Burr Ridge, IL — The North American Spine Society, the leading multidisciplinary spine organization worldwide, has dramatically revised its existing disclosure policy for both members and nonmembers participating in NASS activities. Going several steps further than the original policy (which was adopted in January 2006), the new policy adopted by the NASS Board of Directors at the Toronto Annual Meeting in October 2008 requires that participants disclose actual dollar amounts of all relationships held in the 12 months preceding disclosure. According to the NASS Ethics Committee, which authored the new policy, “the goal is to create an environment of scientific validity, in which learners can trust the information they receive is objective and unbiased, and to be sure that our members are current and forthright in their dealings with one another and with their colleagues and patients.” 

The new disclosure policy comes on the heels of a recently-completed retooling of the society’s Board, Committee and staff structure. Part of this restructuring included a rewrite of the NASS mission, which now includes ethics as a pillar of the society’s mission: “NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research, and advocacy.”

Ethicist Added to Board of Directors: David J. Rothman, PhD
The Board of Directors has also taken the groundbreaking step of appointing a non-member, academic ethicist to the NASS Board. David J. Rothman, PhD will serve on the NASS Board for a three-year term beginning in January 2009.  According to Dr. Rothman, “The issues of best practices in the governance of professional medical societies is now of central concern to medical leaders, the media, and public officials.” He continued, “NASS is in a position to set national standards in this domain and I am eager to do all that I can to move this process forward.”

Dr. Rothman is President of the Institute on Medicine as a Profession (www.imapny.org) and Bernard Schoenberg Professor of Social Medicine at Columbia University’s College of Physicians & Surgeons. Trained in social history at Harvard, David Rothman joined the Columbia medical school faculty in 1983 and his subsequent work examines the history of health care practice and policy. He is the recipient of the Robert Wood Johnson Health Policy Investigator Award, and is now addressing the place of professionalism in medicine. His publications include “Medical Professionalism – Focusing on the Real Issues” (NEJM, 2000), “New Federal Guidelines for Physician-Pharmaceutical Industry Relations” (with Susan Chimonas, Health Affairs, 2005), and “Physicians and Drug Representatives,” (with Susan Chimonas, JGIM, 2007). He co-chaired the ABIM Foundation-IMAP task force that produced “Health Industry Practices that Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers” (JAMA, ’06). In 2007, IMAP and Community Catalyst received a grant from PEW Community Trusts to conduct the Prescription Project. IMAP also received a grant from the Oregon Attorney General Consumer and Prescriber Education Program to explore Rational Prescribing in a World of Marketing. His publications from this project appeared in JAMA in 2008.

Restrictions on COI for NASS Leaders Established
The NASS Board of Directors has also unanimously approved a new “Policy on Conflict of Interest in Leadership Positions.”  This policy governs the relationship that any Committee or Board member serving in each specific volunteer role may have with industry. The policy establishes three levels of divestment from industry relationships, with the most stringent divestment occurring within the Presidential Line, and including the chairs of certain highly influential committees. Relationships at this level are severely restricted and are examined in detail by the vetting committee, with consideration of the exact nature of remuneration (including dollar amounts for financial arrangements) and services provided. If a potential candidate for a leadership position has an industry relationship deemed unacceptable for the desired leadership level, the individual will be given the opportunity to divest from that relationship before assuming a new position.

Violations a Sanctionable Offense
As with the original policy, the revised NASS Disclosure Policy is not a voluntary “guideline,” but a binding covenant which applies to all relationships engaged in by all participants in all NASS activities. According to new language in the NASS Code of Ethics, a failure to abide by the disclosure policy is considered to be in violation of the Code of Ethics. It is, therefore, a sanctionable offense, and may be adjudicated by the newly created Conflict of Interest Review Board, with sanctions to be ratified by the Board of Directors.  Sanctions may include but are not limited to: one- or two-year suspension of membership, membership expulsion, public letters of censure, and/or—in conjunction with NASS Education Council Chairs—barring the member from presenting at a specified number of future meetings.

Conflict of Interest Review Board Established
In acknowledgment of the complex issues surrounding Conflict of Interest (COI), the NASS Board of Directors has established a COI Review Board, which will serve as a consulting entity for NASS members seeking advice on how to disclose, and even help determine appropriate relationships between NASS leaders and outside organizations.   It may also act in a consulting capacity to the Professional Conduct & Ethics Committee for its hearings which may encompass COI issues. In addition, the COI review committee plays a significant role in the vetting of nominees for the presidential line, Board of Directors, and certain committee chairs.  The creation of the COI Review Board was approved by the NASS Board of Directors in May 2008, and it has recently been populated.

A Tradition of Ethics and Professionalism
Beginning in November 2001 with Dr. Stanley A. Herring’s NASS presidency, NASS has taken an aggressive role in ensuring that its members are fully informed of their ethical obligations, the definition and pitfalls of conflicts of interest, and the need for full disclosure. In October 2002, the NASS Board of Directors adopted a new Code of Ethics, along with Expert Witness Guidelines and a comprehensive procedure with which the Professional Conduct & Ethics Committee could handle members’ complaints of violations of standards of professional conduct. In 2005, the NASS Board of Directors formed a Disclosure Task Force to discuss conflicts of interest between NASS members and the spine industry, and to develop a policy that would raise the bar for disclosures in every NASS-affiliated publication, research project, board or committee meeting, and educational program. That policy was adopted by the Board of Directors and implemented in January 2006. Since then NASS has shared its program with other medical societies, encouraging them to adopt similar rules.

The NASS Board of Directors is committed to the highest level of ethics and professionalism for its members and has created an environment in which full disclosure is not only encouraged, but mandatory. According to Dr. Marjorie Eskay-Auerbach, the current Chair of the NASS Ethics Committee, NASS strives to “raise the bar for ethics and professionalism, not only within NASS but in the entire field of spine care…to that end, our policies are constantly being reviewed and strengthened.” 

The new Disclosure Policy, in addition to a Timeline of NASS’ ethics-related activities, the Code of Ethics, and other documents, can be viewed on the NASS Web site here.

To accompany the revised policy NASS has also established an online Web module for disclosure to replace the previous paper disclosure form. The online module can be found at http://disclosure.spine.org.

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About NASS
The North American Spine Society (NASS) is a multidisciplinary organization that advances quality spine care through ethics, education, research and advocacy. Active NASS members are MDs, DOs and PhDs in 24 spine-related specialties including orthopedics, neurosurgery, physiatry, pain management and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators and other allied health care professionals involved in spine care are also represented in NASS as affiliate members.  For more information on spine care or to find a spine specialist in your area, please contact 1-877-SPINE-DR or visit www.spine.org.

MEDIA CONTACT:
Pam Towne
Director of Publications
(630) 230-3642
ptowne@spine.org