Astrocitomas

P ERS P E C T IV E

Disclosing Industry Relationships

additional costs associated with increased monitoring and reporting of industry relationships. These proposed changes in federal policy would represent a step toward creating a more organized, efficient, and effective system related to academic–industry relationships. Like all policy changes, however, they would be neither perfect noreasily implemented. Research relationships with industry should be allowed and even encouraged, but we must

ensure that they are consistently disclosed and properly managed by institutions according to empirically based guidance.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. From the Mongan Institute for Health Policy, Massachusetts GeneralHospital, Boston (E.G.C.); and the Heller School for Social Policy and Management, Brandeis University, Waltham, MA (D.E.Z.). This article (10.1056/NEJMp1006973) was published on July 14, 2010, at NEJM.org. 1. Zinner DE, Bolcic-Jankovic D, Clarridge B,

Blumenthal D, Campbell EG. Participation of academic scientists in relationships with industry. Health Aff (Millwood) 2009;28:181425. 2.Institute of Medicine. Conflict of interest in medical research, education, and practice. Washington, DC: National Academies Press, 2009. 3. Department of Health and Human Services, Office of the Inspector General. How grantees manage financial conflicts of interest in research funded by the National Institutes of Health. Washington, DC: DHHS/ OIG, November 2009. (Publication no. OEI03-07-00700.) 4.Rockey SJ, Collins FS. Managing financial conflict of interest in biomedical research. JAMA 2010;303:2400-2.
Copyright © 2010 Massachusetts Medical Society.

Quality Measures and the Individual Physician
Danielle Ofri, M.D., Ph.D. he quarterly “report card” sits on my desk. Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels atgoal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets. It’s hard not to feel like a failure when the numbers are so abysmal. We’ve been getting these reports for more than 2 years now, and my numbers never budge. It’s wholly dispiriting. When I voice concern about the reports, I’m told that these are simply data, not criticisms, and that any feedbackof data to doctors is helpful. On the face of it, this seems logical. How can additional information be anything but helpful? It’s easy, of course, to find scientific reasons why the data are less clinically meaningful than they seem. Success and failure in these measures tend to be presented as a binary function, although clinical risk is almost always a variable function. My patients whoseblood pressure is 140/85 (quite near the 130/80 goal) are counted as failures equiva606

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lent to patients with a blood pressure of 210/110, even though their risks for adverse cardiovascular outcomes are vastly different. And although these quality measures focus on diabetes in pristine isolation, my patients inconveniently carry at least five other diagnoses and routinely have medication listsin the double digits. Practicing clinicians know from experience that micromanagement of one condition frequently leads to fallout in another.1,2 What happens when my patients read these data? I wouldn’t blame them if they concluded that I’m a lousy doctor and switched to another physician who manages to get glycated hemoglobin levels at goal for 38% of her patients with diabetes. The quarterlyreport card stokes a perennial fear: maybe I really am a substandard doctor, and these statistics simply shed light on what I’ve refused to accept. If I’m doing my patients a disservice, then I’m morally obliged to vacate my office to make room for a more competent practitioner. I appreciate the efforts and good intentions behind the report cards, and I’m certainly not
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