Saturday, January 21, 2012

Taking the Right (Though Small) Steps in Conflict of Interest

Amidst the braying and screeching of the Republican Presidential candidates in South Carolina came a small news bit that the Obama administration will institute new requirements that drug companies must disclose their payments to physicians for speaking, consulting, and research activities. As noted here, this has been backed in large measure by Republican Senator Chuck Grassley and Democratic Senator Herb Kohl, who have been at the forefront of conflict-of-interest issues in medicine for the past several years.

Two facts in the articles bear repeating: a) that physicians can be mightily influenced by the largesse of drug companies; and b) that "about a quarter of all doctors take some cash payments from drug or device makers and nearly two-thirds accept meals or food gifts" [my emphasis]. As you can find on the ProPublica website in the above link, companies invest millions of dollars in these little gifts. If you think that doctors can go to a fancy dinner sponsored by Drug Company X and not have their subsequent prescription patterns influenced in favor of Drug Company X, then you would wonder why the industry invests such resources in the first place.

Disclosure is a nice gesture, but it is mostly only a gesture. Like the disclosure of nutrition facts for food producers (something that industry likewise fought against tooth and nail), it is utilized only by a very small group of people. Similarly, the vast majority of patients won't have the determination and persistence to track down the disclosure information. And besides, when two-thirds of docs are on the take, what difference does the research make, anyway?

The only legitimate long-term solution is to tighten existing rules about doc-industry relationships. There are a few areas where docs have to work hand-in-hand with industry (surgical subspecialties are the main ones that leap to mind) and would need to be carefully thought out, but otherwise it's really not that difficult to create rules by which docs are supposed to operate with respect to drug companies. We already have such rules for scientific ethics in research; why there can't be a similar arrangement for the daily business of doctoring is quite beyond my understanding. In the meantime, the standards we have now would be regarded as appalling by most people if they understood the situation.

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