Breaking the cycle of dependency–Conflicts of Interest

When I was in practice the the drug industry’s promotional efforts at meetings, in the hospital, in our offices, even as a sponsor of information on the internet was overwhelming. In evaluating recommendations, medicynic found himself always reviewing the declared conflicts of interest of speakers/authors/researchers (if they were available) and frequently deciding that their conclusions were unduly influenced by the sponsor.

Financial interactions between physicians and the drug industry (this could also refer to insurers and other suppliers as well) compromise our integrity and that of the entire health care system. Not only must we avoid frank conflicts of interest but we must also avoid even the appearance of these conflicts in order to maintain our role as fair, ethical, and independent patient advocates.

Jerome Kassirer a former editor of the New England notes the extent of the industry’s influence in On the Take–How Medicine’s complicity with Big Business can Endanger your Health (Oxford Press 2005). It’s a good educational read. His suggestions for addressing this issue follow.

“Items for immediate implementation:

1. Exclusion of all gifts from industry (by law if necessary), even including items that might be considered useful in a doctor’s practice or education; elimination of physician participation in company-sponsored speaker’s bureaus.

2. Prohibition of consultations with industry for anything except scientific matters, and outlawing of marketing by physicians of drugs or devices in which they have a financial interest.

3. Full disclosure to patients in all doctors’ private offices of any and all financial incentives for patient care or clinical research.

4. Elimination of “finder’s fees” for identifying patients to drug companies or their intermediates; no “farming out” of patients for clini-cal research.

5. Permission to conduct clinical research on devices or drugs in which the investigator has a financial interest should be proscribed.

6. The requirement of full accessibility for independent analysis of all data in any published clinical trial in which the investigators had a financial conflict.

7. A requirement of full, detailed disclosure in legible handouts at all teaching events of the type (drugs or devices), dollar amounts, and duration of all financial ties of the lecturer that relate to the subject at hand; full disclosure of the sponsorship of all such events.

8. The selection of journal editors, officers of major professional o-ganizations, and leaders of academic institutions among; physicians who have no financial conflicts.

9. A demand for increased scrutiny by medical editors of all financial conflicts of authors, with full disclosure not only of the com-pany relationships but also the specific relevancy of the conflicts to the subject matter (specific drugs and devices).

10. Pressure for a comprehensive analysis of the problem by the Institute of Medicine that would include drafting principles and guide-lines for all types of financial conflicts, not just those associated with research.

Items for further analysis and debate:

1. If CME lectures by individuals with financial conflicts cannot be prohibited, should physicians boycott courses given by financially conflicted lecturers?

2. If clinical-practice-guideline committees cannot be constituted exclusively by non-conflicted individuals, what safeguards can be introduced to reduce the chance of biased recommendations?

3. If ownership of stock in a company that could benefit from a researcher’s work and scientific consultations with a company create conflicts, what is the basis for any specific “minimally acceptable” amount that researchers can hold in stock or receive yearly in compensation for consultations?

4. How could a universal Web-based registry of physicians’ financial conflicts of interest be implemented?

5. How can the financial arrangements of professional organizations with industry be disclosed, including the amounts, duration, and purposes for which the funds were used?

6. How can the dependence of professional organizations on industry support be reduced?

7. Can industry be convinced that in the long run the harm of physicians’ collusion with their marketing practices is more serious than the short-term gain in sales?

None of these questions will be addressed without strong pressure of the public and the avid participation of leaders of professional organizations and academic medicine. I challenge them to take up the battle.”

Read the book for the details.

2 responses to “Breaking the cycle of dependency–Conflicts of Interest

  1. Pingback: Pharmaceutical Patents–history of the problem | Medicynic

  2. Pingback: A first step to health care for all–reforms that won’t cost a penny | Medicynic

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