Blog | Monday, August 24, 2015

Doctors and industry

I wrote a column about doctors and conflicts of interest. This is a perennial topic in the field of medicine, but it's been on people's minds recently because of a set of 3 essays that appeared in successive May issues of the New England Journal of Medicine, America's oldest and most esteemed medical journal. You can read the essays if you like here, here, and here. The Journal's editor-in-chief also weighed in with an editorial introducing the three-part series.

Academic doctors have long had relationships with industry, and the history is complicated. Many of us in academe are trained to be very skeptical of our colleagues that take funding from pharmaceutical manufacturers (aka drug companies) and device makers (think hips, heart valves, pacemakers, surgical robots, etc.). We are skeptical because we feel that these colleagues have sold out, or that they are shills for the companies that have them on the payroll. Though seldom admitted, envy plays a role in our skepticism, also.

There's no doubt that the skepticism originates from a good place. After all, those of us in academics prize objective truth and scientific advancement. The idea that researchers and clinicians are beholden to a commercial interest raises red flags for us about integrity. And there have been many reported examples of harm done by folks in thrall to commercial interests.

The outgrowth of all the skepticism is a set of rules and practices that center around transparency in our daily business. We must disclose any potential conflicts to the universities for whom we work. If we speak at a conference or submit an article to a journal, the same principles apply.

We've reached a point where we evaluate information based on the ‘moral purity’ of who is presenting it (and of course, the purported purity of the information itself, i.e. if it's funded by industry, it's automatically suspect). Moral purity is equated here with meaning no ties to any commercial interests.

The correspondent who wrote the 3 essays for the Journal is asking if perhaps we've gone too far to the extreme, suggesting that when we engage in morality litmus tests for the sake of convenience, we are likely overlooking opportunities to do good work that can have mutual and societal benefit.

Predictably, the response to her pieces has been pretty fierce. Two former editors and a former correspondent for the Journal lambasted their former workplace for even mentioning a reconsideration of academic-industry relations in a retort in the British Medical Journal (now know as just BMJ). The gloves are off! Another commentator opined about “Why [NEJM author] Lisa Rosenbaum Gets Conflict of Interest Policies Wrong.” Ouch.

When poking at sacred cows, you inevitably become a target yourself. The fact is that government (i.e. taxpayer) funded research is a 0 sum game: the NIH budget has remained flat for several years, making the most high-minded, “pure” way of funding research harder and harder for young and mid-career scientists. Many of us see collaborating with industry as the only real possibility of moving progress forward. It's OK to have rules about conduct of industry relationships, but to squelch it all as immoral benefits no one except those mandarins in charge of the litmus tests.

Coda: NPR ran an interesting piece on “Dollars for Docs,” a searchable database by the non-profit investigative news source ProPublica that reveals how much your doctor takes from drug companies as part of the Physician Payment Sunshine Act. Apparently I received $24 in 2014. I have no recollection of these inducements. My best guess is that some foodstuffs were brought to our nursing staff to encourage them to administer vaccines against shingles and cervical cancer. I can live with that.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.