Physicians, Conflicts of Interest, and Wishful Thinking

A PostScript blogger seemed surprised about study results showing that a majority of doctors in hospitals in the Mount Sinai School of Medicine consortium were okay with accepting meals and small gifts from industry. According to the study, which appeared in the Archives of Surgery, 72.2% had no problem having lunch on pharma’s dime, and 25.4% were good with accepting gifts. Again, if gifts and lunches are having such a deleterious effect on patient care, where is the outcome data to suggest this assertion?

PostScript surveyed doctors as well. It found: “Despite [the] sea change in public and governmental attitudes during the last several years, the physicians surveyed retain generally positive attitudes toward many industry gifts, and more than two-thirds still find gifts and lunches from industry acceptable. In fact, our findings are remarkably similar to results of other studies of physician attitudes toward industry from as early as 2001….”

Did the purists expect change would happen right away once states instituted conflict of interest guidelines and regulations? The answer is yes, but it is not happening fast enough for some.  Take a look at some of the various medical associations listed on Pam Pohly’s Net Guide: Industry-physician relationships are alive and well. Look at the amounts companies are reporting on their own compliance Web sites for payments.

This relationship is not easy to untangle. Yes, industry is selling drugs and devices, but they are developing drugs and devices, too, and physicians are interested in the science of how this happens. In fact, many of them are the ones driving this forward.  Many universities are receiving significant royalty payments for work done in their labs as a result of these talented physicians.  For its part, industry is not in the clinic – it needs to hear that side of the story.

And there is prestige in being a sought-after Key Opinion Leader; anyone who has ever sat in an advisory board can see the pride these physicians take in being asked and in giving their opinion. If they don’t like a drug, they generally say so. If they do not think it should be developed, companies typically will not develop the drug or device.

The PostScript blog says that the culture of medicine must reject “industry marketing interactions more fully” before physicians’ attitudes will concur with the public’s stance on conflict of interest. Our point of view is that while culture may change the course of behavior in medicine, people need to ask: What are the consequences to the advancement of medicine if practicing experts are not able to give their opinions to drug and medical device developers? Who will launch these innovations?