I attended a talk this morning by Dr. Patrick McDonald, a Paediatric Neurosurgeon based off of Vancouver, on the topic of disclosing conflicts of interest. He shared a lot of wisdom with the attendees and basically inspired me to write this post. Some of the material I have used and/or mentioned in this post are directly or indirectly related to what he presented during his talk.
A lot of us have very busy schedules. Physicians are normally even busier and this might be the premise behind many physicians and surgeons not wanting to add more to their already busy schedules. Disclosing every conflict of interest they might have in a research paper is time consuming, requires a considerable amount of effort and attention and of course, adds more to their already busy schedules. However, doing that could potentially save a lot of time for the same person and/or their fellow researchers in the long run. It could also lower the burden on the healthcare system, save lives of thousands of people and inspire patients’ trust in the healthcare system.
Conflicts of interest arise in situations where we have diverging secondary interests that affect our primary professional obligation(s). For a physician, the primary professional obligation is to treat patients and protect their wellbeing. For instance, secondary interests might arise when the same physician is reimbursed by a company for research they did on a drug or device developed by that company, or when they serve in a board of a non-profit that believes in a specific set of health-related activities, or when they are a practicing member of a religious community that considers a medical act “sinful.” As you can see, not every conflict of interest is financial in nature and it can take various shapes and forms.
Disclosing any “potential” conflicts of interest has been shown to mitigate a lot of problems. It is also common sense that when I’m reading a research article from a researcher about a drug from a company that has “sponsored” the study, I would make sure to tread carefully, do more research and take things with a grain of salt until I have more (independent) data to prove that what the researcher is saying is factually true and that the secondary interests haven’t influenced their primary obligation in a way that would deem the conclusions of the study incorrect. As another example, suppose a researcher believes in an ideology that considers any non-straight sexual act a sin and they report findings in a research article that a specific non-straight sexual act is a health risk to people involved. Consider the different approaches you would take on this finding when the researcher has disclosed their conflicts of interest and when they haven’t. This is also true in disciplines other than medicine. Suppose an environmentalist is a member of the environmental advisory committee to the government. Their views on the environment could potentially impact the way they propose action and eventually pass laws. In contrast, if the person is a firm believer in climate change being a “hoax,” their proposed approach and policy will potentially be influenced by their views as well.
The US government has introduced legislation and some journals have started processes in order to make the disclosures mandatory and open to public. In 2009, the United States government introduced the so-called Sunshine Act that made it mandatory for all the drug and device manufacturing companies to disclose any payments to the physicians. The Centers for Medicare and Medicaid Services has a website that you can type in a physician’s, hospital’s or company’s name and get the information about the payments transferred between the involved parties. Studies have shown that since the introduction of this piece of legislation, a lot of medical researchers have started to disclose conflicts of interest and the amount of nondisclosures, in most cases, have decreased significantly. Canada and some European countries are following suit, but there is still a lot more work to be done.
Last but not least, it is very important to emphasize again that physicians and medical researchers are in no way the only people with conflicts of interest or the only people whose conflicts of interest could result in dire repercussions, nor are all pharmaceutical companies and their C suite executives thinking of their market cap (as you can probably tell, I’m very pro-business and I don’t hold grudges against big corporations just because). Medical research is under a lot of scrutiny because its results and the results of any (even small) misbehaviours are in the public eye, which is not the case for many other fields whose nondisclosure of conflicts of interest could result in repercussions in the same level of magnitude as the ones caused by nondisclosures in the medical field. Therefore, by all means, let’s ask physicians and medical researchers to disclose their conflicts of interest (and I will try to disclose my conflicts of interest as well), but let’s not discriminate against them as the only people who have to report that information. Hopefully, that will open the doors to more open communication and open data that can give us more confidence in trying to make a decision when it comes to our health (and other aspects of our lives as well).
References and further reading:
- The Royal College of Physicians and Surgeons of Canada: http://www.royalcollege.ca/rcsite/bioethics/cases/section-3/personal-conflict-interest-medical-research-e
- Industry Financial Relationships in Neurosurgery in 2015: Analysis of the Sunshine Act Open Payments Database: https://www.ncbi.nlm.nih.gov/pubmed/29581013
- Conflict of interest policies and disclosure requirements in neurosurgical journals: https://www.ncbi.nlm.nih.gov/pubmed/30117775
- US conflict-of-interest case draws attention across continent: http://www.cmaj.ca/content/185/15/1309
- Avandia Drug Case: https://www.ucsusa.org/silencing-scientist-who-first-exposed-truth-about-dangers-diabetes-drug-avandia#.XEJdEi3Mx24 and https://www.nejm.org/doi/full/10.1056/NEJMoa072761
- The Open Payments Data Website: https://openpaymentsdata.cms.gov