AMA: Patents for Procedures Raise Ethical Hackles

CHICAGO, June 27 -- The American Medical Association has decided not to soften its 1995 position that it is unethical to patent surgical procedures.

Such a change was proposed by AMA's Council on Ethical and Judicial Affairs to permit the patenting of procedures so long as "the patent is not used to limit access to the procedure." But that plan was rejected by the AMA's House of Delegates, which wrapped up its annual meeting today.

The ethics group, a quasi-independent body within the AMA that sets the Code of Medical Ethics, reasoned that the public disclosure that is required as part of the patent process helps rather than hinders the dissemination of medical knowledge.

Richert E. Quinn, Jr., M.D., of Denver, who chaired the ethics group, said that a CEJA investigation of patents suggested that those who patent procedures "do not derive income from the patent nor is there evidence that a patent limits access to a procedure."

Nonetheless, the House of Delegates, which cannot amend CEJA reports but can bounce then back to the council with a request for more study, did just that after prompting from the American Academy of Dermatology and delegates from Illinois who said the AMA should continue to hold that "patents on procedures are unethical-period."

Likewise, an attempt by CEJA to "clarify" conflicts of interest involved with physician ownership of hospitals or other health care facilities, was quashed when the delegates suggested that CEJA's clarifications would lower the ethical bar too many notches.

During reference committee testimony and again in during the House of Delegates debate, several doctors provided anecdotal data about physicians who refer paying or insured patients to hospitals in which the referring physician has an equity stake, while sending uninsured or poor patients to other hospitals.

The ethics council sought to prevent that and other potentially unethical practices by recommending that physician owners follow these guidelines lines when making referrals:

• The primary basis for the referral must be the needs of the patient.
• Physicians' ownership interests must be disclosed to the patients.
• If a patient chooses not to accept the referral, the physician should help the patient find an appropriate alternative.

But the House said those safeguards lacked the necessary teeth and sent the report back to CEJA for reworking.