Conflicts of Interest – More Pervasive and Problematic Than We Think
Here’s a very interesting piece from the New York Times’ Review of Books: “Drug Companies & Doctors: A Story of Corruption.”
The basic story is that whereas only a few decades ago physicians generally lacked any lucrative ties to pharmaceutical companies, these days such conflicts of interest permeate the field, and debase it.
Take the example of Dr. Charles B. Nemeroff, the psychiatry department chair at Emory University. He received a NIMH grant to study drugs made by GlaxoSmithKline AND at the same time he also got $500,000 in fees from GlaxoSmithKline. Talk about a conflict of interest!
That’s not the only egregious case – there are many. As it turns out a recent survey found that about two thirds of academic medical centers hold equity interest in companies that sponsor research within the same institution… And here is another one: Of the 170 contributors to the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), ninety-five had financial ties to drug companies. The top dogs aside, many physicians accept hefty salaries to consult for drug companies, and most accept pharmaceutical gifts like pens and free lunches.
So the medical profession is teeming with conflicts of interest – but it doesn’t stop there. Look at politics, wall street, consulting — it is everywhere and I worry that unless we understand just how big this problem is, we are not going to deal with it.
My latest book, The Upside of Irrationality, explores some positive and some negative ways that irrationality plays out in our lives.
hey dan,
i believe larry is trying to address this problem. spread the word.
http://change-congress.org/
You raise a very important point.
My wife is a doctor and she got sick of all the drug sponsored lunches and pens. She didn’t think she needed them to do here job, so she joined http://www.nofreelunch.org/.
I am glad to see increasing discussion of this issue. I am a doctor and in the past was guilty of accepting gifts and sponsorship to travel to meetings etc. I gave the issue a lot of thought and since qualifying as a consultant psychiatrist I no longer even meet with drug company reps. I accept no gifts. There are a growing number of doctors like me. Many of us subscribe to an organisation called “no free lunch” which aims to change the relationship between doctors and drug companies. The website is worth a look – nofreelunch.org
Harrison Ford’s version of The Fugitive, from 1993, goes into this problem in sensationalistic detail. So awareness has been around for a long time. Trust no one!
Hi Dan. I am an Indian doctor, having just finished Med school. You can say in a way I am new to the profession. Your post of conflict of interest reminded me of med reps in my hospital during student days. They just came along giving ‘free’ pens and writing pads. As I progressed in the course I realised that the reps didn’t limit themselves to stationery. Lavish dinners, holiday trips, fancy gadgets were a few other give aways.
There are no rules in my country regarding gifts from pharma guys. Recently a newspaper ran articles on this subject and the pharma guys agreed to self regulate the practice.
One of the senior most Profs in my college once said during a class – the money in med has attracted all the wrong kind of people to the field. And as you’ve amply demonstrated in your Harvard experiment, when given an opportunity people will be dishonest. And most of us think we have the American drug companies to thank for this non conventional marketing methods.
Dan,
You’re correct. Nobody is going to “deal with it” because it is the world’s most profitable system and it supports the goals of the status quo. As the old saying goes, “If you can’t beat ‘em, join ‘em”
Rich
…and that should be The New York Review of Books, not the New York Times Review of Books…
If we are going to critique the pharmaceutical industry: this is easy to do, and personally witnessed as a practicing PA. However, I cannot fully blame both pharmaceutical companies or MDs and other health care providers. How much does it cost to bring a new drug on the market? 800 million, and it takes at least seven years or more. And then the patent runs out, which is why Nexium is now advertised(truly just a S-isomer of omeprazole/Prilosec, now named esomeprazole/Nexium).
When we look skeptically at “Conflict of Interest” (which the basic issue is), we also need to bring the focus the same curiosity towards NCCAM. For example, instead of bringing malaria nets or iron sulfate pills to Africa (this would increase IQ points as well as longevity and productivity to some of the poorest places on Earth), the WHO published that homeopathy works. The head of WHO is pro-homeopathy.
Talk money, think of the trials on distal healing by prayer, acupuncture, homeopathy and the relentless barrage of substandard clinical trials, compliments of NCCAM.
Worse, all popular media show mistaken information from MDs such as Weil (who did not do a residency) who advise the public and not disclosing their financial interest. Weil for his own line of supplements and skin care with Origins, Perricone for his astronomically priced skin care and these are just the most prominent examples.
So far, the public is more at risk from supplements thanks to the de-regulation from 1991 asthe Dietary Supplement Health and Education Act of 1994 (DSHEA)than from pharmacauticals and health care providers’ entangled relationship. Think all the weight loss supplements as well as herbal medications, many of whom are interfering with allopathic drugs.
That said, every health care provider ought to abide by the honor code, as taken when he or she entered the medical field. That is, to not expose patients to medication that can harm them physically and financially, thus including the caveat NOT to prescribe based on financial gain. That is why we always need to look at the disclosures at the end of each and every published study, whether it comes from NIH, NCCAM or NIMH. And always to be careful with adverse side effects of medications.
Primum, non nocere.
Karin, really stop crying about poor pharmaceutical companies who are out there not to make people healthy but to make a buck on somebody’s inability to take care of themselves.
That’s a nanny state you have in the US. Sickos by their own choice.
We all know, except in rare cases, many physicians are legalized drug pushers. The society encourages it by creating ailments we need drugs to fix, and then addicting us on the drugs so we need the drugs to function, at least well enough to get us to the doctor to refill the prescriptions so they can charge us for the visit! IT is a well oiled wheel that keeps on turning. Often diet, exercise and less stress, which are all free works wonders. Just like wateer is better than diet coke, though both have 0 calories, which is advertised during peek super bowl time, not water! That is the American way, and now the global way which many countries aspire to emulate.
My physician told me the only reason she sees drug reps is to get samples that she can give patients that have no drug insurance plan.
I agree that conflicts of interest are a pervasive problem, and one that is often given little attention. Aside from issues with physicians and pharmaceutical companies, there is also a major problem brewing between industry and academia. Universities are selling out to the highest bidder – renaming professorships, scholarships, buildings, even schools, but the influence and social capital is really what the so-called donors are after. Many of the agreements involved in these donations include things such as exclusive rights to proprietary or intellectual “property”, caps on fees for royalties, and even the right for industry to use facilities at public universities and to bar access by faculty. The public should be irate! But instead the public and the institution are beholden to industry because they have supported education out of “goodwill”. Companies don’t just give away money for nothing, especially publicly traded ones which have an obligation to maximize profits and returns to shareholders. For more on this, see Jennifer Washburn’s book “University Inc., The Corporate Corruption of American Higher Education.”
And of course it wasn’t a conflict of interest for the administration which everyone knew would continue to bail out the banks and money handlers, permitted these same institutions to bankroll more than 50% of the cost of the inauguration.
add Nurse Practitioners to the mix:
http://www.pharmalot.com/2011/02/nurse-practitioners-like-pharma-lunches-dinners/