There is a serious and expanding effort to address corruption in medicine. Regulators and lawmakers are addressing cozy relationships between physicians and industry to protect patients from financial conflicts of interests that may skew doctors’ medical advice. This is murky territory since not every potential conflict is corrupt. For example, is it acceptable for an orthopedist to benefit financially by using a particular artificial hip if the physician believes that this is the best product available for his patients? Does this practice become ethical if the physician discloses this financial arrangement? Are his patients entitled to know the actual dollar amount that the online pharmacy receives? Is it proper for a gastroenterologist to receive a generous honorarium by a heartburn drug company to speak to primary care doctors about reflux treatment? Could this physician be trusted to offer truly objective information to his primary care colleagues with the company’s pharmaceutical representative sitting beside him? If medical researchers receive ‘consulting fees’ from drug companies or medical device companies, does this taint their scientific studies? Does a bland disclosure at the end of the study, such as Dr. Diamond is a paid speaker for Quartz Drugs, Inc, enough to sanitize the study?

Three Harvard researchers are being investigated for promoting certain medications after accepting millions of dollars from the drug companies that manufacture them. These fees were not properly disclosed. With every passing month, we learn that entangled financial relationships between physicians and industry are not aberrations. Currently, there are many similar allegations under review, and more will surely follow.

However, there is nothing intrinsically evil or unethical about physicians making money or even becoming rich. I make money every time I perform a colonoscopy. One could argue that I have a conflict of interest because my recommendations for colonoscopies are contaminated by my financial self-interest. Of course, this would also be true for attorneys, car mechanics, financial advisers, plumbers, retailers and anyone else who sells a product or a service. However, as long as the advice is pure, or the service is truly needed, then it is reasonable and proper that the professional or tradesman is paid for his effort.

Hidden financial relationships, however, that a reasonable patient would want to know about, are unethical. Disclosure should be sufficient so that patients or medical journal readers can consider their potential influence and impact.

Disclosed conflicts, however, can be proper and beneficial. For example, you consult a highly qualified heart surgeon to discuss replacing your aortic valve. He recommends a particular type of valve and discloses that he is an investor with the company and serves as a senior medical consultant. He has helped the company to improve the valve’s performance and longevity. He further states that he has been doing heart surgery for 20 years and truly believes that this is the best product on the market today. This is why he is affiliated with the company.

Do we want the anti-conflicts of interest brigades to end relationships between physicians and industry like the one described above? If such a doctor is compensated, does that imply that he is corrupt? Of course not, but it would be quite easy to tarnish his reputation with a few salacious headlines. Collaboration between physicians and industry has brought great benefits to the public. We need to be cautious before we erect too a high wall between them in the crusade against conflicts and corruption. Naturally, there are abuses, and they should be exposed, investigated and sanctioned. But let’s not rush to embrace a puritanical policy that will stifle medical advancements as it takes wild aim at every perceived conflict.

I hire lots of folks and pay them for their time and advice. Just because they make money on me, doesn’t mean that their advice is improper. We want a policy that handcuffs rogue individuals, not an entire profession.

Should every professional be paid a straight salary so that their income is not linked to their advice or performance? While the potential for corruption under such a system will be markedly diminished, the level of quality may sink even lower. Mediocrity is too high a price to pay for purity. Here’s a doctor’s advice for the regulators and lawmakers who are looking to sweep up my profession. Put down your chainsaws. I’ll loan you a scalpel instead.

ProjectManager,ClinicManager,Outreach team supervisor,STIcare providers,VCCT Counselor,Outreach workers,Accountant,Driver with PSF-CI_Dead: Feb 20, 09

Brody School of Medicine

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