Who are we working for?

Concerns over the pervasive and growing influences of vested interests in the practice of medicine, clinical practice guidelines and pay-for-performance measures, public health policies, medical and nursing school training, and medical research, including clinical trials, have been growing for years and discussed here frequently. But realizing just how extensive and deep the conflicts have infiltrated medicine can be hard to grasp. A report just published in the Journal of the American Medical Association has attempted to quantify academic-industry ties and the results may be startling to some.

The study was led by Eric G. Campbell, Ph.D., at Massachusetts General Hospital in Boston, and reviewed 459 detailed questionnaires randomly sent to university medical school chairpersons at accredited medical schools and teaching hospitals across the country. They found that 65% of academic leaders have financial ties to industry, and in ways that go far beyond simply funding for research.

Dr. Roy M. Poses M.D., has written a detailed summary and analysis of the study’s findings at Health Care Renewal. He reviews the media coverage and range of commentary, adding some thought-provoking points of his own concerning how these relationships can compromise the mission of medicine and patients’ trust, and the validity of clinical research, medical training, and the dissemination of medical information. These relationships may suggest to faculty and students, he writes, “that they ought to be particularly friendly to certain health care corporations, and at least not criticize such corporations and their products, and certainly not complain about any related conflicts of interest on the part of their supervisors.” It may also contribute to failing to prepare medical professionals to question threats to their values that they encounter in the real world of medicine, he said.

Industry involvement is a complicated issue. While companies have information on new drugs and products that illustrate the benefit of some exchange of information between medical schools and industry, and objective research can lead to better drugs and treatments for patients, what is happening goes far beyond that. Yet research is showing that even subtle industry ties can unwittingly bias medical thinking and practice, and that can be hard to admit.

It has become so commonplace for drug companies to have significant relationships in every aspect of the training of doctors and nurses, that it seems “normal” anymore. But Dr. Poses asks a question few ever stop to ask: Why? Why are they there? “What knowledge do they have that is not currently available in the biggest medical schools in the country?”

Other perspectives of this were discussed in the November issue of the British Medical Journal. Dr. Aubrey Blumsohn, for instance, suggested that healthcare professionals need to search within themselves for the role they have played and can play. It was a call to action to speak out for the integrity of good science. He wrote:

The Beast is ourselves

[W]e are fighting the wrong beast. The beast is not the pharmaceutical industry — it is ourselves.

Pharmaceutical companies sell products under the banner of science. But their only raison d'être is to make money. Industry has to balance genuine hypothesis testing and transparency against commercial interests and the financial consequences of dishonesty. This is not in itself a criticism — it is a simple fact.

It is also of course true that the industry provides products which are often beneficial to our patients. It is equally evident that many actions of industry have not resulted in benefit, and have instead caused harm. More importantly, we are often completely unable to assess the degree of harm, because information is hidden by gag clauses, the threat of litigation, and cozy commercial arrangements between the regulators and industry.

We, as doctors, have created the atmosphere which has allowed companies to malfunction. We have allowed industry to subvert the rules of science. We have watched quietly as governments and academics have colluded with industry to hide information critical to our patients. We have remained silent as our medical schools have churned out graduates who have no knowledge of the dilemmas and scandals of medicine. We have allowed many of our medical journals to become corrupted and timid. We have remained silent as the General Medical Council and other bodies charged with maintaining integrity have taken action against doctors for raising questions of integrity, while ignoring serious concerns brought to their attention. We have failed to support our colleagues who have raised concerns.

The soft parts that need biting may well be our own.