Friday, April 18, 2008

The Conflicted Again Defend Conflicts of Interest

The Boston Herald just ran an op-ed arguing against proposed legislation to ban gifts by pharmaceutical representatives to physicians. It included arguments that pharma reps are educators, not salespeople:

Despite extensive training, physicians cannot know the details of all products, especially new ones. Therefore, company salespersons complement physicians’ information derived from many sources.

To see what pharmaceutical representatives do other than providing education, see this post and its links to earlier ones. For a more graphic, and we do mean graphic demonstration of what some pharma reps are about, see this post (but be careful with the links).

Finally, the op-ed warned,

It threatens to dismantle a system that has served us well, and is deeply disrespectful of physicians and companies alike.

Not to be too snide, but I wonder to whom the "us" above refers. As discussed in posts by Ed Silverman on PharmaLot, and on the WSJ Health Blog, the two authors of the op-ed, Dr Thomas Stossel and Dr Dennis Ausiello, have multiple financial ties to the pharmaceutical industry.

Aussiello serves on the board of directors of Pfizer Inc, and hence has a fiduciary duty to protect the financial interests of the company's stockholders. According to PharmaLot, he is also "is on the advisory boards of Promedior, Proventys and Pulmatrix."

As we wrote last year, in a commentary in the New England Journal in which Stossel attacked the rigorous conflicts of interest rules that were once again imposed on the US National Institutes of Health (NIH), Stossel disclosed "having received consulting fees from ZymeQuest, owning stock options in ZymeQuest and Biogen, and having pending and issued patents, owned by Brigham and Women's Hospital, some of which are licensed to ZymeQuest." [Stossel TP. Regulating academic-industrial research relationships - solving problems or stifling progress? N Engl J Med 2005; 353: 1060-1065.] But in another paean to a laissez-faire approach to conflicts of interest in Perspectives in Biology and Medicine, Stossel also disclosed that he "is a member of the Board of Directors of Zymequest Inc, and the Scientific Leadership Advisory Board of Merck & Co. The author is a founding scientist of Critical Biologics Corporation and a consultant to Boston Scientific, Inc., and Gerson-Lehrman, Inc." [Stossel TP. Regulation of financial conflicts of interest in medical practice and medical research. Perspect Biol Med 2007; 50: 54-71. ]

So, the current system seems to have served Stossel and Aussiello well, at least financially. Whether their argument against restrictions of physicians' conflicts of interests are motivated by their own financial interests, or their concern for the future of health care for all, I cannot tell.

I have yet to see a good argument for physicians', especially academic physicians' financial involvement with for-profit health care corporations made by someone who does not have any such relationships.

ADDENDUM (19 April, 2008) - See also the comments by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog.


Anonymous said...

Even with the typos I will stick with my previous comments. What I found to be unbelievable was the comment section of the WSJ Health Blog. Doctors rallied to preserve the current system that is little more than kickbacks and pay-to-play business practices.

One doctor commentator, a voice in the wilderness, was asking how doctors could accept these business practices in good faith? He then went on to note that the NEJM receives over 50% of it's income from pharma. This then begs the question: Has corruption become institutionalized?

How do we, as patients, accept medical advice knowing that one of the largest, and most respected medical institutions in the country, will actively fight state legislation to eliminate conflicts of interest?

Mass. has the right idea. The reality is the worse way to solve a problem is through legislation, but I see no alternative.

Steve Lucas

Anonymous said...

I'd like to see a conflicts database for all physicians who publish...

Anonymous said...

nice post