Facing Conflicts: The Battle between Medicine and Industry

In a similar incident, Harvard psychiatrists Joseph Biederman, MD, Thomas Spencer, MD, and Timothy Wilens, MD, were similarly identified by Senate investigators for failure to report industry income exceeding $1 million each. These failures of disclosure appeared to violate institutional disclosure requirements, and also raised red flags because of these researchers’ advocacy of unapproved uses of psychiatric medicines in children.(3)

What’s the Problem?

While stories such as these should not be sensationalized, they can serve to provide an opportunity for professional introspection. A simple search of the blogosphere provides a glimpse of public opinion as it relates to the perception of relationships between the medical profession and industry.(4) Further, medical students have become more vocal in expressing misgivings about the potential ill effects of industry influences on medical education.(5,6) So it stands to reason that these revelations should also serve as a signal within the medical community itself. A recent national survey of 3167 US physicians revealed the extent to which physicians and industry are entwined. In this study, 94% of physicians reported at least some type of relationship with industry in the form of receipt of food (83%), drug samples (74%), support for CME or professional meetings (35%), or remuneration for consulting, speaking, or enrollment in clinical trials (28%).(7)

In such an environment, it becomes understandable how the line between the medical profession and industry becomes blurred. In a statement recorded in the Wall Street Journal, Dr. Nemeroff contended that his lectures weren’t product-specific but were limited to general medical topics such as depression and bipolar disorder. As a part of an investigation of Dr. Nemeroff, Emory found that his speaker slides and interviews with attendees at presentations supported that contention.(8) In fact, Dr. Nemeroff crossed no line by receiving payment for working with GSK. The problem arose from failing to disclose financial arrangements that could ultimately affect patient care. In that simple omission, the line that separates professionalism from commercialism became smudged.(9)

Disclosure: Is It Enough?

For years, the medical profession has relied primarily on financial disclosure as a means by which to deal with the issue of conflict of interest. This process of disclosure is intended to provide the necessary information that allows audiences or readers to identify and resolve bias.(10) However, the assumption that the act of disclosure alone eliminates conflict and provides transparency has been challenged. Dana and Loewenstein, in a commentary on the social science of gifts and their impact on bias, cite a large body of evidence linking financial conflict of interest with unintended bias.(11) The authors note ample data that strongly suggests an individual’s judgment of fairness is biased by his or her own self-interest, and that this bias is frequently unrecognized.