AMA accepts funds or royalties from external organizations only if acceptance does not pose a conflict of interest and in no way impacts the objectivity of the association, its members, activities, programs or employees. For example, exclusive relationships with manufacturers of health-related products marketed to the public could impair the AMA's objectivity in promoting the health of America. The AMA's objectivity with respect to health issues should not be biased by external relationships.
4. The activity must provide benefit to the public's health, patients' care, or physicians' practice.
Public education campaigns and programs for AMA or Federation members are potentially of significant benefit. Corporate-supported programs that provide financial benefits to the AMA but no significant benefit to the public or direct professional benefits to AMA or Federation members are not acceptable. In the case of member benefits, external relations must not detract from AMA's professionalism.
Special Guidelines
The following guidelines address a number of special situations where the AMA cannot utilize external funding. There are specific guidelines already in place regarding advertising in publications.
1) The AMA will provide health and medical information, but should not involve itself in the production, sale, or marketing to consumers of products that claim a health benefit.
Marketing health-related products (e.g., pharmaceuticals, home health care products) undermines the AMA's objectivity and diminishes its role in representing healthcare values and educating the public about their health and healthcare.
2) Activities should be funded from multiple sources whenever possible.
Activities funded from a single external source are at greater risk for inappropriate influence from the supporter - or the perception of it, which may be equally damaging. For example, funding for a patient education brochure should be done with multiple sponsors if possible. For the purposes of this guideline, funding from several companies, but each from a different and non-competing industry category (e.g., one pharmaceutical manufacturer and one health insurance provider), does not constitute multiple-source funding. The AMA recognizes that for some activities the benefits may be so great, the harms so minimal, and the prospects for developing multiple sources of funding so unlikely that single-source funding is a reasonable option. Even so, funding exclusivity must be limited to program only (e.g., asthma conference) and shall not extend to a therapeutic category (e.g., asthma). The Board should review single-sponsored activities prior to implementation to ensure that: a) reasonable attempts have been made to locate additional sources of funds (for example, issuing an open request for proposals to companies in the category); and b) the expected benefits of the project merit the additional risk to the AMA of accepting single-source funding. In all cases of single-source funding, the AMA will guard against conflict of interest.
3) The relationship must preserve AMA's control over any projects and products bearing the AMA name or logo. The AMA retains editorial control over any information produced as part of a corporate/externally funded arrangement.
When an AMA program receives external financial support, the AMA must remain in control of its name, logo and AMA content, and must approve all marketing materials to ensure that the message is congruent with the AMA's vision and values. A statement regarding AMA editorial control as well as the name(s) of the program's supporter(s) must appear in all public materials describing the program and in all educational materials produced by the program. (This principle is intended to apply only to those situations where an outside entity requests the AMA to put its name on products produced by the outside entity, and not to those situations where the AMA only licenses its own products for use in conjunction with another entity's products.)
4) Relationships must not permit or encourage influence by the corporate partner on the AMA.
An AMA corporate relationship must not permit influence by the corporate partner on AMA policies, priorities, and actions. For example, agreements stipulating access by corporate partners to the House of Delegates or access to AMA leadership would be of concern. Additionally, relationships that appear to be acceptable when viewed alone may become unacceptable when viewed in light of other existing or proposed activities.
5) Participation in a sponsorship program does not imply AMA's endorsement of an entity or its policies.
Participation in sponsorship of an AMA program does not imply AMA approval of that corporation's general policies, nor does it imply that the AMA will exert any influence to advance the corporation's interests outside the substance of the arrangement itself. The AMA's name and logo should not be used in a manner that would express or imply an AMA endorsement of the corporation or its policies.
6) To remove any appearance of undue influence on the affairs of the AMA, the AMA should not depend on funding from corporate relations for core governance activities.
Funding core governance activities from corporate sponsors, ie., the financial support for conduct of the House of Delegates, the Board of Trustees and Council meetings could make the AMA become dependent on external funding for its existence or could allow a supporter, or group of supporters, to have undue influence on the affairs of the AMA.
7) Funds from corporate relations must not be used to support political advocacy activities.
A full and effective separation should exist, as it currently does, between political activities and corporate funding. The AMA should not advocate for a particular issue because it has received funding from an interested corporation. Public concern would be heightened if it appeared that the AMA's advocacy agenda was influenced by corporate funding.
