AMA~ ~ AMERICAN MEDICAL ASSOCIATION "- Michael D. Maves, MD, MBA, Executive Vice President, CEO December 23, 2009 Charles E. Grassley Ranking Member United States Senate Committee on Finance Washington, DC 20510-6200 Dear Senator Grassley: On behalf of the American Medical Association (AMA), I am responding to your December 7, 2009 inquiry about "industry funding that pharmaceutical, medical device companies, foundations established by these companies or the insurance industry" have provided to the AMA from January 2006 to the present. The AMA believes transparency and protections against conflicts of interest can be established without inhibiting productive relationships that can improve medical knowledge and care. For the past decade, the AMA has annually, including for the period covered by your inquiry, disclosed to all member organizations of the AMA's House of Delegates all grants and donations received by the AMA during the respective annual period. A fonnal written report by the AMA's governing body, the Board of Trustees, is presented to the House of Delegates at each Annual Meeting of delegates. Attached are copies ofthose reports presented to the delegates, which list each grant or donation received by the AMA since January 1,2006 and identify the source (without limitation' to pharmaceutical, medical device, insurance companies, or related foundations) and the purpose for each grant or donation, including the dollar amount. The detail in these reports responds fully to your requested accounting and in the desired fonnat. The attached reports are reflected in the official proceedings of the AMA House of Delegates' Annual Meetings and have been accessible on the AMA's publicly accessible web site [the most recent report is accessible at www.ama-assn.orglamal/pub/upload/mm/475/finaJhandbook.pdf(P. 971)]. A similar report covering the current year will be prepared for presentation at the next Annual Meeting of delegates in June 2010. The AMA Foundation and the AMA Alliance, both of which are legally separate entities with their own governing bodies and managements/staff, are not encompassed within this response to your inquiry although both entities are authorized to use the AMA name and both purchase American Medical Association 515 N. State St. Chicago IL 60654 phone: (312) 464-5000 fax: (312) 464-4184 www.ama-assn.org Charles E. Grassley December 23, 2009 Page 2 administrative support services from the AMA. Each entity discloses a substantial amount of information publicly about their respective operations and funding, which can be accessed at their respective web sites, www.amafoundation.org and www.amaalliance.org. Amounts received by the AMA from the AMA Foundation are included in the attached copies of annual reports of grants and donations presented to the AMA House of Delegates. The following are responses to your questions regarding the AMA's policies for accepting industry funding and the disclosure requirements of our top executives and Board members since January 2006. 1) Please describe the policies Jar accepting industry Junding and whether or not AMA allows companies to place restrictions or provide guidance on how Junding will be spent. For over a decade, the AMA has had formal written guidelines governing relationships with corporations and other entities (including, but not limited to, those specified in your inquiry). A copy of those guidelines is attached. The attached guidelines explain current AMA policies for accepting industry funding. These guidelines are reviewed periodically (including by the AMA House of Delegates) to assure continued adequacy. The AMA does not allow companies to provide guidance on how industry funding will be spent. The attached guidelines specify that external funding may not influence AMA policies, priorities and actions. The AMA proactively chooses its priorities for external relationships and only accepts funding if doing so will not pose a conflict of interest or affect the AMA' s objectivity, including the AMA's retaining editorial control over any projects or products bearing the AMA name or logo. A restriction that external funding will be used only for a specified purpose in accordance with the attached guidelines is acceptable. 2) If AMA allows companies to place restrictions on industry Junding, then please explain all restrictions and/or guidance Jar each transJer oJvalue Jrom industry. For every transJer oj value with a restriction, please provide the Jollowing inJormation: year oj transJer, name of company, and restriction placed on Junding. See response to (l) above. 3) Please explain what policies, if any that AMA plans to adopt to ensure transparency oj funding in order to provide a greater public trust in the independence ojyour organization. Existing AMA policies provide transparency of industry funding. Grants and donations received from industry (including pharmaceutical, medical device and insurance companies and related foundations) are listed on the attached copies of annual reports of grants and donations presented to the AMA House of Delegates. Charles E. Grassley December 23, 2009 Page 3 4) Please explain your policies on disclosure of outside income by your top executives and board members. The AMA requires its top executives and members of its Board of Trustees to annually complete a disclosure form designed to assure compliance with the AMA's conflict of interest policies. Copies ofthe disclosure form and conflict of interest policy are attached. A review ofthe completed disclosure forms during the period of your inquiry confirms the absence of any relationships with pharmaceutical or medical device companies or foundations established by them. Similarly, no relationships with national health insurers were reported (currently, one of the twenty-one members oTtlie? AMKBoatd ofTtlisrees i-s adtrectorohmutrral-rrabi:lity insurance company associated with a state medical society; in prior years during the period of your inquiry no more than three of the twenty-one directors, at that time, had a similar relationship). 5) Please provide the disclosures of outside income filed with your organizations by your top executives and board members. The AMA does not receive disclosures of outside income by top executives and Board members. The AMA's top executives and Board members are required to comply with the AMA's conflict of interest policies, as mentioned above. In order that you may fully appreciate the context in which the information above has been provided, the AMA has published annual reports describing the breadth of its activities. Copies ofthe 2006-2008 reports are attached. These reports present the AMA's overall operating results by product line and group. The AMA's principal revenue sources include: [i] membership revenues (dues paid solely by individual physician or medical student members); [ii] revenues from publication of AMAjoumals (subscriptions, advertising, site licensing, reprints, electronic licensing, and royalties); [iii] sales of AMA-published books, affinity products and reimbursement products; [iv] licensing of AMA's proprietary database products; [v] educational offerings