[HSF] Conflict of Interest
Ani Anyanwu
anianyanwu at hotmail.com
Fri Apr 27 22:36:26 EDT 2007
Travel expenses is one of the most powerful, if not the most powerful, sources of conflict of interest in the medical profession worldwide. There are two main scenarios of conflict which even if not explicit are implied
1) During my training I recall asking a boss why he chose a St Jude over a Carbomedics and he replied "it depends who paid for my last golf trip". In reality there is little to chose from various medical devices; companies "buy" doctors out by paying for their trips (see article Ben referred to in this weeks NEJM). This practice is particularly pronounced in Europe. I remember being at a Transplant meeting few years ago where a third of attendees had their air ticket paid for by industry. While we may chose to think we are unbiased and use what is best for our patient, do we really think Edwards would pay for your air-ticket if you did not use their products or if they did not think they could get you to use their products? Morally would you accept a ticket from ATS when you implant only Carbomedics?
2) Companies are unlikely to sponsor physicians for academic lectures if the physician is likely to speak against their product. They will seek doctors who will likely promote them - hence the conflict. If your data found the company's product to be deficient they would not pay for you to go and say that. They only pay for researchers who find in their favor. Similarly a doctor being paid for by a company is extremely unlikely (though possible) to heavily criticize a product manufactured by his sponsors. There is an unwritten code of conduct. Hence sponsored lectures are intrinsically biased.
Conflict of interest is not a problem provided it is known. People do not attend industry sponsored lectures to get unbiased or educated opinions - usually they either go for the free meal or just to hear what the company (and its supporters) say about their product. If however conflicts are not declared it becomes deception as the attendee is deceived into thinking he is listening to an unbiased opinion (which, despite the good intentions of the presenter, is by definition biased).
Both sources of conflict are strongest in socialized health systems where income of doctors or government support for travel is limited. In most underdeveloped or socialized countries, such as the UK, most cardiac surgeons have their trips paid by whichever companies products they patronize. In the US where institutional support is greater, travel expenses is a source of lesser conflict.
Fortunately, most of us who accept traveling expenses are at worst unwilling participants in industry's marketing strategy and are either being rewarded for patronizing the sponsor's product or being bribed to adopt their product. Of course what we do (with the acceptance of expenses) is up to us and most will not accept such expenses if it forces them to treat patients (or to present research) in an unethical manner. However we must accept that some of our colleagues do prostitute themselves to industry and are wiling to say whatever it takes, or implant whatever device, in return for favors.
Ani
----- Original Message -----
From: bbiocina at kbd.hr<mailto:bbiocina at kbd.hr>
To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
Sent: Wednesday, April 25, 2007 4:21 AM
Subject: Re: [HSF] Robert Jarvik {OT}
Dear dr Frater
so , do you think that travel expenses ( providing that you present
objective data) is or is not a conflict of interest ?
Bojan Biocina
On 4/25/2007, "rwmfglycar at aol.com<mailto:rwmfglycar at aol.com>" <rwmfglycar at aol.com<mailto:rwmfglycar at aol.com>> wrote:
>I had a funny experience once. A company asked me to test the T6 anticalcification treatment in juvenile sheep. We did the work and found no difference. We had not yet got the data in publishable form when I got a call from the company asking if I would present the data at the annual German meeting in Bad something or other. I was pretty naive in those days and thought they were objectively interested in the data. I duly got up and presented it, to be greated afterwards by fury from the company. I had , of course, accepted the ticket and hotel expenses and did not see any need to return the money they had wasted on my trip.
> Bob
>
>-----Original Message-----
>From: ebender001 at charter.net<mailto:ebender001 at charter.net>
>To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>Sent: Tue, 24 Apr 2007 10:26 PM
>Subject: RE: [HSF] Robert Jarvik {OT}
>
>
>I've been thinking long and hard about this topic, and it is very disturbing on
>so many levels. Dr. Jarvik has been in the limelight in our field for many
>years, and his name is almost iconic with artificial hearts. Therefore, on a
>professional level, we would expect that it his duty and responsibility to
>uphold what standards that we as a group hold as exemplary, professional, and
>deserving of our praise. Those beliefs are, of course, very subjective and
>change from person to person. It seems to be understood that speaking for a
>private company with whom the only relationship is that of money is beneath what
>we believe should obtain. I agree that it is disappointing on that level. On
>the other hand, do we expect that fame, stature, and reputation should be
>rewards in their own right that exclude one from pursuing other avenues of
>interest, income or wealth? Who are we to state what is acceptable or even
>necessary for another individual - barring illegal or immoral activities. I
>don't think that Dr. Jarvik's commercial participation falls to that low level.
>
>
>Given other circumstances which we can not even predict, would any of us say
>that we would not participate in similar activities? If Edwards labs offered
>Dr. Hal Roberts (a name as iconic as Jarvik) $15 million to appear on TV
>espousing the benefits of the ETLogix ring, would he demur? And if he did,
>would he be foolish in some other peoples eyes?
>
>Personally, I am respectful of and disappointed at Dr. Jarvik at the same time.
>Perhaps my disappointment arises from the fact that our society undervalues the
>work that our kind does and rewards those that claw for ever increasing profits
>(but that is capitalism).
>
>Ed Bender, MD
>
>---- Ajit Damle <damle at cableone.net<mailto:damle at cableone.net>> wrote:
>> Hal,
>>
>> If you did, (" I made a serious ..........................") what makes you
>> think others do not?
>>
>> I have never heard an industry sponsored speaker speak against the sponsored
>> company's product.
>>
>> You may call it what you will, but the freebees we all accept are not much
>> different than bribes.
>>
>> Ajit Damle
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>> From: openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsforum.com>
>> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Hgrmd at aol.com<mailto:Hgrmd at aol.com>
>> Sent: Monday, April 23, 2007 7:57 PM
>> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>> Subject: Re: [HSF] Robert Jarvik {OT}
>>
>> Gabi,
>> Yes, we did get Edwards to sponsor our get together a few months ago at
>> the STS. However, I can assure you that about the surgical
>> management of ischemic MR in an organized 45 minute talk.
>>
>> Hal
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.com<http://www.aol.com/>.
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