The following document was signed in May 2008 by the American Association of Neurological
Surgeons (AANS) and the Congress of Neurological Surgeons (CNS).
Joint Statement on the Guidelines on Neurosurgeon-Industry Conflict of Interest
We, the undersigned speak on behalf of organized neurosurgery in the United States. The
Guidelines on Neurosurgeon-Industry Conflict of Interest is a joint effort that culminated after
many months of association leadership and committee input. The respective Boards of Directors
of the AANS and the CNS approved these guidelines.
Rationale
The impetus for crafting these guidelines was in part elicited by the heightened scrutiny initiated
over the last year by the Federal government into the relationship between physicians and
industry.
In September 2007, Senator Charles Grassley (R-IA) and Senator Herb Kohl (D-WI), chairman
of the Special Committee on Aging, introduced the “Physician Payments Sunshine Act,” which
would require drug and device makers to disclose the amount of money they give to physicians
through payments, gifts, honoraria, travel and other means.
In 2006, Medtronic reached a $40 million-settlement with the federal government over
accusations that the company had paid illegal kick backs to physicians for using spinal devices.
Subsequently, in late September 2007, the U.S. Department of Justice announced that settlement
had been reached with five major medical device makers that accounted for nearly 95 percent of
the market in hip and knee surgical implants after a multiyear investigation into violations of the
federal anti-kickback statute.
Consequently, the number and degree of questionable financial relationships between physicians
and industry has gained significant public attention through a series of articles in high profile
media outlets including The New York Times and The Wall Street Journal.
The practice of device and pharmaceutical companies paying physicians, and the lack of
transparency around this can potentially obscure the most important question that exists between
physician and patient: what is best for the patient?”
As professional medical societies, the AANS and the CNS hold the public trust, seeking to
advance the field of neurosurgery as a whole − through public and professional education, and
through the development and evaluation of new technology. It is with this goal in mind that the
Guidelines on Neurosurgeon-Industry Conflict of Interest was crafted.
Guidelines
The guidelines encompass the following purpose: “Neurosurgeons are necessary collaborators
with industry for technical innovation by providing ideas and feedback, conducting research
trials, serving on scientific advisory boards, and serving as faculty to teach the use of new
technology related to neurosurgical practice. Neurosurgeons with innovative ideas to improve
patient care rely on industry to bring their creative ideas to practical application in the healthcare
market. The collaborative relationship between neurosurgeons and industry must be structured to
avoid pitfalls of improper inducements or incentives.”
In their daily practice, all neurosurgeons must be guided by ethical principles upon which to base
their decisions for the care of their patients. The goal of medicine always should be to serve the
best interest of the patient, whereas business must promote profitability for the success of its
investors.
“A potential conflict of interest exists whenever professional judgment concerning choices in
patient care has a reasonable chance of being influenced by self-interest of the neurosurgeon.”
Accurate, complete, and understandable disclosure of any potential conflict of interest is required
in communications to patients, the public and colleagues.
“When faced with a potential conflict of interest that cannot be resolved, a neurosurgeon should
consult with the appropriate committee in an institutional or professional society to determine
whether a conflict of interest exists and how to address it.”
We encourage you to read the guidelines and utilize them as a tool to help provide ethical care to
those that entrust you with their health and lives – your patients.
James R. Bean, MD
President, AANS
Anthony L. Asher, MD
President, CNS
CONTACTS
American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008
Contact: Thomas A. Marshall
Congress of Neurological Surgeons
10 North Martingale Road, Suite 190
Schaumburg, IL 60173
Contact: Laurie L. Behncke