presented by the AMA; and [vi] commissions from the sale of insurance products by the AMA's subsidiary insurance agency. While the specifics of particular transactions with AMA' s customers are proprietary and confidential, companies within the pharmaceutical, medical device or insurance industries are among those which do purchase or license AMA products or services. Revenues from these transactions do not constitute grants or donations but result from arms-length transactions on commercially competitive terms. As examples: a subsidiary of a national health insurance company purchases and then resells certain AMA publications; pharmaceutical and medical device manufacturers purchase reprints of articles, which appeared in AMA peer-reviewed scientific publications; and the AMA's subsidiary insurance agency earns commissions from insurance companies resulting from the sale of life, disability or other types of insurance products offered by those companies. Also, licensees of AMA's proprietary database prodncts Charles E. Grassley December 23, 2009 Page 4 [none of which licensees are themselves pharmaceutical, medical device or insurance companies] make available those database products to a large number of end users in a broad range of industries, w.hich include pharmaceutical, medical device or insurance companies. The AMA participates in the activities of a wide range of other organizations (in which pharmaceutical, medical device, or insurance companies or their related fouudations may also participate). Except as disclosed in the attachments to this response or referenced above, these activities do not result in revenues or grants and donations to the AMA. The AMA is pleased 10 provjde you with above information-and attached-documents-inresponse to your inquiry. Please do not hesitate to contact me if you are in need of additional information. Sincerely, ~i/t~ Michael D. Maves, MD, MBA Attachments Charles E. Grassley December 23, 2009 PageS Blind copied recipients (with attachments): Members of BOT EXCOM and Senior Management Team REPORT OF urn BOARD TRUSTEES B ofT Report # - A-07 Subject: Presented by: 2006 Grants and Donations Cecil B. Wilson, MD, Chair I 2 In response to Resolution 612 (A-99), attached is an infonnational financial report which details all grants or donations received by the American Medical Association during 2006. B ofT Report # -A-07 - page 2 American Medical Association Grants and Donations For the Year Ending December 31. 2006 (amounts in thousands) Funding Institution Project Funding $ Go"ernment Funding: Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Electronic Health Record System Effecting Change in Chronic Care Transfonn Medical Educational Conference First National Congress for Public Health Readiness Local EMS Linkages 2nd Annual Disaster Preparedness Conference Clinical Quality Measures Partnership for Healthcare Research and Quality Childhood Obesity Registration of Healthcare Professionals Bioterrorism Training Program Partnership in Program Planning for Adolescent Health Elder Driver's Guide National Institute on Drug Abuse Consumer & Prescriber Education Grant Core Disaster Life Support Training Grant 30 67 2 46 85 245 218 Center for Disease Control Center for Disease Control Center for Disease Control (thru Professional and Scientific Association) Centers for Medicare and Medicaid Services (thru Mathematica Research Policy) Department of Health and Human Services Department of Health and Human Services Department of Health and Human Services Department of Health and Human Services Maternal and Child Health Bureau National Highway Transportation Safety Administration National Institute of Health (thru lBS Inc.) Oregon Department of Justice U.S. Department of Homeland Security Total Government Funding Private Foundation AMA Foundation AMA Foundation AMA Foundation AMA Foundation AMA Foundation AMA Foundation Commonwealth Foundation Connecticut Health Foundation Health Research and Educational Trust Robert Wood Johnson Foundation Robert Wood Johnson Foundation Robert Wood Johnson Foundation Fun~ing: 50 2 64 91 130 69 80 187 1,367 US Holocaust Museum Project Health Literacy Problems Among Youth II National Service Project Hispanic Health Cardio-HIT Medical Education Research Consortium Patient Centered Communications Patient Centered Communications Physician Consortium for Performance Improvement Disparities in Healthcare National Program Office to Reduce Underage Drinking Through Coalitions National Program Office to Reduce High Risk Drinking Among College Students 6 30 4 198 98 10 II 29 4 39 222 654 1,305 Total Private Foundation Funding l/niversitv Contributors:. Johns Hopkins University Drexel University University of Southern California Total University Contributors Research Support for Disaster Preparedness and Response BDLS Educational Session Youth Violence Prevention Guide 18 8 19 4S B ofT Report # -A-07 - page 3 American Medical Association Grants and Donations For the Year Ending December 31, 2006 (amounts in thousands) Funding Institution Project Nathan Davis Award Nathan Davis Award Nathan Davis Award Nathan Davis Award Nathan Davis Award Nathan Davis Award Nathan Davis Award Funding $ Other Non-Profit Contributors: The Society of Thoracic Surgeons American Academy o[Cosmetic Surgery Maryland State Medical Society Washington State Medical Association California Medical Association Texas Medical Association West Virginia State Medical Association Total Other Non-Profit Contributors Industry Supported Educational Funding: 2 2 2 3 5 5 20 Daiichi Pharmaceuticals Wyeth Pharmaceuticals Foundation for Better Healthcare purdue Pharma CME Monograph on Chronic Bronchitrd'or the Asian Market CME Program on Immunization CME Metabolic Syndrome Conference CME Pain Management CME Pain Management CME Pneumonia CME Program on Genetic Susceptibility to Cancer Syndromes CME Patient Education Booklet on Overactive Bladder CME Understanding Vaccines CME Personalized MED Improving Immunizations Series Hispanic Physicians Leadership Development Task Force Health Disparities Mini*Conference Medical Communications Conference Medical Communications Conference Medical Communications Conference Medical Communications Conference Medical Communications Conference Medical Communications Conference Nathan Davis Award Nathan Davis Award Nathan Davis Award Nathan Davis Award National Conference on Continuing Medical Education Science News Media Briefings - Oncology Science News Media Briefings - Cardiovascular Disease Science News Media Briefings - Oral Health 20 52 50 22 Enda Pharmaceuticals Inc Daiichi Pharmaceuticals Myriad Genetics, Inc. Astellas Pharma GlaxoSmithKljne 196 89 297 7 123 Hoffman-La Roche Sanofi Pasteur Pfizer Blue Cross Blue Shield US News and World Report, Inc. Bacon's INA Services Co. (thru Customized Newspaper Advertisings) On The Scene Productions Inc. Merck & Company Inc. National Association of Medical Communicators Pharmaceutical Research & Manufacturers of America Merck & Company Inc purdue Pharma Johnson & Johnson Merck & Company Inc Genetech Sanofi Aventis Inc Cohn & Wolf c/o Colgate-Palmolive Total Industry Supported Educational