American Medical Association Conflict of Interest Principles - Councils, Committees, and Task Forces
The Board of Trustees has approved Conflict of Interest Principles to assist the Trustees in interpreting the AMA's Conflict of Interest Policy and Statement on Disclosure of Affiliations. The Board of Trustees has directed that Conflict of Interest Principles be established to assist Council, Committee, and Task Force Members (“Member or collectively, “Members”) in interpreting their obligations under the AMA's Conflict of Interest Policy and Statement on Disclosure of Affiliations.
Handling of Conflicts of Interests
Members of the AMA's Councils,Committees, and Task Forces have certain obligations they must fulfill to insure that a conflict of interest does not harm the interests of the Association:
A Member who has an interest in a matter under consideration by the Member’s Council, Committee or Task Force must disclose all material information regarding his or her interest. Any personal interest or affiliation with another organization should be disclosed, e.g. employment or consulting arrangements, and memberships on board of trustees or councils. Disclosure benefits the Member, as it provides a certain level of protection for the Member from a claim that he or she is not acting in the best interest of the AMA. Disclosure also provides notice to the other Council, Committee or Task Force Members of the Member's interest and potential bias.
Obligations of the Interested Member
The interested Member must act in the best interest of the Association. If the Member's personal interest or affiliation with another organization does not prevent the Member from fairly evaluating the matter before the Council, Committee, or Task Force, the Member may participate in the Council's, Committee's, or Task Force’s actions. If the Member's interest will cause the Member to take action or to try to influence other Members to take action that would benefit the Member, or the organization the Member is affiliated with, the Member's participation in Council or Committee actions should be limited. Specifically, the Member should excuse himself or herself from discussion and/or vote. In certain circumstances, it may be appropriate for the Member to resign from either the AMA Council, Committee, or Task Force or from the other organization with which he or she is affiliated.
Obligations of the Non-Interested Members
Each Member has an obligation to evaluate the opinions and recommendations made by an interested Member in light of the interest such Member holds. If a Member has an interest arising out of an affiliation with another organization, the other Members should consider that such Member may be biased by his or her affiliation. Usually, an awareness of this possible bias coupled with the ability of the non-interested Members to fairly evaluate the matter under consideration and to outvote the interested Member is sufficient to insure that the best interests of the AMA are served. If the other Members believe that a Member's interest may result in the approval of a policy or the undertaking of activity that is not in the best interest of the AMA, the other Members may raise concerns and attempt to resolve this conflict.
Examples of potential conflict of interest situations and recommended actions are set forth below. While these examples are intended to provide guidance in resolving conflicts, it is not possible to identify every potential conflict of interest situation. Therefore, these recommendations include a procedure intended to identify and resolve conflicts. Under this procedure, the Members are required to disclose their personal interests and affiliations with other organizations, and the entire Council, Committee or Task Force is informed of these affiliations and participates in resolving conflicts which arise out of such affiliations.
Examples of Conflicts of Interest
There is little guidance provided by the courts and legal and business experts in resolving conflicts arising out of affiliations with other organizations. However, concepts underlying the conflict of interest statutes and concerns raised by commentators provide a framework for analyzing potential conflict of interest situations and suggesting appropriate resolutions.
The following are examples of possible affiliations which may raise conflict of interest concerns, and recommendations for resolution of such conflicts.
In general, the recommendations can be summarized as follows:
- Affiliations with organizations with conflicting goals should be avoided.
- Affiliations with organizations that do not have a financial interest in an AMA
- policy are generally permissible.
- Affiliations with organizations that have a financial interest in an AMA policy, or that have competing business activities, raise concerns. Public advocacy and political activities also raise concerns. In these situations, limitations on a Member's affiliation or on participation in Council or Committee actions may be appropriate.
A. Position As An Officer, Trustee or Council or Committee Member With Another Organization.
AMA encourages participation on the Boards of Trustees and councils or committees of other organizations. The AMA also recognizes that Members may hold officer positions in other organizations. Participation in policy-making positions of other organizations is frequently beneficial to the AMA, as Members gain expertise and form relationships which help further the AMA's goals.
Conflicts of interest arise from these affiliations when decisions intended to further the best interests of each organization conflict. In resolving these conflicts, the predominate concern is insuring that the Member's actions in fulfilling his or her duties to another organization do not cause the Member to violate his or her duties to the AMA.
Conflicting Organizational Goals
A Member would be unable to act in the best interests of the AMA and another company if the fundamental goals of the two organizations were in conflict. Acting in the best interest of one organization would necessarily mean breaching the duty of loyalty owed to the other organization. In these situations, the Member should resign from one of the organizations.
