Doctors, Expertise and Conflicts of Interest



I’ve owned my own business for many years. Before I began my work in patient advocacy and empowerment, I was a marketer, and advised dozens of businesses of all sizes (from individual professional services like lawyers and therapists to large corporations like GE and Kodak.) I get business, I understand development of income streams and I fully realize that profitability is always the goal among these businesses.

But I also know that profitability and business models are at the very heart at what is WRONG with healthcare. No matter what the problem with the system, its roots are grounded in the need to make money by someone.

This statement holds true whether we are talking about those large corporations, like pharma manufacturers, large hospitals and treatment centers, insurers, or medical device manufacturers — or individuals like doctors or yes, even patient advocates. We all need to make a buck.

And making a buck is fair! Yes — at my heart I am a capitalist. And for many aspects of life, I believe that the profit motive and fair competition are fair and work well.

But making the buck at the expense of patients, rather than to the advantage of patients, is not fair and it’s not right. Profiting by hurting a patient is wrong. Profiting while providing no benefit is wrong. Profiting by withholding the truth is wrong. Profiting through non-disclosure of a conflict of interest is wrong, too.

Unfortunately, healthcare is not about health or care. It’s about sickness and money. And conflicts of interest go to the very heart of that statement.

One of the early recognitions of this problem came from the New England Journal of Medicine which, in 1993, attempted to define such conflicts and suggested remedies for them. The conflicts cited ranged from self-referral by physicians, to gifts from drug companies to physicians to research being sponsored by those industries that stood to profit by the results.

Hundreds of medical journals followed suit. They joined the legions of organizations that have their own policies about conflicts of interest, including the Canadian Medical Association, and the American Medical Association includes policies about conflicts of interest in its code of ethics.

But it seems that there are plenty of doctors who either don’t care, aren’t paying attention, or are just plain unethical. At the very least they don’t let some little conflict of interest get in the way of making a buck.

This article in the latest edition of Slate Magazine provides too many examples, making the hairs on the back of my neck stand on end. It asks the question, and proves the point; Stealth Marketers: Are Doctors Shilling for Drug Companies on Public Radio?

Cases in point:

Mike Taibbi, a former smoker and reporter for NBC Nightly News interviewed Dr. Claudia Henschke, a professor of radiology at Weill Cornell Medical College who reported that regular lung scans could prevent 80 percent of deaths from lung cancer. Other professionals called this claim outrageous. It turns out that Dr. Henschke’s research was being subsidized by tobacco companies which had a major stake in the outcomes of her statements.

Recently, PBS radio stations aired Prozac Nation, an edition of its award-winning program, An Infinite Mind. Four prestigious mental-health experts discussed the link between antidepressants and suicide, and all four concluded that the link was blown out of proportion. (Really? Tell that to Kim Witzcak, whose husband Woody died from taking an antidepressant which had been prescribed off label for his inability to get a good night’s sleep.)

What the program failed to reveal is that all four of the experts have financial ties to Eli Lilly, the manufacturer of the antidepressant Prozac.

Examples of these conflicts of interest could go on ad nauseum. The real point here is that we patients need to be aware of them, and know when it’s appropriate to ask questions about them. Here are some examples of times we may be the victims of conflicts of interest:

1. Many doctors who work in clinical trials may be receiving referral fees for finding patients who can participate. A conflict of interest may exist if there is no benefit to you, the patient, for participating. You may still choose to participate! But you need to be asking your doctor what’s in it for him.

2. Medical device kickbacks are rampant among doctors. Need a knee replacement? Ask your doctor if he’ll be receiving any payments from the manufacturer, or payments beyond his usual fee for doing the surgery. You may still want to get your knee replaced! But you should know if one type of artificial knee is being recommended or planned for over another based on how much your doctor will make from it, and you should have the option to choose the one that’s better for you.

3. Does your doctor travel a great deal? or speak at conferences frequently? If so, he may be receiving “speakers fees” for convincing his peers that a particular drug or device is better for their patients. The manufacturers love to pay doctors to take advantage of their credibility. But if you take that through to its logical conclusion, who do you think is paying for those kickbacks? We are. And is that drug the best for us just because the doctor is making money by supporting it? Maybe not.

There are no easy answers here — just awareness, and another opportunity to be wise and savvy patients.

One has to wonder how often patients have gotten sicker, or died, because some doctor or organization was involved in a conflict of interest?

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Comments

  1. d. m. lagrone says:

    As a doctor with 38 years of clinical experience, I’ve come to understand that a patient is always a three dimensional human being and, while their chief complaint may take only a few minutes to repair, it is always just the tip of the iceberg. There is no substitute for knowing your patient and the only way to know them is to talk with them. – No lab test can replace this.
    As a consultant to legal foundations, I have found in case after case, that doctors don’t- or can’t-talk with their patients. Part of this problem is their training, but part is also their experience with the overwhelming impact of other systems: insurance companies(while taking 40% of every healthcare dollar spent vs. 4% Medicare takes) use time consuming authorization of care procedures driving dr.’s office expenses up 3 times what they were in 1998; legal system- drives costs up in many ways, eg: Two years is usually required to adjudicate a lawsuit, taking time and producing enormous stress. Bureaucratic systems: from boards to taxes to the DEA. Information systems: misinformation on the internet, for example, used by attorneys promoting class action.
    These are only a few of the dynamics which must be dealt with to reform healthcare, a cause to which I am firmly committed. We all should support Obama in his effort.
    -DML

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