Funding Total Grants and Donations 95 72 69 16 3 3 3 9 10 15 10 50 50 103 10 160 160 160 1,854 $ 4,59\ REPORT OF THE BOARD TRUSTEES B ofT Report #26 - A-08 Subject: Presented by: 2007 Grants and Donations Edward L. Langston, MD, Chair I 2 In response to Resolution 612 (A-99), attached is an informational financial report which details all grants or donations received by the American Medical Association during 2007. B ofT Report #26A-08 - page 2 American Medical Association Grants and Donations For the Year Ending December 31, 2007 (amounts in thousands) Funding Institution Government Funding Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Proiect Effecting Change in Chronic Care - Tipping Point Electronic Health Record System Leadership Summit on Injury Prevention Preparedness Communications & Training Grant on Terrorism Bioterrorism Training Program Foodbome Jllness Primer Partnership in Program Planning for Adolescent Health Elder Driver's Guide National Institute on Drug Abuse Core Disaster Life Support Training Grant Second Hand Smoke Exposure for Low Income Patients Prevention of Second Hand Smoke Exposure $ Funding Center for Disease Control Center for Disease Control Department of Health and Human Services Federal Drug Administration Maternal and Child Health Bureau 243 22 39 82 78 8 104 National Highway Transportation Safety Administration National Institute of Health (thru JBS Inc.) U.S. Department of Homeland Security U.S. Environmental Protection Agency U.S. Environmental Protection Agency 94 334 101 81 I 187 Total Government Funding Private Foundation Funding AMA Foundation AMA Foundation AMA Foundation AMA Foundation California Endowment Health Research and Educational Trust Robert Wood Johnson Foundation Cardio-HIT Phase I Cardio-HIT Phase II Suicide Prevention US Holocaust Museum Project Patient Centered Communications Physician Consortium for Performance Improvement Alcohol Education Grant ~ A Matter of Degree (AMOD) 328 201 4 5 399 3 100 Total Private Foundation Funding College & University Contributors Medical College of Georgia Oregon Health and Science University 2nd National Congress on Health System Readiness Consumer & Prescriber Education Grant 1040 41 59 Total College & University Contributors Other Non-Profit Contributors American Academy of Pediatrics Critical Path Institute Infectious Disease Society of America Adult Immunization (12) Summit Warfarin Dosing Brochure Adult Immunization (lZ) Summit 100 10 20 31 Total Other Non-Profit Contributors Industry Supported Educational Funding Novartis Vaccines & Diagnostics, Inc. PhRMA 2nd NationaJ Congress on Health System Readiness 2nd National Congress on Health System Readiness 2nd National Congress on Health System Readiness Adult Immunization (LZ) Summit Adult Immunization (IZ) Summit Adult Immunization (JZ) Summit Adult Immunization (JZ) Summit Adult Immunization (lZ) Summit CME Program on Depression 25 25 Pfizer Inc. GlaxoSmithKline Merck & Co., Inc. Novartis Vaccines & Diagnostics, Inc. Sanofi Pasteur Inc. Wyeth Phannaceuticals Eli Lilly and Company 30 50 20 20 10 20 499 B ofT Report #26A-08 - page 3 American Medical Association Grants and Donations For the Year Ending December 31. 2007 (amounts in thousands) Funding Institution Industry Supported Educational Funding (continued) Takeda Phannaceutical Co. Purdue Phanna, L.P. Teve Neuroscience, Inc. Daiichi Sankyo Co. Lill GlaxoSmithKline Sanofi Pasteur Inc. Merck & Co., Inc. INA SelVices Company MediaLink Worldwide, Inc. Merck & Co., Inc. Semaphore Media CME Program on Diabetes CME Program on Pain Management CME Program on Parkinson's Disease CME Program on Pneumonia Immunization Card Project Immunization Card Project Immunization Card Project Medical Communications Conference Medical Communications Conference Medical Communications Conference Medical Communications Conference National Conference - Continuing Medical Education National Conference - Continuing Medical Education National Conference - Continuing Medical Education National Conference - Continuing Medical Education Physician Education on Smoking Cessation Roundtable Proiect Funding $ 499 212 450 93 87 87 87 3 4 10 Me Communications, LLC Pfizer Inc. Procter & Gamble WebMD Pfizer Inc. Total Industry Supported Educational Funding Total Grants and Donations 5 30 9 15 143 2434 $,~~4"7",9,,,2 REPORT OF THE BOARD TRUSTEES B ofT Report 24-A-09 Subject: Presented by: 2008 Grants and Donations Joseph M. Heyman, MD, Chair 2 In response to Resolution 612 (A-99), this informational financial report details all grants or donations received by the American Medical Association during 2008. B ofT Report 24-A-09 - page 2 American Medical Association Grants & Donations For the Year Ended December 31, 2008 Amounts in thousands Amount Received $ Funding Insitution Agency for Healthcare Research and Quality Centers for Disease Control Federal Drug Administration HRSA (thm Medical College of Georgia) National Highway Transportation Safety Administration National Highway Transportation Safety Administration National Institute of Health (thru JBS Inc.) Oregon Department of Justice U.S. Department of Homeland Security U.S. Department of Homeland Security Project Health Infonnation Technology to Improve Cardia Care Communications & Training Grant on Terrorism Foodbome Illness Primer Bioterrorism Training Program Elder Driver's Safety Guide Engage Physicians in Addressing Older Driver Safety NationaJ Institute on Drug Abuse Consumer & Prescriber Education Grant Citizen Ready Training Grant Core Disaster Life Support Training Grant Prevention of Second Hand Smoke Exposure Second Hand Smoke Exposure for Low Income Patients 368 42 22 16 34 34 63 107 U.S. Environmental Protection Agency U.S. Environmental Protection Agency Government Funding AMA Foundation Markle Foundation Private Foundation Funding Medical College of Georgia University/College Contributors Qualis Health 144 155 93 140 1 218 115 13 Health Infonnatian Technology to Improve Cardia Care Physician Survey on Patient Health Infonnation 128 2nd National Congress on Health System Readiness 6 6 53 53 25 10 Clinical Perfonnance Measures Other Non-Profit Contributors Wolters Kluwer Health Gilead Sciences Inc. Ql Productions LLC Semaphore Media LLC Pfizer Inc. Pfizer Inc. Sanofi-Aventis Inc. WebMD Wyeth Pharmaceuticals CSL Biotherapies Inc. Novartis Sanofi Pasteur Inc. Mathematica Policy Research, Inc. Pfizer Inc. Indu~try 2nd National Congress on Health System Readiness GLBT - Grand Rounds Training Program Medical Communications Conference Medical Communications Conference Medical Student Section Assembly Meeting National Conference - Continuing Medical Education National Conference - Continuing Medical Education National Conference - Continuing Medical Education National Conference - Continuing Medical Education National Influenza Vaccine Summit National Influenza Vaccine Summit National Influenza Vaccine Summit Physician Quality Reporting Initiative Tool Kit Resident Fellow Section Assembly Meeting 42 3 15 15 5 5 3 6 6 6 100 15 256 $--1661 Supported Educational Funding Total Grants and Donations Board of Trustees, Officers aud Senior Managers Disclosure