Is it a fairy tale to believe that our doctors always acted in our best interest?
Unfortunately, it may be.
Paul Thacker recently published an opinion piece in The BMJ Opinion highlighting the rampant failure of doctors disclosing their numerous financial conflicts of interest. The most public recent example was the NYT article on Dr. Jose Baselga, the prominent cancer researcher from Memorial Sloan Kettering Cancer Center. He failed to disclose over $3 million in funding from pharmaceutical and health care companies.
On the surface this sounds bad, but is it really an issue? The doctors in question almost always respond by saying their interest is helping medicine progress, and the money does not alter how they practice. I, and the majority of the population, beg to differ.
A study in JAMA showed that industry sponsored meals led to an increase in doctors prescribing the company’s brand-named prescriptions. And that is just the tip of the iceberg. The effect is likely compounded for more expensive medical devices and even deciding in treatment options such as surgery.
Dr. Jason Fung likes to call these payments “legal bribery.” He also points out how this “bribery” can impact not only physician decision making, but also how scientific evidence is reported. Dr. Fung quoted former NEJM editor Dr. Relman as saying “The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research.” That’s a scary thought.
Think about it. If you were designing a study being funded by a pharmaceutical company, and your job depended on getting more grants and running more studies, could you be more likely to design a study that was likely to benefit the company? That would put you in their good graces and make it more likely they will fund your studies in the future. It’s subtle, yet very powerful and difficult to deny.
How do we combat this problem? Is demanding disclosure enough?
I remember hearing a story about one doc who claimed he received funding from so many different companies that they effectively canceled each other out so in the end he didn’t really have any conflicts. We are all human. We like to think that we are above influence. That we can accept money for our advice and our work and not let it affect our decisions. But that doesn’t seem to be the case.
Until the time when these payments are outlawed, we have to rely on doctors disclosing their conflicts, and we have to rely on ourselves to interpret their findings with care. We can also use sites such as Open Payments to be our watch dog by investigating industry payouts and providing the information to us “to promote a more transparent and accountable healthcare system.”
That’s a goal we can all support.
Thanks for reading,
Bret Scher, MD FACC