The New York Times published a forceful editorial about physicians' conflicts of interests, entitled, "Seducing the Medical Profession."
The editorial took its cues from the recent JAMA article by Brennan and colleagues which advocated tough restrictions on physicians' conflicts of interest (see our post here).
The Times charged that "the medical profession has sold its soul in exchange for what can only be described as bribes from manufacturers of drugs and medical devices." So, "it is long past time for leading medical institutions and professional societies to adopt stronger ground rules to control the noxious influnece of industry money on what doctors prescribe for patients." It seconded the "ban on all gifts, free meals and payments for attending meetings," rejection of "free drug samples," and "ban on consulting arrangements that entail no specific scientific duties" advocated in the JAMA article. It concluded that physicians' "judgment must not be clouded by financial self-interest or the desire to please industrial benefactors."
I agree with a ban on gifts, free meals, payments for meetings, no-show consulting jobs, which represent relatively small, but very prevalent conflicts of interest that may collectively have major deleterious effects on patient care. (I am ambivalent, however, on the issue of free samples, since these can, in an imperfect world, benefit patients who can't pay for their medications).
But I am afraid that the Times editorial reinforces the notion found in the JAMA article that the only important conflicts of interests in health care involve individual physicians' relationships with pharmaceutical and device companies. The Times also silently endorses the idea that the leaders of academic medical centers (AMCs) should police such relationships.
On Health Care Renewal, however, we have shown that conflicts of interest are prevalent everywhere in health care. Furthermore, it is likely that conflicts of interest affecting leaders of health care organizations may have more severe bad effects than do those affecting individual physicians.
Yet the Times and the authors in JAMA kept silent about such conflicts. And the authors in JAMA gave enforcement power to leaders of AMCs while imposing no particular restrictions on conflicts of interest affecting such leaders.
A reminder that major conflicts affect leaders of AMCS appeared a few weeks ago in the London Times (thanks to PharmaGossip for this related post). The international pharmaceutical company GlaxoSmithKline had appointed Dr Ralph Horwitz to be a non-executive director. Horwitz is also Dean of the School of Medicine and Vice President for Medical Affairs at Case Western Reserve University. The appointment was quashed before Horwitz could assume the 60,000 pounds sterling per year position, because GSK felt that an article Horwitz had helped write about adverse effects of over the counter medications containing phenylpropanolamine represented a conflict of interest that could negatively affect GSK. Unsaid was whether having a medical school dean and vice president assume fiduciary responsibilities to the share-holders of a large, for-profit pharmaceutical manufacturer could negatively affect Case Western's academic mission or its patient care.
As I suggested before, we should develop a broad set of principles about conflicts of interest, and generally about business ethics in health care, focused on all transactions with outside organizations with their own vested interests or agendas. These principles should apply to all who make decisions in health care, physicians, other health care professionals, and leaders of health care organizations. The details of the implementation of these principles could vary, so as to apply to the setting and role of each individual.
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