of Affiliations and Statement of Compliance with the American Medical Association Conflict of Interest Policy and Principles The American Medical Association's Conflict of Interest Policy requires each Trustee, Officer and Senior Manager to disclose annually his or her affiliations and to execute a statement confinning that, to his or her knowledge, the Trustee, Officer or Senior Manager has complied with the Conflict of Interest Policy and Principles. Disclosure of a Trustee's, Officer's or Senior Manager's affiliations is intended to assist the AMA in resolving conflicts of interest, in highlighting the importance of avoiding the appearance of a conflict of interest, in identifYing dualities of interest and in managing clear business risk. A Trustee's, Officer's or Senior Manager's affiliation with another organization does not necessarily mean that an unacceptable conflict of interest exists or that the affiliation would unduly influence the Trustee, Officer or Senior Manager. Indeed, a duality of interest( as opposed to an?actilalor apparent conflict of interest) is to be expected for those whose participation is on a voluntary basis. A "duality of interest" exists when an individual has a fiduciary duty to more than one organization. A listing of all Trustees', Officers' and Senior Managers' affiliations will be distributed to all Board members. Affiliations Please complete each question to the best of your knowledge. You may list your answers directly on this fonn or you may provide your answers on a separate sheet of paper. If you attach your C.Y., please indicate on this fonn to which questions your c.y. responds, and please answer all questions not addressed by your c.y. Jfyou become affiliated with another organization or cease an affiliation, please promptly provide updated infonnation on such affiliation to the AMA's Board Office. (Senior Managers should provide this infonnation to the Office of the General Counsel and to Human Resources). The following tenns used in this statement have the following meanings: "AMA" means the American Medical Association and its subsidiaries and affiliates (including the AMA Foundation and the AMA Alliance). "Material financial interest" means: o o o a financial ownership interest of 5% or more, or a financial interest or relationship which contributes materially to your income, or a position as proprietor (including member of an LLC), partner, director, officer, managing partner, governing board member (including of a not-for-profit organization) or key employee. "Immediate family member" shall mean spouse, domestic partner, parent or child. "Extended family member" shall mean spouse, domestic partner, parent, mother-in-law, father-in-law, child, spouse of child, grandchild, brother, sister, or spouse or child of a brother or sister. Guidelines relating to interests held by an immediate family member or extended family member shall apply to the extent such interests are known to the Trustee, Officer or Senior Manager. Effective February 10,2008 \ hp2 I. What is your current principal occupation? Please be specific/provide detail. 2. What is your current connection, if any, with a healthcare provider organization (e.g., member of group practice or solo practitioner, hospital medical staff), or with any organization which contracts with providers and/or payors (e.g., director of a professional liability insurer or managed care organization, medical school faculty, etc.)? Please be specific/provide detail. 3. Do you hold, or do you anticipate holding within the next twelve(12) months, any faculty appointments? No: _ __ Yes: _ __ If yes, please list the name of each institution, posiiion held, and term of appointment. Effective February 10,2008 Page 3 4. Do you now selVe, or do you anticipate in the next twelve (12) months, serving as a trustee, director, officer, council, or committee member, consultant or employee of a health care accrediting body (e.g. The Joint Commission, LCME, ACCME), or an organization which sets standards for care, education or professional status (e.g., ABMS) or a licensing board? No:, _ __ yes: _ _ __ If yes, please provide details.,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 5. Are you, or any immediate family member, or do you, or any immediate family member, ... anticipate..becoming...withi.n1he..nexUwelYf!-'12J-months,..aJ:ru.ste.e,...d.iJ:e_ctQr._officer,.co_un.dl or committee member, employee or consultant of any health care related professional society? No: _ __ yes: _ _ __ If yes, please list the name of each organization, position held, and term of position. If the organization is not a nationally known organization, please provide a brief description of the organization. 6. Do you or an extended family member hold or plan to hold a material financial interest in any business which furnishes goods or services, or is seeking to furnish goods or services, to the AMA? No: - - - yes: _ _ __ If yes, please list the name of each business and the type of goods or services involved. Effective February 10,2008 Page 4 7. Are you or any extended family member, or do you or any extended family member, anticipate becoming within the next twelve (12) months, a trustee, director, officer, council or committee member, employee or consultant of any bnsiness which furnishes goods or services, or is seeking to furnish goods or services to the AMA. No: _ __ Yes:_ __ If yes, please list the name of each business and type of goods or services involved. 8. Do you or an extended family member hold or plan to hold a material financial interest in any health care-related businesses (including an organization which provides or evaluates health care services or products) not disclosed above? No: _ __ Yes: _ __ If yes, please list the name of each business, the type of goods or the services involved and your (or your extended family member's) involvement. 9. Are you or an extended family member, or do you or an extended family member anticipate becoming within the next twelve (12) months, a trustee, director, officer, council or committee member, employee or consultant of any health care related business (including an organization which provides or evaluates health care services or products) not disclosed above? No: _ __ Yes: _ __ If yes, please list the name of each business, the type of goods or services involved and your (or your extended family member's) involvement. Effective February 10,2008 Page 5 10. Have you or any extended family member asserted or filed, or intend to assert, a lawsuit, legal complaint, personal claim for damages or formal grievance against the AMA? No: _ __ Yes: _ __ If yes, please describe the nature and status of the legal action. II. Are you, or do you anticipate becoming within the next twelve (12) months, a trustee, director, officer, councilor committee member, employee or consultant of any non-health care type of organization or society? No:, _ __ Yes:- - If yes, please list the name of each organization, position held, and term of position. If the organization is not a nationally known organization, please provide a brief description of the organization. 