Medical Conflicts of Interest and the Glass Houses

June 19, 2009— -- Health care reform is focused on the quality of care, its accessibility and its cost. The debate is heated and likely to intensify in the months to come. It is also loud, so as to drown out debate on a focus for reform far more critical than impending fiscal bankruptcy.

There is debate on the degree to which health care in the United States is ethically bankrupt, and what to do about it. The Institute of Medicine and nearly every other professional organization in the health arena has chimed in. Academic health centers and unaffiliated hospitals are racing to write or expand policy statements on conflicts of interest in regard to clinical activities.

Much of the gnashing of teeth relates to conflictual arrangements between individual practitioners and drug or device manufacturers. Policy is targeting the marketing that seems on the surface to be innocuous: the on-site "detailing" by drug and device representatives, the trinkets and "free meals," the samples that cause one to become more familiar with prescribing the product than with the product's limitations, the sponsored educational programs that engender comfort with the sales personnel if not the product, etc.

All these are easy targets for the race to policies that cleanse the collective conscience of my profession. That's overdue. So, too, is a peer review that decries the feigned or real naiveté on the part of professionals who claim they are above being influenced in such an obvious way. Physicians owe their patients much more than naiveté. The degree to which policy rather than personal ethics is necessary to bring an end to obvious marketing schemes is a reproach to my profession.

But this is all obvious. So the free lunches, the trinkets and other gifts, and the smiling sales representatives with their bags full of samples are banished from many an institution, although not all and not many a private practice. There is much more that affronts moral philosophy:

The Disclosure Dodge: "Industry" is not a curse word. Industry is the fountainhead of jobs that sustain and nurture all of us directly or indirectly. Furthermore, relationship between industry and the professional not employed by industry is not intrinsically wrong, let alone evil. To the contrary, such relationships can enhance the productivity of both parties.