Conflict-of-interest rules go too far, Harvard doctor argues
A prominent Harvard physician comes down hard on conflict-of-interest rules, comparing anti-business advocates who champion them to street evangelists preaching sermons against accepting gifts or payments from medical manufacturers.
Dr. Thomas P. Stossel, a Harvard Medical School professor and hematologist at Brigham and Women's Hospital, airs his views in answer to a question posed in the British Medical Journal: Has the hunt for conflicts of interest gone too far? Stossel gives a resounding yes while Kirby Lee of the University of California at San Francisco answers with a firm no in the head-to-head feature.
The conflict of interest movement demonizes company-sponsored education, maligns researchers who fail to honor "overblown journal disclosure requirements," and labels doctors mingling with corporations "ill advised, corrupt or both," Stossel writes.
"All of these charges obscure the fact that only private companies bring new products to patients and that medical care has improved steadily and spectacularly because of them," he writes. "Fraud and pathological bias could never have conferred these monumental achievements."
Kirby counters that while a conflict of interest does not always lead to harm, it must be monitored to prevent bias.
"There are some individual clinicians, researchers and industry employees who serve their own interest at the expense of patients," he writes. "Trust and credibility, once damaged, are difficult to restore. And when you become the patient, wouldn't you want to be assured that medical decisions are made in your best interest?"
Stossel disclosed having financial ties to two companies and receiving fees from other organizations for speaking about conflict of interest. Kirby declared no competing interests.
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COMPANIES CANNOT OBTAIN THE BEST SCIENTIFIC ADVISE WITHOUT CONTACTS WITH ACADEMIC LEADERS AND RESEARCHERS.
COMPANIES DO MUCH TO SUPPORT RESEARCH AND, ESPECIALLY, RESIDENT TEACHING THAT COULD COME FROM NO OTHER SOURCE (GOVERNMENT ?)
WHEN BIAS OCCURS (I BELIEVE MUCH RARER THAN SOME WOULD HAVE US BELIEVE), THE INVOLVED PERSON & COMPANY SUFFERS, AT THE LEAST, BLOWS TO THEIR REPUTATION.
ASSOCIATION DOES NOT PROPERLY PROVE DISHONESTY!
Before Dr. Stossel does any more trash talking he should look at some detailed case studies of the problems that he says don't exist. Here is a link that describes the corruption of a major journal by key opinion leaders in cahoots with Pharma executives: http://hcrenewal.blogspot.com/2008/01/antipsychotic-drugs-for-depression.html Every sleazy deceit in the book was in play here.
There are similar problems in commercially funded continuing medical education. See here: http://hcrenewal.blogspot.com/2008/01/variations-on-theme-of-sleaze.html
I agree with Dr. Stossel. If I don't believe a medication is good for a patient, it does not matter how many times I am out to dinner sponsored by pharma companies, I just won't prescribe them. In fact, I have been out to dinner more than once sponsored by the makers of two medications (to remain nameless) that I am yet to prescribe. This happened many years ago, and I have never prescribed these medications. On the other hand, I will readily prescribe medications that I believe in, regardless of whether I am taken out to dinner or not. Sure, there are always exceptions to the rule however, I believe most physicians keep their patients' interest at heart first and foremost. I find offensive the suggestion that because I attend a conference or am invited to dinner that my professional integrity would be so readily and cheaply bought and compromised.
That our profession includes both uncompromising physicians who always put their patients' best interests first, and physicians who are blatantly "on the take" and put their patients' welfare last, is a fact of life. The extreme cases are easy to detect and have been publicized. The problem lies in the vast middle ground, where bias in data reporting can be subtle and not even deliberate. The gradual erosion of objectivity and consequent loss of confidence in the medical literature, as a result of enormous sums of business money at play, is the most disconcerting, because it is insidious, pervasive, and currently unstoppable.
Both men are right, sort of. Patients' best interests are served by having physicians, who understand the complexities and also see the effects of new drugs and treatments on their patients, act as the liason between the pharma interests and the patient. In the absence of physicians, patients are forced to rely on advertising in People magazine, or whatever. At the same time, some areas are so profitable - orthopedic implants for the hip, knees and spine come to mind - that the temptation for abuse is very high and, in the case of orthopedics, at least, appears to be irresistable. Some monitoring is clearly needed. As with most "policies" and "guidelines", it is rigidity that is the enemy. Blanket statements from which there can be no deviation are always a problem; Ronald Reagan recognized that when he said "Trust - but verify."
Dr. Gonzalez - Why do you go out to dinner with drug reps? Ask yourself that question and see what answer you can produce. If you are reading the literature, which should be part of your job description, you should not need to get your medical information from reps, so there must be some other reason that you join them for dinner and a night on the town. You may find it offensive that people question your professional integrity as a result of your affiliations with drug reps, but perception is 99% of reality. Upsetting as it may be, the public will not stop questioning the legitimacy of your interactions with drug reps just because you claim objectivity - that is not the way public opinion works. You can choose to consort with drug reps and continue to feel offended, or you can cut off your connections with drug reps and feel confident that patients have no reason to question your integrity.
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