12. Are you currently or do you anticipate becoming (or is your employer) a registered lobbyist in any jurisdiction or are you involved in, or do you anticipate becoming involved in, public representation and advocacy, on behalf of any organization other than the AMA? No: _ _ __ Yes: _ __ If yes, please list the name of each organization and describe the nature of the activities you are or will be involved in. Effective February 10,200& Page 6 13. Do you hold or intend to seek within the next twelve (12) months any political office (elected or appointed)? No: _ __ Yes: _ __ If yes, please list each political office. 14. Are you involved in, or do you intend to become involved in within the next twelve (12) months, any other significant political activities (excluding voting and political contributions)? No:. _ __ Yes: _ __ If yes, please describe your political activities. 15. Are you aware of any activity of any of your extended family members which may conflict with AMA's policies or activities? No: _ __ Yes: _ __ If yes, list the family member involved and the nature of the activity. Effective February 10, 2008 Page 7 16. Are you involved in any other personal relationship, activity or interest which may involve a duality? of interest or may impair your objectivity on AMA policies Or issues not disclosed above? No: _ __ Yes: _ __ If yes, please describe each relationship, activity or interest. 17. I certif'y that (except as identified below): (i) I have not and will not knowingly disclose or use confidential or proprietary information relating to the AMA for personal profit or advantage or for the profit or advantage of any other organization. If any exceptions exist, please explain. (ii) I have not and will not divert for myself or for any other person or entity any business opportunity I know to be available to the AMA. If any exceptions exist, please explain. (iii) I have not and will not use AMA staff or resources to perform personal services for me or for another organization in which I have a financial interest. If any exceptions exist, please explain. (iv) I have not and will not use the AMA 's name or logo or my affiliation with the AMA in a manner that would incorrectly imply an AMA endorsement of a non-AMA product or service. If any exceptions exist, please explain. Effective February 10, 2008 Page 8 (v) in the course of carrying out my responsibilities for the AMA, my decisions have been and will continue to be based on what I believe to be in the best interests of the AMA and the not-for-profit purposes for which it has been created. If any exceptions exist, please explain. (vi) I understand even the appearance of a conflict of interest must be avoided and any duality of interest must be explained fully and publicly. If any exceptions exist, please explain. Effective February 10,2008 Page 9 Statement of Compliance with the Conflict ofInterest Policy and Principles I understand that I am expected to comply with the Conflict ofInterest Policy and Principles of the American Medical Association. To my knowledge and belief as ofthe date hereof, I am in compliance with the Conflict ofInterest Policy and Principles (except as specifically disclosed above) and have disclosed as required my affiliations. I understand that I have a continuing responsibility to comply with the Conflict of Interest Policy and Principles. If any time following submission of this form, I become aware of any actual, potential, or appareut conflict of interest, or if the information provided becomes inaccurate or incomplete, I will promptly update this form by providing the update to the BOT office. Date_ _ _ _ _ _ __ Signature_ _ _ _ _ _ _ _ _ _ _ _ __ Any questions about how to respond to the disclosures or certifications requested above (including questions about potential affiliations or material financial interests) should be reviewed in advance with the Office of the General Counsel. Effective February 10,2008 Page 10 Additional Qnestion In order for the AMA to comply with its license with the Ohio Bureau of Workers' Compensation for use of Physicians' Current Procedural Terminology (CPT) code, AMA must affirm, as a contract requirement that no AMA Trustee or hislher spouse has made certain campaign contributions. Therefore, please respond to the following question: Have you or your spouse, as individuals, within the last two calendar years, made one or more contributions totaling in excess of$I,OOO to the Governor of Ohio or hisfher campaign committee? Yes_ __ No _ __ The AMA has a continuing obligations to notify the Ohio Bureau of Workers' Compensation of any contributions. Please notify the AMA Board Office if you make any such contributions. This question has been included on this form for convenience, and is not a part of the conflict of interest disclosure. Updated February, 2008 G:\DBD\Barney\Conflict of Interest Disclosure of Affiliations - final clean 2-1 O-OS.doc Board of Trustees, Officers and Senior Managers American Medical Association Conflict oflnterest Policy PURPOSE As the leading physician organization in the nation, the American Medical Association (nAMA") holds a unique position as the representative of patients and physicians on issues that affect the health of all Americans. In formulating its policies, the AMA seeks the involvement of trusted, knowledgeable individuals, and encourages the expression of diverse views on important health issues facing America now and in the future. Members of the AMA Board of Trustees, Officers of the AMA and members of the AMA's councils, committees and task forces bring to the AMA expertise drawn from their diverse knowledge and backgrounds. The AMA recognizes that, at times, the diverse background and activities of its Trustees, Officers and members of its councils, committees and task forces may conflict with the interests and activities of the AMA. Trustees and Officers hold a special position of responsibility to the Association, and owe a fiduciary obligation to act in the best interest of the Association. Members of councils, committees and task forces are an integral element of the AMA's decision-making process, and have a responsibility to place the achievement ofthe AMA's goals and mission above their personal interests. Although not elected, Senior Managers are also expected to serve the best interests ofthe AMA. Conflicts of interest may arise from Senior Managers' affiliations with other organizations, or from other personal activities. It is important for the Board of Trustees to be aware of any affiliations or activities which may raise conflicts, as Senior Managers are responsible for advising the Board and making recommendations on AMA policies and activities. The AMA has adopted a Conflict ofInterest Policy to provide guidelines to assist the Trustees, Officers, Members and Senior Managers in resolving conflicts between personal interests and the interests of the AMA. This Conflict ofInterest Policy strives to insure that Trustees, Officers, Senior Managers and council, committee and task force members will not act for their own personal benefit, contrary to the interest of the AMA, but instead will serve the best interests of the AMA. In