BLOG: Conflicts of interest in medicine

ByDarrell E. White, MD

Lots and lots of talk of late, on Twitter of all places, about “conflicts of interest,” or COI, in medicine. To be sure, no one agrees on just what it is that constitutes a COI. Not even a little bit. In general, those who have a large stake in a single position argue against the existence of any COI whatsoever. Academics who are contractually forbidden to accept outside payment of any kind insist that any money taken from industry for any reason at all constitutes a COI so egregious that it nullifies any opinion you might hold. Indeed, one “professor” went so far as to declare that profit itself is a COI.

No word as to whether he cashes his paychecks.

Still, the specter of COI is out there, so I thought it would be wise to state more boldly what my industry connections are. You can then decide if I’m on the up-and-up or more full of crap than you’ve already decided. Note that this blog is listed in the “Opinion” section of Healio.com/OSN, if that matters.

Let’s start with ownership and investment. I have no idea whatsoever if I hold any shares of publicly traded companies in our space. An outside company with whom I have no communications when it comes to picking stocks manages the White family’s meager funds. My very tiny ownership interest in TearScience was liquefied when Johnson & Johnson acquired it. At the moment I have a teeny-weeny interest in Ocular Science and Eyevance (through a larger investment vehicle).

On and off over the years I have done “on-label” speaking for various companies that make stuff we prescribe and use in our everyday practice. These talks are very tightly controlled; they are intensely vetted by the legal beagles of the sponsoring company lest they run afoul of the FDA. I only accept invitations to speak on products I actually use; I am quite comfortable talking about competing products (much to the consternation of the makers of said products, ie, Restasis and Xiidra). The fee to give these talks is enough to make it worth my while if I only have to get on one plane to do so. At the moment, I speak on behalf of Allergan, Shire, Omeros and Sun.

A significant majority of my interactions with the eye care industry take place behind the scene. For many years I have been a consultant to executives at all levels of the org chart. My expertise is pretty much exactly what I’ve brought to bear here: insight into the real world of actually taking care of a patient. As such, I have been paid to advise on product development, branding, sales force and end-user education, and both short- and longer-term strategy. These interactions are sometimes as a member of an advisory board, but often as not are solo efforts. My active engagements are with Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros.

For years I have noted that I am an “acquired taste” when it comes to this kind of work. The book on me appears to be, “If you want the truth, ask White. If you don’t want to know the truth, ask anyone but White.” Fair enough. Some companies have successfully resisted my “charms” entirely; for example, I have never provided services of any kind to Alcon. TearScience/J&J is not listed above. Neither is Bausch + Lomb. In past years I’ve worked with both and enjoyed that work very much. Both companies have undergone significant change. It remains to be seen if they will find my advice helpful again.

At the end of every day, I am not really any different from anyone who reads my stuff. I go to the office and the OR, and I take care of patients. If asked, I try to help the companies that make the things we use when we care for those patients, and in so doing, I try always and ever to tell the truth. It’s up to you to decide if that is a disclosure of a true COI.

Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.