Tuesday, June 13, 2006

The Web of Conflicts of Interest: New Jersey Legislators' Ties to Hospitals

The Philadelphia Inquirer investigated the source of the "massive resistance" in the New Jersey state legislature to the Governor's proposal to tax hospital beds. Their reporters proposed the resistance was due to a web of relationships between hospitals and the individual members of the state legislature.

The article described the hospitals as "sacred ground in New Jersey." "Hospitals enjoy unique political clout in New Jersey. Just about every lawmaker has some kind of connection to a hospital, whether it's sitting on an advisory board, having an employed relative, doing legal or insurance work, or remembering where a sick parent was treated." So, "lawmakers' deep ties to hospitals can become an obstacle, keeping health-care problems from being discussed, Sen. Joseph Vitale (D., Middlesex) said. Hospitals, Vitale said, have 'a strange degree of influence, and it can be conflicting for someone who is trying to do the right thing but has a built-in bias.'" "Veteran lobbyist Dale Florio, who counts several hospitals as clients, said hospitals' strong support system 'makes it very tough for state government to do battle with them.'"
Some examples of law-makers' ties to hospitals included:
  • "'Hospitals can't afford a thing, not a penny,' said Assemblywoman Joan Quigley (D., Hudson), an administrator at St. Mary Hospital in Hoboken, N.J., and a member of the Budget Committee. "
  • "The board of South Jersey's major hospital, Cooper University Hospital in Camden, is chaired by the region's most powerful political figure, Democratic power broker George E. Norcross III."
  • "Assemblyman Herb Conaway (D., Burlington), who chairs the Assembly Health and Senior Services Committee, is employed by Cooper, as is his wife."
  • "Farther north, former Gov. Richard J. Codey - who as president of the Senate remains a key budget gatekeeper - sells insurance to St. Barnabas Health Care System in Essex County."
  • "The twin brother of Senate Minority Leader Leonard Lance (R., Hunterdon) sits on the board of Hunterdon Medical Center, and Assembly Budget Committee Chairman Lou Greenwald's wife used to work at Cooper."
  • "Sen. Robert Singer, vice president of corporate relations at Kimball Medical Center, said he had carefully walked a line during the debate over the bed tax."
In summary, "more than a dozen other lawmakers sit on boards or have a relative involved with a medical center."

We posted a while back about the growing movement to have doctors sever all ties with pharmaceutical and device corporations that could raise the slightest question of conflicts of interest. The authors of a prominent article advocating this position in JAMA (Brennan TA et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA 2006; 295: 429-433) argued that even minimal financial relationships between corporations and physicians, e.g., small gifts such as pens, coffee mugs, or lunch sponsored by a drug company etc, could influence physicians' professional decision-making: "social science research demonstrates that the impulse to reciprocate for even small gifts is a powerful influence on people's behavior. Individuals receiving gifts are often unable to remain objective; they reweigh information and choices in light of the gift." Thus they proposed that such relationships should be banned.
If small gifts can influence physicians' professional behavior as the evidence suggests, how much more could relationships such as working full-time for a hospital, or sitting on a hospital's board of directors influence the decision-making of state legislators?

The Philadelphia Inquirer article provides more evidence that a web of conflicts of interest, whose strands are often very strong, pervades health care, and links the leaders of all sorts of health care and related organizations together. This web likely has profound effects on health care policy throughout the country. It is likely an important reason that important health care problems never seem to be addressed, that we seem impotent to address ever rising costs, declining access, stagnant quality, and dissatisfied health care professionals.

Parenthetically, the web of conflicts of interest is likely also a cause of what we have called the "anechoic effect," the lack of pubic discussion of health care mismanagement, conflicts of interest and corruption.
I applaud the Philadelphia Inquirer's reporters, and the other investigative journalists who have revealed some strands of the web of conflict of interest in health care. I wonder when more medical journals will have the courage to join them? Regardless, we physicians need to educate themselves about how the web of conflicts compromises our professional values, and then take up our brooms and pull the web apart.

1 comment:

Anonymous said...

Two recent conversations come to mind. In the first a friend discussed how residents expect gifts, food, and special treatment from drug reps. The second conversation covered how new doctors were willing to accept the convoluted payment system but expected drug reps to outfit their offices with all of the necessary supplies. Pens, pads, staplers, even the tissue and magazines along with a steady stream of food.

The point was strongly made that they saw no conflict, and felt they were not influenced in their decisions. This is just business as usual.

I have worked around salespeople all of my life and there is an expected quid pro quo. Whether it is a small portion of your income or, in some of these cases all, you will be biased when making your decisions.

Steve Lucas