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Divergent Views on Managing Clinical Conflicts of Interest
| Content Provider | Semantic Scholar |
|---|---|
| Copyright Year | 2007 |
| Abstract | To the Editor : The discussion by Camilleri and Cortese 1 on conflicts of interest in medicine, including policy recommendations for addressing them at Mayo Clinic, is more measured than many other such commentaries. Nevertheless, it contains characteristic factual errors and conceptual confusion associated with this contentious topic. The intent of the article and many like it is presumably to encourage scientific rigor in medical research and evidence-based decision making in medical care. The implicit assumption of the conflict of interest literature is that financial motives interfere with these desirable attributes and that nothing short of extensive disclosure and regulation of such conflicts will ensure them. However, almost no evidence supports that such interference exists in research. 2 Rather, as physicians and scientists increasingly have interacted with industry since the establishment and early expansion of the biotechnology industry, financial incentives afforded these physicians and scientists have resulted in incontrovertibly useful products. Only a decade after the founding of biotechnology, a handful of inevitable incidents put conflict of interest on the radar screen, unleashing a horde of critics applying “the trappings of virtue as instruments of ambition.” They, in turn, incited the press and Congressional demagogues to intimidate administrators of academic medical centers (AMCs). Because of these administrators’ distance from research, clinical care, and e ucation on the gr ound and their fear of scandal, t he result has been a piling on of disclosure requirements, the empowerment of bureaucracies to enforce them, the imposition of prophylactic rules setting prices for consulting ( de minimis sums), and the forbidding of equity incentives that encouraged entrepreneurship in the years preceding today’s obsession with conflicts of interest. 4 Conflict management services are expensive, and, based on testimony of investigators and university technology transfer officers, the regulations have significantly delayed or completely inhibited technology licensing, corporate-sponsored research programs, and, of greatest concern, establishment of start-up companies. The intrusion of commercialism into clinical practice and continuing medical education is a more complex matter. Whereas critics cited by Camilleri and Cortese aver that marketing “inappropriately” informs medical care, rigorous data suggest only that it “informs, ” in ways that are predominantly but not always favorable to the promoted products. The unsolved chall enge is to determine whether “on balance” product promotion directs useful and safe medications and devices to patients who need them or whether it forces these modalities on patients who do not or who could use older and cheaper ones. Another way to think about this problem is to ask whether in the real world any mechanism exists for obtaining absolutely unbiased information, much less the best information, concerning the huge and growing array of technologies available to physicians. The answer is that such pe rfection, hardl y manifest in academic, noncommercial communication, is impossible, and attempts to engineer it may do more damage than good. Lacking data—the essence of rigor and evidence-based medicine—commentators turn to conjecture and taste. Commercial involvement “might” detract from patient care (which is always possible), for which reason such involvement is inherently distasteful, and therefore its mere “appearance” deserves censure and prohibition. Rules based on the possibility of harm are fine as long as the rules themselves are not harmful. But these rules are harmful, and proposing to preserve rigor and evidence-based medicine by regulating subjective appearances violates that which is to be preserved. The oft-repeated mantra that the appearance of conflict endangers public trust also has no basis in fact and erroneously confuses physicians and scientists with guardians—government officials—which they are not. 5 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://media4.manhattan-institute.org/pdf/Mayo_Clinic_Proceedings_TS.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
