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Should disclosures of conflict of interest in studies have a bearing in the physician-industry debate?
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No, collaboration is integral to excellence in health care
It is unfortunate that we are considering this question under the premise that there is a ‘conflict of interest’ when experts in their field do clinical research and educate their peers on it. The Association of Clinical Researchers and Educators does not accept this premise. It stands to reason that these experts are the best suited to teach their peers through publications and medical education. This is how science advances, and it is part of the legal and ethical work product of physicians and brings value to medicine and patients.
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Attacks on the physician-industry working relationship have become extreme, and it harms medicine and patients. There is tremendous personal gain for the individuals behind these attacks, including some journal editors, a handful of physicians and lawyers. It is to their advantage to discredit physicians and attack pharmaceutical companies. Conflict of interest also benefits institutions that want to have a monopoly on medical education, the manufacturers of generics and HMOs that excel at controlling the drug market to their advantage.
The question we should focus on is: Who gets hurt by the conflict of interest agenda? There is patient harm from physicians having obstacles to all sources of knowledge and patients not gaining early access to better treatments. ACRE supports the physicians who actively engage in clinical research and education. ACRE affirms that the collaborative relationships between physicians and industry are integral to excellence in health care and are directly responsible for the great advances in medicine.
J. Michael Gonzalez-Campoy, MD, PhD, FACE, is Medical Director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology.
Yes, disclosure statements are clearly not enough
Physicians may consider themselves above the financial fray when practicing their art. But, despite assertions to the contrary, there is plenty of evidence that some are often not, especially when it comes to remaining objective in their medical activities in the face of allurements. Be it a grant or a token, there are plenty of anecdotal and empirical data that show an influence of such blandishments, on a recipient’s expressed medical views (sometimes ghostwritten) and practice patterns (eg, prescription writing) that largely tends to be favorable to the interests of a financial benefactor.
Physicians can even sometimes be disdainful of disclosure of such conflicts — real or potential. This disdain is exemplified by the low rate of disclosure to the appropriate parties, (Fontarosa et al) as well as by the perfunctory and incomplete nature of such disclosure when it does occur.
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Medical institutions like hospitals and medical schools are continuing to address the pernicious effect that money or its equivalent has on the scientific objectivity of even their superstars (Insel et al). These institutions are implementing more rigorous guidelines for disclosure of potential conflicts of interests and commitment of their employees (Lo et al). Government institutions have similarly responded by instituting more rigorous disclosure policies and by including in the recent health care legislation a “sunshine” provision that requires web posting by drug companies of monies given to physicians (Section 6002, Patient Protection and Affordable Care Act). Several drug companies and medical schools have anticipated and complied with this provision.
However, disclosure requirements are clearly not enough, as they are often ignored. Medical institutions and professional societies should impose and enforce sanctions on individuals who violate the trust of the privileged position that physicians continue to have in our society, a position of eminence threatened by cupidity. While most physicians are scrupulous in their practice, a few can cause all to suffer from the erosion of this trust.
L.J. Deftos, MD, JD, is Distinguished Professor of Medicine, University of California, San Diego, and Professor of Law, California Western School of Law.