Example 1: Member is elected to the Board of directors of a tobacco company.
Recommendation: Acting to further the goals of the tobacco company would prevent the Member from acting to further the AMA's goals on public health. The Member should resign from one of the positions.
Conflicting Goals on Major Policy Issue
A Member may hold a position with an organization that generally strives to reach the same public health goals as the AMA. The organizations can be expected to hold different positions on certain issues from time to time. Conflicts arising from an occasional difference in policy can be resolved, as discussed in the following sections. However, differences in policy on major issues, such as health system reform, may warrant special consideration.
Example 2: A Council Member is on the Board of Trustees of an insurance company. The insurance company supports a health system reform proposal that differs from the proposal supported by the Council.
Recommendation: Unlike Example 1, in this example the fundamental public health goals of the organizations are related. However, there is a difference on a significant policy issue.
Major policy positions define the goals of an organization. A Member may vote against a particular major policy position; however, if that position is approved by the Council, Committee, or Task Force and if the Member remains on the Council, Committee, or Task Force then the Member is obligated to support this major policy position.
Differences in major policy positions of the Council, Committee or Task Force and other organizations would require a Member to support conflicting positions. Under these circumstances, a Member could not fulfill his or her obligations to each organization, and, accordingly, should resign from one of the positions.
As shown in this example, however, it may be difficult to determine which policy issues are "major" policy issues sufficient to result in a Member's resignation. The AMA Board of Trustees, or the Council, Committee, or Task Force itself, may designate certain issues as major policy issues, or the Board, the Council or Committee may decide on a case by case basis whether the position of an organization with which a Member is affiliated is in such conflict with the Council's, Committee's, or Task Force’s policy that the Member should resign.
Organizations Without A Financial Interest In An AMA Policy
A Member may hold a position with a medical society or other organization that addresses issues similar to those issues addressed by the Council, Committee, or Task Force. If the medical society or other organization does not have a direct financial interest in a Council, Committee, or Task Force policy, a Member's affiliation with such organization normally will not interfere with the Member's obligations to the AMA.
Example 3: A Council Member is a member of the Board of Trustees of a medical specialty society. The specialty society has approved a policy on a specific issue that differs from the policy under consideration by the Council.
Recommendation: The AMA encourages participation by its Members in other medical organizations. The organizations can be expected to approve different policies on specific issues from time to time. In this example, the specialty society does not have a financial interest in the matter before the Council. While there may be a tangential benefit to the specialty society if the Council approves a similar policy, the benefit is likely to be too remote to affect a Member's judgment. Therefore, it is not likely that a Member will be unduly influenced by his or her affiliation with the society, and the Member should be allowed to maintain his or her affiliation with the specialty society and participate in Council actions on the issue. However, if there are indications that either the specialty society or the Member may derive a significant benefit from approval of a particular AMA policy, the Council may limit the Member's participation.
Organizations With A Financial Interest In An AMA Policy
This situation is very similar to the conflict of interest situations governed by conflict of interest statutes.
Example 4: A Council Member is a member of the Board of Directors of a pharmaceutical company. The Council is considering a policy on the direct-to-consumer advertising of prescription drugs.
Recommendation: The Council's policy could have a direct financial effect on the pharmaceutical company. As a Director of the pharmaceutical company, the Member is required to pursue the financial benefit of the pharmaceutical company. This obligation would prevent the Member from considering the AMA policy objectively. The Member should not participate in the vote on this issue. The Council may place limitations on the Member's participation in discussion and access to information it deems confidential on this issue.
Competing Business Activities
Medical societies and other organizations with which a Member may be affiliated conduct business activities that compete with AMA's business activities. In most cases, conflicts relating to competing business activities can be resolved without requiring a Member to choose between organizations.
Example 5: A Committee Member is a member of the Board of Trustees of an organization that conducts several business activities, one or more of which compete with AMA business activities (e.g. CPT, Physician Data Base, Consumer Books, Sponsored Insurance Plans, etc.)
Recommendation: The Committee Member should not participate in the vote on any issue relating to the competing activities. The Committee may prohibit or impose limits on the Member's participation in discussion of the competing activities and on the Member's access to business plans, financial information, and other information which could harm the AMA business activity if known by a competitor.
Example 6: A Committee is established to review CPT activities. A Committee Member becomes a director of a for-profit company whose primary activity is developing and marketing coding products intended to compete with AMA's CPT products.