Organizational Review
Every proposal for an AMA corporate relationship must be thoroughly screened prior to staff implementation. Currently, all proposed corporate arrangements are reviewed by a cross-disciplinary group of senior managers called the Corporate Review Team (CRT). CRT recommendations that meet certain criteria requiring further review are forwarded to a committee of the Board of Trustees. The full Board reviews any proposals that meet defined criteria for a heightened level of scrutiny.
1) All AMA corporate arrangements will be annually reported by the Board of Trustees to the House of Delegates at the Interim meeting in December.
It is important for the AMA to have an orderly and predictable reporting process to the Board and the House of Delegates. The Board of Trustees will present a summary report to the House of Delegates at each Interim meeting.
2) Every new AMA Corporate relationship must be approved by the Board of Trustees, or through a procedure adopted by the board.
Every new AMA Corporate relationship must be approved by the Board of Trustees, or through a procedure adopted by the Board. Specific procedures and policies regarding Board review are as follows: (1) The Board routinely should be informed of all AMA corporate relationships; (2) The Board should perform an annual audit of an appropriate sample of AMA corporate relations activities; (3) Upon request of a dissenting member of the CRT, any dissenting votes within the CRT, and instances when the CRT and the Board committee differ in the disposition of a proposal, are brought to the attention of the full Board; (4) All externally supported corporate activities directed to the public, except patient materials linked to CME, should receive Board review and approval; (5) All activities that have support from only one corporation within an industry should either be in compliance with ACCME guidelines or receive Board review; and; (6) All relationships where the AMA takes on a risk of substantial financial penalties for cancellation should receive Board review prior to enactment.
3) The Executive Vice President is responsible for the review and implementation of each specific arrangement according to the previously described principles.
The Executive Vice President is responsible for obtaining the Board of Trustees authorization for externally funded arrangements that have an economic and/or policy impact on the AMA.
4) The Corporate Review Team reviews corporate arrangements to ensure consistency with the principles and guidelines.
The Corporate Review Team is the internal, cross-organizational staff group that is charged with the review of all activities with external funding to assure adherence to the guidelines.
The Corporate Review Team is chaired by the Senior Vice President, Governance and Operations and composed of senior managers from Ethics Standards; Legal; Finance; Communications; Publishing; AMA Bookstore; Membership; Advocacy and Science.
The review process is structured to specifically address issues pertaining to AMA's policy, ethics, business practices, corporate identity, and reputation. Written procedures formalize the committee's process for review of corporate arrangements.
All activities placed on the Corporate Review Team agenda have had the senior manager's review and consent, and following CRT approval will continue to require the routine approvals of the Office of Finance and Office of the General Counsel.
The Corporate Review Team reports its findings and recommendations directly to a committee of the Board.
5) The AMA's Office of Risk Management in consultation with the Office of the General Counsel will review and approve all marketing materials that are prepared by others for use in the US and that bear the AMA's name and/or corporate identity.
All marketing materials will be reviewed for appropriate use of AMA's logos and trademarks, perception of implied endorsement of the external entity's policies or products, unsubstantiated claims, misleading, exaggerated or false claims, and reference to appropriate documentation when claims are made. In the instance of international publishing of JAMA and the Archives, the AMA will require review and approval of representative marketing materials by the editor of each international edition in compliance with these principles and guidelines.
Organizational Culture and its Influence on Externally Funded Programs
Organizational culture has a profound impact on whether and how AMA corporate relationships are pursued. AMA activities reflect on all physicians. Moreover, all physicians are represented to some extent by AMA actions. Thus, the AMA must act as the professional representative for all physicians, and not merely as an advocacy group or club for AMA members.
As a professional organization, the AMA operates with a higher level of purpose representing the ideals of medicine. Nevertheless, non-profit associations today do require the generation of non-dues revenues. The AMA should set goals that do not create an undue expectation to raise increasing amounts of money. Such financial pressures can provide an incentive to evade, minimize, or overlook guidelines for fundraising through external sources.
Every staff member in the association must be accountable to explicit ethical standards that are derived from the vision and values of the association. In turn, leaders of the AMA must recognize the critical role the organization plays as the sole nationally representative professional association for medicine in America. AMA leaders must make programmatic choices that reflect a commitment to professional values and the core organizational purpose.