order to insure that all individuals participating in AMA decisions and activities are governed by consistent guidelines, this Conflict ofInterest Policy shall apply to Trustees, Officers, Senior Managers, members of councils, committees and task forces, and other individuals participating in AMA decision making activities. Copyright 1999 American Medical Association. Updated June 2007. All rights reserved. No reproduction or translation of any part of this work is permitted without the express permission of the American Medical Association. American Medical Association Contlict afInterest Palicy Page 2 of7 DEFINITIONS "Trustee" means members of the AMA Board of Trustees, including Officers of the AMA. "Member" shall mean a member of an AMA council, committee, task force or other decision-making group. "Senior Manager" means the Executive Vice President, Deputy Executive Vice President, Chief Operating Officer, General Counsel, Chief Financial Officer, Senior Vice Presidents and any other Vice President who reports directly to the EVP or to the Deputy EVP. "AMA" or "Association" shall mean the American Medical Association and its subsidiaries and affiliates. "Immediate family member" shall mean spouse, domestic partner, parent or child. "Extended family member" shall mean spouse, domestic partner, parent, mother-in-law, father-inlaw, child, spouse of child, grandchild, brother, sister, or spouse or child of a brother or sister. Guidelines relating to interests held by an immediate family member or extended family member shall apply to the extent such interests are known to the Trustee, Member or Senior Manager. GUIDELINES Ownership of a material financial interest in any company that furnishes goods or services, or is seeking to furnish goods or services, to the AMA. The AMA recognizes that individuals have investments, through stock ownership, mutual funds, and similar vehicles, in companies that provide goods and services to businesses. Only those investments that constitute a significant financial investment raise a concern about a possible conflict of interest. The AMA also recognizes that a Trustee, Member, or an extended family member of a Trustee, Member or Senior Manager may be employed by, or have a consulting arrangement with, an organization that does business with the AMA. A conflict of interest may arise if the Trustee, Member, Senior Manager or extended family member of a Trustee, Member or Senior Manager holds a key position in such company and is responsible for approving the provision of goods or services to the AMA. Accordingly, "ownership of a material financial interest" shall mean holding a financial ownership interest of 5% or more, or holding a financial ownership interest which contributes materially to the Trustee's, Member's or Senior Manager's income, or holding a position as proprietor, director, managing partner or key employee. The following requirements shall be followed: A. A Trustee, Member and Senior Manager shall disclose his or her ownership of a material financial interest in any business which furnishes goods or services, or is seeking to furnish Copyright 1999 Updated June 2007 American Medical Association. American Medical Association Conflict oflnterest Policy Page 3 of7 goods or services, to the AMA. A Trustee, Member and Senior Manager shall also disclose material financial interests owned by any extended family member. B. A Trustee or Member shall excuse himself or herself from voting on any issues relating to the provision of the goods and services by any company in which the Trustee, Member, or any extended family member owns a material financial interest. A Trustee or Member shall also excuse himself or herself from participation in the discussions on such issues, except as requested to participate by the Board. A Senior Manager shall not be involved in making the final decision on any issues relating to the provision of the goods and services by any company in which the Senior Manager or any extended family member owns a material financial interest. Also, a Senior Manager shall not be involve-dinLhepreparation ofany-arrangement to acquire ~uch~o0ds?and-seFViee~.-? Claims against the AMA A conflict of interest arises if a Trustee, Member or Senior Manager has a personal interest in a legal claim against the AMA. A. A Trustee, Member and Senior Manager shall disclose any lawsuit, legal complaint, personal claim for damages or formal grievance which the Trustee, Member, Senior Manager, or any extended family member, has asserted or filed, or intends to assert or file, against the AMA. B. A Trustee, Member and Senior Manager shall not be involved in any decisions relating to AMA's resolution of such claims. Participation on Boards of Trustees or councils or committees of other organizations. Participation by Trustees and Members on the Board of Trustees, Board of Directors, or on councils or committees of other organizations is beneficial to the Association, as the Trustees and Members gain important expertise and establish business relationships. To insure that the Trustee or Member is not placed in the difficult position of serving organizations with conflicting overall goals and objectives, a Trustee or Member shall disclose his or her participation in other organizations. If the overall goals and objectives of the AMA and the other organization do not conflict, participation is permitted. If a conflict exists, the Trustee or Member shall choose between the conflicting organizations, and shall resign from one of the positions. Participation by a Senior Manager on a Board of Trustees, Board of Directors, councilor committee of another organization shall be disclosed by the Senior Manager, and will be evaluated on a case-by-case basis to insure that the affiliation will not conflict with the Senior Manager's responsibilities in his or her position with the AMA. Copyright 1999 American Medical Association American Medical Association Conflict oUnterest Policy Page 4 of7 Participation by a family member of a Trustee, Member or Senior Manager on a Board, councilor committee generally will not raise conflict of interest concerns. There may be circumstances, however, in which a family member becomes involved in an activity that conflicts with AMA's policies and activities. Accordingly, Trustees, Members and Senior Managers shall disclose any affiliations of an immediate family member with any health care organization or health-related professional society. Potential biases of the Trustee, Member or Senior Manager will be evaluated and, if necessary, appropriate limits will be placed on the Trustee's, Member's or Senior Manager's participation in AMA actions related to any conflicting activity. The AMA's Conflict ofInterest Principles provide guidance in evaluating affiliations with other organizations, and provide recommendations for resolutions of conflicts arising out of such affiliations. Other personal relationships, activities, or interests which may impair a Trustee's, Member's, or Senior Manager's objectivity or which may inappropriately influence a Trustee's, Member's or Senior Manager's decisions or actions on AMA matters. Situations