Recommendation: In certain circumstances, competition with a significant AMA business activity may be so direct and so potentially harmful that a Member could not fulfill his or her duties to both organizations. In this example, the sole purpose of the other organization is to compete with an AMA business activity which is the subject of the Committee. The Member would be unable to objectively perform his or her obligations on the Committee. Under such circumstances, it would be appropriate for the Member to resign from one of the positions.
B. Employment or Consulting Arrangements with Another Organization.
Participation on the AMA's Councils, Committees, and Task Forces is not intended to significantly impair employment opportunities. Restrictions on outside employment may discourage qualified physicians from seeking a position on the Councils, Committees, and Task Forces. Accordingly, employment and consulting arrangements should generally be permitted. However, certain employment or consulting activities may conflict with AMA interests and should be avoided.
Conflicting Organizational Goals
Employment or consulting arrangements with companies whose principal goals conflict with the AMA's principal goals could be detrimental and embarrassing to the AMA. These arrangements should not be permitted.
Example 7: Member is a consultant to a tobacco company.
Recommendation: Although the Member is not in a fiduciary role for the tobacco company, and may not be involved in setting policy for the company, the Member's affiliation with the tobacco company could undermine AMA's public health initiatives and present an appearance of impropriety. The Member should resign from one of the positions.
Organizations Without A Financial Interest In AMA Policy
A Member may have an employment or consulting arrangement with a medical organization, such as a state medical society or specialty society, that addresses issues similar to those addressed by the Council or Committee. Unless the Member has a personal interest in a specific policy, a Member's employment by such an organization is not likely to influence the Member in considering AMA policy.
Example 8A: Member is employed by a medical specialty society. The specialty society has approved a policy on a specific issue that differs from the policy under consideration by the Member's Council. The Member was directly involved in developing the policy for the specialty society.
Recommendation: This example raises the possibility of a personal interest that may conflict with AMA's interests. Since the Member was personally involved in developing the specialty society's policy, he or she may not be objective in considering the AMA's policy. However, the Member's opinion and knowledge on the issue may be useful to the Council in its deliberations. In these situations, the interested Member should disclose his or her participation in the development of the specialty society's policy. The other Council members should evaluate the potential bias of the Member and determine appropriate limits, if any, on the Member's participation.
Example 8B: Same as Example 8A, except the Member did not participate in developing the policy for the specialty society.
Recommendation: Since approval by an AMA Council of a certain policy will not have a direct financial effect on the specialty society, and since the Member does not have a personal interest in the policy before the Council, this affiliation probably would not prevent the Member from acting in the best interest of the AMA. In most cases the Member should be allowed to participate in Council actions. There may be instances where the Member may derive a personal benefit, e.g. increased status in the specialty society, if the Member successfully encourages the Council to adopt the same policy as the specialty society. If there are indications that the Member is acting to benefit himself or herself, the Council may limit the Member's participation.
Organizations With A Financial Interest In An AMA Policy
If a Member's employer may be affected financially by an AMA policy, the Member may have a difficult time separating the financial interest of his or her employer from AMA's interests. Similarly, if a Member's personal financial interests may be affected, the Member may not be able to separate his or her own financial interest from AMA's interests.
Example 9A: A Council Member is a consultant to a pharmaceutical company. The Council is considering a policy on the direct-to-consumer advertising of prescription drugs. Member provides consulting services on this specific issue.
Recommendation: Approval of a specific policy would financially benefit the pharmaceutical company, and could benefit the Member personally. The Member's personal interest would most likely influence the Member's consideration of the policy. The Member may consciously or inadvertently attempt to influence the Council to approve a policy favorable to the pharmaceutical company. In addition, the Member's participation would raise the appearance of impropriety to outside parties. The Member should not participate in the vote on this issue. The Council may place limitations on the Member's participation in discussion and access to information it deems confidential on this issue.
If the Member's consulting activities will frequently involve issues that will be considered by the Council, the Member should resign from either the consulting position or the Council.
Example 9B: Same as Example 9A, except that the Member's consulting activities do not relate to this issue.
Recommendation: Participation on the AMA Councils, Committees, and Task Forces is not intended to prohibit outside employment. Although approval of a certain policy on this issue would affect the pharmaceutical company financially, the Member does not have a personal interest in the policy. The Member will probably not have a strong incentive to place the financial interests of the pharmaceutical company above the interests of the AMA. Therefore, the affiliation should be permitted, and the Member should be allowed to participate in Council actions. However, if there are indications that the Member is acting in a manner to benefit the pharmaceutical company instead of the AMA, the Council may limit the Member's participation.
