January 2011: Ethics is an intrinsic part of medicine, from the Hippocratic Oath and the principle of “first, do no harm,” to the daily considerations of patient privacy and informed consent. The ASCO Ethics Committee helps members navigate the ethical complications of the modern practice of oncology. In the following conversation with ASCO Connection, Ethics Committee Chair Paul R. Helft, MD, of Indiana University Simon Cancer Center, discusses potential changes to the Society’s conflict of interest (COI) policy and how ethics and medicine intersect.

AC: What led to your interest in ethics?

	Dr. Helft

Dr. Helft: In some ways, my life’s work is in ethics. I became interested in the subject in high school, studied philosophy and ethics in college, then went to medical school and decided very early on that I wanted to be an oncologist who worked on ethics. Now I direct an ethics center for a large hospital system in Indianapolis. Much of my academic and scholarly work has been in ethics as well. What ethics has allowed me to do in my practice is to think systematically about the difficult decisions that I have to make and that I have to help patients make.

AC: Are there ethical pitfalls or gray areas particular to oncology?

Dr. Helft: Oncologists are, in a sense, practicing ethics every day of their life. They do extremely high-stakes work, taking care of a very sick population who has an extremely high level of consciousness about their disease. By definition, nearly all cancers are life-threatening, and oncologists use therapies that involve substantial risks to patients. They have to deal with issues surrounding end-of-life care and palliative care across the spectrum of illness.
Some hot-button ethical issues have gained national attention, such as the treatment of persons who are in the United States without documentation. Fulfilling our own obligations to treat every patient with cancer, while at the same time finding financial resources to do that in an acceptable way, is a huge challenge.

AC: What kind of work will the Ethics Committee undertake in 2011?

Dr. Helft: We’re undertaking a research project related to ASCO’s COI policy. Depending on the results and our experience implementing the policy over the past several years, we may recommend that the ASCO Board revise the policy. The current policy has been in effect for about five years, and there has been a tremendous amount of national attention from the press and others about the issue of conflicts of interest in medicine, so it makes sense to look at the policy this year. ASCO, as the largest society of clinical oncology in the world and whose meetings get 4,000 to 5,000 papers submitted each year, has an enormous amount of data for us to analyze in order to inform whether our COI policy is doing what we hope it to do. We also have a new committee member this year: Dr. Beverly Moy, an internationally known expert in the area of conflicts of interest in medicine. She will be a key player in helping us go through this analysis.

AC: Participants in the ASCO Leadership Development Program will be involved in the COI policy review. What unique perspective will earlycareer oncologists bring to the table?

Dr. Helft: Leadership Development Program participants are involved in this important project at a time of enormous scrutiny of and consciousness about COI. This presents a great opportunity to make a meaningful contribution to the ongoing national and international dialogue about the effects of COI on research and patient care. I’m really excited about this collaboration and the focus these program participants will bring to the issue. AC: Will ASCO members have an opportunity to provide feedback on changes to the Society’s COI policy? Dr. Helft: The entire process will begin with an internal review and reconsideration. We’re hoping to use data to guide us in our review to lend perspective on what effects the current policy has had. We will also reach out to our members to make sure they are well-informed about the policy and the impact of any changes ultimately adopted by the Board.