A New Way to Think About Conflicts of Interest in Medicine

By Bill Sacks, Vice President, COI Product Management, HCCS - A HealthStream Company

On August 31^st Health Economist Austin Frakt published an article in in the New York Times “TheUpshot” column suggesting “A New Way to Think About Conflicts of Interest in Medicine”. This article expanded on a blog post he had written two months earlier suggesting that while moral responses to conflicts of interest were natural, (for example, decrying the “corruption” of some researchers or the “perversion” of the research process resulting from industry financing of research), these responses were impeding thinking on creative solutions to the problem.

Frakt points out that human beings will often over- or under-correct their perceptions based on real or perceived conflicts of interest. Some patients, upon hearing that their doctor receives funding from a pharmaceutical company will question his or her objectivity regarding that company’s drugs. “To other people,” he notes, “the disclosure of industry ties might be interpreted as signs of honesty and expertise.” Disclosure alone is no panacea.

The author’s main point is that while efforts to identify and manage financial conflicts are laudable, they represent only one part of a much needed larger solution. Frakt believes that only more rigorous oversight of scientific research will restore public confidence, and over time mitigate concerns over conflicts of interest. Frakt argues for several strategies aimed at improving the scientific method of clinical research, regardless of the funding source, to eliminate bias and increase reproducibility.  He suggests:

1. Registration of trials and reporting of all registered analysis (or clear metrics of the extent to which they are not reported);
2. Archiving of trials’ analytical data files (see BMJ‘s Open Data campaign and GlaxoSmithKlein‘s commitment to provide access to anonymized patient-level data);
3. Archiving of statistical programming (reproducible research); and
4. Expert evaluation of study methods by an individual or individuals without conflicts of interest 

Frakt concludes by saying: “Good science is how we avoid fooling ourselves, even when we have incentive to do so, financial and otherwise. The true merits of a study stem from its design and methods, so long as they are fully and transparently reported — and there are many ways we could do a better job of that.”

So much effort is expended, these days, collecting disclosures of financial interests from providers and comparing them to reported payments made by pharmaceutical and device manufacturers. This article points out that the issues we seek to address are bigger than we often admit to ourselves, and our solutions are only the first step in the effort to reduce and eventually eliminate conflicts of interest.