Example 10: An AMA Council is considering a policy on the referral of patients to physician-owned health care facilities. The Member has an ownership interest in a health care facility.
Recommendation:The Member has a direct financial interest in the issue before the Council. As the Member has made a decision to invest in such a facility, the Member has already considered the issue and made a personal decision that his or her investment is appropriate. The Member would most likely not be able to make an objective, unbiased decision on this issue. Therefore, the Member should not participate in the vote on this issue. The Member may be allowed to participate in discussion of the policy, as the Member has personal knowledge and experience which may be useful to the Council.
It is important to recognize that many of the issues that come before a Council, Committee, or Task Force could affect a Member's medical practice or personal finances. A concern about a conflict of interest arises if the Member has a direct and significant financial interest in the issue before the Council or Committee, as in this example. In most instances, the financial effect of a policy would probably not be so significant as to prevent a Member from setting aside his or her personal interest and making a fair and independent decision.
A Member may be employed by an organization which conducts business activities that compete with AMA's business activities. While this type of employment would not be permitted in for-profit corporations, such employment in a not-for-profit setting is not likely to interfere with a Member's ability to further the AMA's mission. Restrictions are appropriate, however, if the Member's employment relates directly to a competing product which is the subject of the Member's Council, Committee, or Task Force.
Example 11A: A Committee is established to review CPT activities. A Committee Member is employed by an organization that markets a coding product that competes with AMA's CPT. Member's employment involves the competing coding product.
Recommendation: The Member must act in the best interest of the AMA, which includes acting to encourage the success of AMA business activities. The Member's employment on a competing product benefits his or her employer at the expense of the AMA. The Member should resign from either the employment position or the Committee.
Example 11B: Same as Example 11A, except the Member's employment does not involve the competing coding product.
Recommendation: Since the Member does not work directly on the competing product, this employment arrangement may be permitted. The Member would be expected to maintain the confidentiality of any business plans or other information relating to the AMA's product.
C. Public Representation During Term
Special areas of concern are positions held by a Council, Committee, or Task Force Member which involve public representation and advocacy. An inherent conflict exists when a Member espouses the views of another organization, in an attempt to influence legislators, government officials, or the public, while representing the AMA. The Member's affiliation with the AMA may imply AMA endorsement or support for the position promoted by the Member on behalf of the other organization. Also, the affiliation with the AMA may be used, consciously or inadvertently, to establish credibility and to gain access to legislators or other public officials.
This conflict will arise if a Member is hired as a paid lobbyist for a specific company or for an industry. This conflict may also arise if a Member is a Trustee, council member or officer of another organization and is expected to participate in public advocacy on behalf of such other organization.
Example 12: Member is hired as a paid lobbyist for the insurance industry or pharmaceutical industry.
Example 13: Member is a member of the Board of Trustees of a medical society. The medical society asks the Member to meet with government officials and speak on behalf of a specific policy.
Recommendation: In these examples, there is a risk that the AMA may be viewed as being affiliated with another organization's policy positions. These situations may also place the Member in the difficult position of representing conflicting policies. The Member's public advocacy of a conflicting policy could undermine the AMA's efforts to promote its policy, and is likely to cause confusion in the minds of government officials and the public.
The Board of Trustees and the Member's Council, Committee, or Task Force will review these activities on a case by case basis. Activities which would be in direct conflict with an AMA policy or activity will not be permitted. If the activity would not conflict with AMA policies or activities, it may be permitted. The Board or the Council, Committee, or Task Force may place restrictions on the Member's activity to protect AMA interests, such as prohibiting the Member from promoting his or her affiliation with the AMA in conversations with government officials. The Member's affiliation with the AMA may inevitably become known during the course of the Member's public advocacy activities. The Member should clarify that he or she is not representing the AMA in conducting these activities.
In those circumstances where a Member's activities as a paid lobbyist are permitted, the Member should not vote on any issue which has been the subject of his or her lobbying activities. The Board of Trustees or the Member's Council, Committee, or Task Force may impose additional limitations on the Member's participation in Council, Committee, or Task Force action.
Example 14: Member is a member of the Board of Trustees of a medical society. The medical society approves a policy that conflicts with AMA policy. The medical society wants to inform the public of its policy, using the Member's name and affiliation with the AMA.
Recommendation: The Member should not permit the medical society to use the Member's affiliation with the AMA to promote a policy that conflicts with AMA policy.