may arise, from time to time, where a Trustee, Member or Senior Manager is unable to separate his or her personal interest in an issue from his or her obligation to objectively serve the interests of the AMA. To insure that the Trustee's, Member's and Senior Manager's obligations to the AMA are met and that the interests of the AMA are paramount, disclosure of any such personal interests is required. However, it is important to keep in mind that the Trustees and Members will invariably have a personal interest in and opinion on the issues that come before the Board and councils and committees, due to the broad range and nature of the AMA's mission and activities. In most instances, personal interests will not prevent a Trustee or Member from rendering an objective opinion. In order to fulfill the responsibilities of the Board of Trustees and of councils and committees, and to make appropriate and informed decisions, representation of different viewpoints is required, and an environment of full and open discussion must be maintained. It is necessary to insure that the broadest range of views and expertise is available to the AMA in its decision-making process. At times, the contributions of an individual with a personal interest are valuable precisely because of the knowledge or expertise obtained through the personal interest. A requirement that a Trustee or Member be excused from discussions on any issue in which he or she has a personal interest would diminish the benefits the AMA receives from full, informed debate. Accordingly, full participation by all Trustees and Members should be encouraged. Limitations shall be placed on a Trustee's, Member's or Senior Manager's activities in those cases where a Trustee, Member or Senior Manager cannot separate his or her personal interest from the interest of the Association and render a fair and independent decision. In such cases, the Trustee or Member should excuse himself or herself from discussion and/or vote on the issue. If a Trustee or Member does not appropriately excuse himself or herself, Copyright 1999 American Medical Association American Medical Association Conflict oUnterest Policy Page 5 of 7 but the majority of the remaining Trustees or Members believe that the Trustee or Member should be excused from either discussion or vote, the Chair shall require the Trustee or Member to excuse himself or herself from discussion and/or vote. In such cases, a Senior Manager shall not participate in consideration or resolution of the issue. Gifts To avoid any inference that a decision was unduly influenced, a Trustee, Member, Senior Manager, and members of the Trustee's, Member'S, and Senior Manager's immediate family, may not offer, solicit or accept any gift, money, benefit, loan, or other payment of any kind from any entity with whom AMA does business, with wheID AMA is seeking tecte business, er frem any entity seeking to do business with AMA. The term "entity" includes, but is not limited to, financial institutions, business and professional firms, and individuals providing goods or services. This provision is not intended to prohibit the following gifts or benefits: o Acceptance or offering of nominal gifts, or social amenities and entertainment which are given in normal business practice and which would not raise an inference of undue influence. Acceptance or offering of gifts for a non-business reason, and which are motivated by a family relationship or personal friendship. Benefits or discounts offered under any AMA -sponsored program. Benefits or discounts which are offered as a professional courtesy to members of the medical profession, or to members of their immediate family, provided such benefits or discounts are not intended to influence an AMA decision. Books, journals, (ludio or videotapes, computer software or other informational material provided to assist the Trustees or Members in performing their duties for the AMA. o o o o Honoraria Any honoraria received by a Trustee or Member for AMA-related engagements shall be given to the Association. Alternative arrangements may be allowed, provided that the Trustee or Member notifies the Chair of the Board of Trustees and receives the Chair's prior approval. Any honoraria received by a Senior Manager for AMA-related engagements shall be given to the AMA Foundation. Alternative arrangements may be allowed, provided that the Senior Manager notifies his or her manager and receives the manager's prior approval. Illegal Payments Copyright 1999 American Medical Association American Medical Association Conflict ofInterest Policy Page 6 of? A Trustee, Member or Senior Manager shall not give any bribe, kickback, or any other illegal or improper payment of any kind to any person with whom the Trustee, Member or Senior Manager comes in contact in the course of carrying out his or her responsibilities for the AMA. Disclosure of Confidential or Proprietary Information In the course of perfOlming services to the AMA, the Trustees, Members and Senior Managers will have access to information that is confidential or proprietary to the AMA. This information includes, but is not limited to, financial information, business plans, policy proposals and recommendations, policy development plans, confidential membership plans, and other information which would impede implementation of AMA activities if it were disclosed. A Trustee, Member, and Senior Manager shall maintain the confidentiality of such information and shall not disclose confidential or proprietary information for personal gain. A Trustee, Member and Senior Manager shall use his or her best efforts to prevent unauthorized disclosure of confidential or proprietary information. Use of Position or A.MA's Name A Trustee, Member or Senior Manager shall not use the AMA's name, or his or her affiliation with the AMA in a manner that would incorrectly imply an AMA endorsement of a nonAMA product or service, or that would imply AMA support of a personal opinion or activity. Activities Following Term A former Trustee, Member or Senior Manager 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 Trustee, Member or Senior Manager shall not use the AMA name or his or her affiliation with the AMA for commercial gain. A former Trustee, Member or Senior Manager shall not disclose confidential or proprietary information for personal or commercial gain. A former Trustee and former Senior Manager shall refrain from all conduct, verbal or otherwise, which publicly disparages or damages the reputation, goodwill, or standing in the community of the AMA or its Trustees or Officers. 