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For Doctors, Relationships with Drug and Device Makers Raise Conflicts of Interest

Jun 30, 2016

The director of the leukemia program at the Cleveland Clinic, in a post for the New York Times' Well blog, explored conflicts of interest for doctors who have a relationship with a drug or device maker.

Dr. Mikkael Sekeres used the example of his mother-in-law's hip replacement surgery to illustrate the increasingly common conflicts that arise. His mother-in-law had easily developed a trust in the doctor who was to perform the surgery and he had provided a thorough explanation of the surgery and the recovery process. He then told the patient and family that he had been involved in the development of the hip device he intended to implant. He said he would not receive any royalties from the use of the device, but he wanted her to be aware of his conflict of interest.

Dr. Sekeres, who sits on the Cleveland Clinic's conflict of interest committee, wrote that such conflicts of interest are becoming increasingly common. A doctor may invent a technology, or develop a drug, and receive royalties when that drug or device is used. Although a doctor may not receive royalties when using the device at his or her home institution, the doctor might receive payments if other doctors at that hospital use the device. So there is a potential problem of the influence a doctor might exert on his colleagues to use a device or drug.

In other instances, a doctor's relationship may be a bit more distant. He or she may provide advice to a company and receive an honorarium, or may be involved in a clinical trial, for instance. But Dr. Sekeres wonders if payments could influence the interpretation of clinical trial results in favor of the investigational drug, though it may be the case that the doctor made the trial better because of his or her expertise.

Dr. Sekeres writes of a study that shows that a doctor's prescribing practices can be influenced by as little as a free lunch. A recent study looked at about 28,000 doctors who received over 63,000 payments, the majority of which were in the form of meals worth less than $20. The researchers found that the doctors were more likely to prescribe medications promoted as part of the meal than medications of the same type from other drug makers, according to the Times. Dr. Sekeres feels that at the very least, doctors should "have to disclose the conflict to patients, either on a website, where patients could easily view it, or by informing them directly."

Dr. Sekeres also discussed the patient's view of a doctor's conflict of interest. His mother-in-law, he said, was glad her doctor told her about his involvement with developing the hip device. The disclosure made her trust him more and she said the doctor must be "an expert" if he had been tapped for that work. She wanted him to use that device because he knew it so well. This attitude is confirmed by a study of surgical patients. Eighty percent of the 600 patients in the study felt it was ethically acceptable for a doctor to use a device they had helped develop or had consulted on, and some patients felt their doctor's involvement actually benefitted their care.

Dr. Sekeres noted in the Times piece that doctors' relationships with drug or device makers can "drive innovation," and their expertise can help make those products better for patients. But Sekeres cautions that it can be difficult to know whether these relationships influence the "purity of our practice of medicine, even a little."

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