D. Activities Following Term
A former Member's affiliation with another organization following his or her term raises a concern that the Member's prior affiliation with the AMA might be used to promote the policies of such other organization. This situation could arise if the AMA's name is used in connection with any policy of another organization, or if the former Member participates in public representation and advocacy for another organization.
The Board of Trustees has expanded the Conflict of Interest Policy to include the following restrictions on a Member's activities following the end of the Member's term:
- A former Member shall not use the AMA name or his or her affiliation with the AMA in any manner which would imply AMA support or endorsement of policies or activities of another organization.
- A former Member shall not use the AMA name or his or her affiliation with the AMA for commercial gain.
- A former Member shall not disclose confidential or proprietary information for personal or commercial gain.
- A former Member shall also refrain from disparaging the AMA. However, the expression of differences or disagreements with AMA policies that are unrelated to his or her official actions as a Member do not constitute disparagement.
These restrictions on a Member's actions following his or her term shall be a condition of the Member's acceptance of a position on an AMA Council, Committee, or Task Force. The Conflict of Interest Policy shall be distributed to candidates seeking election or appointment to the Councils, Committees, or Task Forces.
E. Affiliations of Family Members
Affiliation of a Member's family members with other organizations may raise possible conflicts of interest. For example, a Member's spouse may be employed by a medical specialty society, or a Member's child may provide consulting services to the pharmaceutical industry.
A Member shall disclose affiliations of his or her immediate family members with any health care organization or health-related professional association. The Council, Committee, or Task Force will evaluate the potential bias of the Member and determine appropriate limits, if any, on the Member's participation in Council, Committee, or Task Force actions related to any conflicting activity.
F. Political Affiliations
While the AMA encourages involvement in political activities, certain activities may conflict with the Member's fiduciary obligations to the AMA. A Member should disclose any significant political activity in which he or she is involved, or intends to become involved, including any positions for political office held or sought.
The Member's political activities are permissible if the political activity or office is compatible with the Member's AMA responsibilities. An example of a position which would likely be permissible is the Director of a State's Department of Public Health.
A Member should not hold an elected office if the Member's obligations to represent his or her constituents would conflict with the Member's obligation to represent the AMA. Further, a Member should not hold political office or participate in a political activity which requires public advocacy on health-related issues. An example of an impermissible position is a Director of the Republican or Democratic National Committee's National Health Care Campaign. This provision shall not preclude participation as an advisor on health care issues on political platform committees or other advisory committees to political parties.
A Member seeking political office during his or her term on an AMA Council, Committee, or Task Force should not use AMA resources to assist in the political campaign. The Member should not use his or her affiliation with the AMA to imply AMA endorsement of the Member's candidacy or positions on public issues without the prior approval of the AMA Board of Trustees.
In order to implement the Conflict of Interest Policy and address any potential conflicts, the following procedure is adopted:
- The Conflict of Interest Policy and these Guidelines will be distributed to all candidates seeking election or appointment to the AMA's Councils, Committees, and Task Forces.
- The Conflict of Interest Policy and these Guidelines will be distributed annually to each Member.
- Prior to October of each year, each Member should disclose all affiliations, including employment, consulting arrangements, memberships on councils and on other Boards of Trustees or Boards of Directors, and political offices. Disclosure forms will be provided by the AMA.
- A listing of all Members' affiliations will be distributed to all other Members of the Council, Committee, or Task Force prior to the October meeting each year.
- If a Member becomes affiliated with another organization, or ceases an affiliation, the Member should promptly notify the AMA. Council, Committee, and Task Force members will be notified of any changes in a Member's affiliations prior to the next Council, Committee, or Task Force Meeting.
- The Member's affiliations will be reviewed by the General Counsel to identify any potential conflicts. The General Counsel may ask a Member for additional information concerning an affiliation.
- Any Member may raise a question about a possible conflict of interest of another Member of the Council, Committee, or Task Force at any time. A Member may express his or her concern at any Council, Committee, or Task Force Meeting, or may notify the Chair of the Council, Committee, or Task Force or the General Counsel of his or her concern.
- The Chair and the General Counsel will recommend any necessary action to resolve a conflict of interest. The Chair and General Counsel may discuss their recommendations with the affected Member or with the Council, Committee, or Task Force, or with the Board of Trustees, as appropriate.
- The Council, Committee, or Task Force will be advised if the conflict of interest has been resolved with the affected Member. If the conflict is not resolved, the Chair and General Counsel will notify the Board of Trustees and the Board shall determine the appropriate resolution.