Sep 24, 2018

Secret Conflicts of Interest

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By now I am sure it is common knowledge that doctors are often paid by drug companies and by the manufacturers of medical devices.  There is a strong correlation between the amount of a company’s drugs a doctor prescribes and the amount he or she receives from the drug company.  The more you prescribe, the more you usually get paid.  Similarly, those who use the most devices from a manufacturer receive the most payments.  Doctors typically feel no great urgency to inform their patients that they may be receiving what some would call a “kickback” for prescribing a medicine or a device for the patient.  These payments raise questions of medical secrecy, ethics and conflicts of interest.

Image result for stacks of medical journals

Similar issues arise when a doctor writes an article for a medical journal.  These articles are used to announce medical advances, medical discoveries, and the results of studies.  They are an important source of information for doctors about news which may affect their practices and their patients.  Virtually all medical journals require that authors disclose any conflicts of interest they may have so that readers can take those potential conflicts into account in assessing the weight to give to the article.  Turns out many authors do not disclose their conflicts.

In a recent article in the online version of JAMA Surgery, a team of researchers compared public data about drug company and device manufacturer payments with conflict disclosures in articles written by doctors who had received these payments.  The researchers identified the top 100 recipients of payments, looked for articles they had written in medical journals and then checked to see if their payments had been disclosed.  They discovered that the payments were reported only about 1/3 of the time.

The payments in question were not small.  For calendar year 2015, the top 100 recipients received a total of almost $12,500,000.  The average payments received by each of them was $95,000.

The researchers hypothesized that the failure to disclose may have resulted from a conclusion by the author that the payments did not create a conflict of interest for the article in question.  Of course, the authors may have been wrong about the existence of a conflict or may simply not have wanted the payments to be disclosed.  Better that all payments be disclosed and let the readers decide if there is a conflict or not.  For that reason, the researchers propose a uniform conflict policy for all medical journals regardless of whether the author believes the payments to be relevant to the article or not.

Over and over again we see the pernicious effects of secrecy and lack of transparency in all aspects of the delivery of medical care.  Malpractice is hidden; bad doctors are hidden; costs of medical treatment are hidden.  One thing that is certain is that secrecy and lack of transparency do not benefit patients or the community as a whole.  Secrecy is used to make it harder for patients and others to know what is going on and to make decisions accordingly.  As long as hospitals and doctors run the system, there will be little change.


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