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. INTERPRETATION Copyright 1999 American Medical Association American Medical Association Conflict of Interest Policy Page 7 of7 The Conflict ofInterest Policy is intended to be an evolving policy, and questions of interpretation and application can be expected to arise. Conflict ofInterest Principles have been developed to provide guidance in resolving conflicts. IMPLEMENTATION Each Trustee, Member and Senior Manager shall execute annually a Compliance Statement, confirming that, to his or her knowledge, the Trustee, Member or Senior Manager has complied with the Conflict ofInterest Policy, and disclosing any matters required to be disclosed under the Policy. The Secretary of each council, committee and task force shall be responsible for obtaining executed Compliance Statements. If no Secretary has been appointed, the council, committee or task force shall designate one of its Members to assume such responsibility. The General Counsel shall review all disclosures made by the Trustees, Members and Senior Managers. Each Trustee, Member and Senior Manager shall have a continuing responsibility to comply with this Conflict of Interest Policy. Senior Managers are also required to comply with the AMA Human Resources Conflict of Interest Policy and such other Conflict of Interest rules or guidelines for employees that are adopted by the AMA. Employees below the level of Senior Manager are subject to the AMA Human Resources Conflict of Interest Policy. The General Counsel shall also provide an annual report to the Board stating that the conflict of interest compliance forms of the Vice Presidents have been reviewed, and reporting how such conflicts have been resolved. The General Counsel's report shall also inform the Board of any relationship, activity or affiliation disclosed by any other employee which may raise a conflict of interest and which would have a material impact on the operation of theAMA. Effective April 8, 1999 BOT Policy G:\DBD\Barney\Sharon's Files on Conflict of Interest\COI Documents BOT 2007\BOT Policy 06-2oo7.doc Copyright 1999 American Medical Association . . . - ..J, 4 . 2 . xswmrv-? cf--7ZSSG. -4Y6., 5 5 -, V, _vrv_`cfi zig; E. - .-pj. rib-ngQ.-- . .1wma.: --: . Lz- . 6-S:--Tmeq . ti: eaJ--wana in;. 9..: $*55 za ?rm 5*:v-V-i sirmy- ass. ir nr- s-my 5 -- - rinciples 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 1998 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 ate met, which can further the AMA's core purpose, retain AMA's independence, avoid conflicts ofinterest and guard our professional values. The AMA House of Delegates adopted revised principles at its June 1999 meeting. The following updated principles were adopted at the June 2002 House of Delegates meeting. 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. The AMA will proactively choose its priorities for external relationships and collaborate in those that fulfill these priorities. 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 and House of Delegates. These guidelines should be reviewed over time to ensure 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. 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 affects the objectivity of the association, its members, activities, programs or 1. The AMA will prOVide health and medical information, but should not involve itselfin 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 health care values and educating the public about their health and health care. employees. For example, exclusive relationships with manufacturers of health-related products marketed to the-public' could~mpair?ilie AMA's objectiviry in promoting the health of America. The AMA's objectivity with respect to health issues should not be biased by external relationships. 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 noncompeting 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 therapeuric 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. 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 that provide 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. 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 ofa 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.) 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 ofundue influence on the affairs ofthe AMA, the AMA should not depend on fundingfrom corporate relations for core governance activities. Funding core governance activities from corporate sponsors, i.e., 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. 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 ofan entity or its policies. Participation in sponsorship of an AMA program does not imply AMA approval of that corporation's general Organizational Review Every proposal for an AMA corporate relationship must be thoroughly screened prior ro 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. 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 continuing medical education, 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 Accreditation Council for Continuing Medical Education 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. 1. All AMA corporate arrangements will be annually reported by the Board of Trustees to the House o/Delegates at the Annual Meeting inJune, 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 Annual Meeting. 3. The Executive Vice President is responsible for the review and implementation ofeach 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. 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 4. The Corporate Review Team reviews corporate arrangements to ensure consistency with the principles and gUidelines. The Corporate Review Team is the internal, crossorganizational staff group that is charged with the review of all activities with external funding to ensure adherence to the guidelines. The Corporate Review Team is chaired by the Vice President, Governance and Program Support, and composed of senior managers from: ethics; science; legal; finance; communications; advocacy; business products; business development; marketing; membership; and publishing. The review process is structured to specifically address issues pertaining to AMA's policy, ethics, business practices, corporate identity and reputation. Written procedutes 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. Organizational Culture and its Influence on Externally Funded Programs Organizational cultute 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 ptofessional 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 nor create an undue expectation to raise increasing amounts of money. Such financial pressures can ptovide 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 tole 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. 5. The AMA's Office ofRisk Management in consultation with the Office ofthe General Counsel will review and approve all marketing materials that are prepared by others for use in the u.s. 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 journals, 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. (C) 2006, American Medical Association AS76:09-0175: 1000:4{09 lA in I- 2008 Annual FRBDOH 2% QVQV VV 1 VV 5 .V TV V'j""41v?JEVyay! V5 O. VV VV ,332; . Z.- - VV VV Mig10V V-VV IVY *18V.V.V 1 V1 Vi VV VVLV V.V.?v .,.,.' ' A>M???????A????l.-. .. ~ .. +Iy!ERICAN l?b.EDICAL ASSOCIATION '~ \ with you the 2007 Annual J1edical Association (AMA). 1.61 st-our members , practice managE3rt\eXlf .. ,," ,'-_' __ ," ",:~-.;:< 'c extend to pnh~nt"'it improving the represent only a the impact the nRti8nt~';While these stories activities, they ,.its membershaye.p:f1ii;s.d~il???? fuif:pbysi<';ians. we serve. illl!9ff:~?~ . A . A A I I ANNUAL I A AMERICAN I A - A I CAL ASSOCIATION -