"Eliminating Conflicts of Interest in Medical Research"
Who funds most of the studies that show that drugs are safe and effective?
The drug companies themselves.
It's self-evidently absurd to look to investor-owned companies
for unbiased evaluations of their own products.
One result of the bias in the medical literature is then
that physicians learn to practice a very drug-intensive style of medicine.
Even when lifestyle changes would be more effective, physicians
and their patients often believe that for every ailment there's a drug.
It's gotten so bad that physicians can no longer rely on the medical literature
for valid and reliable information.
Wow, that's quite an accusation. Says who?
Says a long-time editor of one of the most prestigious medical journals in the world.
To help expose some of these conflicts of interest that are corrupting
the medical profession, the Drug Company Gift Disclosure Act
was introduced into Congress and died there year after year
until it was successfully integrated into the Affordable Care Act.
And now there's a database detailing which doctors get
the billions of dollars dished out, permitting patients to make
better informed decisions when choosing health care professionals
and making treatment decisions.
I described how you could look up your own doctor.
The 2008 version that medical groups endorsed
didn't require public disclosure unless doctors got $500 in gifts.
But the 2009 version got even stricter, requiring disclosure
if you even pocketed $100, leading groups
like the American Academy of Family Physicians to start to get a little nervous.
But the final wording in Obamacare requires disclosure of even a $10 meal,
leading countries around the world to look to the United States of America
for leadership in healthcare ethics— you don't see that every day.
Now that we have this massive public record
we can now really see how honest doctors have been.
The financial disclosures by the authors of the American College of Cardiology
and American Heart Association guidelines
were matched to the public disclosures of the hundreds of thousands of dollars
they received from Big Pharma, thanks to the new law.
And let's just say the overall agreement
between author and drug company disclosure was poor.
Nationally, female physicians each received thousands fewer dollars
on average each year from drug companies, though it's not clear
if that's because the women were ethical or the industry was sexist.
What about conflicts of interest online?
There are purportedly evidence- based medicine websites
allowing physicians to answer clinical questions at the bedside.
For example, clinicians caring for patients are increasingly reviewing
treatment recommendations on these websites
to make clinical decisions in real time.
You're with a patient; you can just whip out your phone and check.
So it's important that there are no financial conflicts of interest
in those that write these online guidelines.
So they examined one such website called UpToDate,
which seemed to provide the most comprehensive diagnoses.
So did they find any conflicts of interest?
Ah, yes, in every single one they looked at.
OK, but so what do you do with that information?
Let's say you see an article claiming that candy consumption
is not associated with health risks, and they disclose that the research
was supported by the National Confectioners Association
who used to run ads that said things like
put candy in their school lunch because it's good for them.
The problem with financial conflicts of interest
is you simply don't know what to believe.
So maybe this preoccupation with disclosure hijacked the whole debate.
Maybe, as the former editor-in-chief of the New England Journal of Medicine
critiqued, the focus should instead be on not just disclosing,
but eliminating commercial conflicts.
It's like campaign finance reform where the issue is managed more
by public disclosure rather than getting money out of politics.
Dr. Kassirer writes that the vast attention paid to failure to disclose
conflicts of interest is misplaced, and that more attention should
be focused on the financial conflicts themselves.
After Dr. Kassirer effectively resigned from the New England Journal of
Medicine, disillusioned with the direction they were taking, Dr. Angell took over.
The first female editor-in-chief in the journal's hundred-year history.
She lasted about a year.
Medical journals "consistently refer to 'potential' conflicts of interest,"
she wrote, "as though they were different from the real thing,
and about disclosing and 'managing' them, not about prohibiting them."
"In short, there seems to be a desire to eliminate the smell of corruption,
while keeping the money.
Breaking the dependence of the medical profession
on the pharmaceutical industry will take more than appointing committees.
It will take a sharp break from an extremely lucrative pattern of behavior."