The New York Times’ Well blog recently explored the conflicts of interest many doctors face in choosing treatments for their patients.
Dr. Mikkael Sekeres, director of the leukemia program at the Cleveland Clinic, wrote about conflicts of interest, using his mother-in-law’s hip replacement as a jumping off point for the Well piece. The doctor who was to perform the hip replacement for Dr. Sekeres’s mother-in-law carefully explained the surgery and the recovery process, and then told her that he had been involved in designing the hip device he planned to implant during the surgery. Although he would receive no royalties from the use of the device, he wanted the patient to be aware of his involvement and the conflict of interest.
Dr. Sekeres sits on the Cleveland Clinic’s conflict of interest committee and he wrote in the Well post that this type of conflict of interest is becoming increasingly common. A doctor may invent a technology, or develop a drug, and receive payments every time that drug or device is used. And even if the doctor receives no royalties when using a medical device at his or her home institution, the doctor would receive royalties if other doctors at that hospital use the device, and so there is the concern that the doctors’ colleagues may be influenced to use that device or drug.
In other instances, a doctor may have lesser involvement, say, providing advice to drug or device maker in exchange for an honorarium, or conduct paid research—in a clinical trial, for instance. Dr. Sekeres asks if such this type of payment could influence the interpretation of clinical trial results in favor of the drug. But it may also be the case that the doctor made the trial better because of his or her expertise.
Dr. Sekeres explains that research has shown that a doctor’s prescribing pattern 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, most of which were in the form of meals worth less than $20. The researchers found that the doctors were more likely to prescribe the medications promoted as part of the meal than other medications of the same type from other drug makers, according to the Times.
Dr. Sekeres says that at the very least, the doctor 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 discussed how patients view their doctors’ conflict of interest. He said his mother-in-law was glad her doctor told her about his connection to the hip device and she said the disclosure made her trust him more. If he helped invent the device, he must be “an expert,” she said, and she wanted him to implant that device because “he knows it better than anyone!” Dr. Sekeres’s mother-in-law’s attitude is confirmed by a study of 600 surgical patients. Eighty percent said it was ethical for doctors to use surgical devices they had helped develop or had consulted on. Some patients felt their doctor’s involvement with the device maker actually benefitted their care. Dr. Sekeres says relationships doctors have with drug or device makers can “drive innovation, and help make those products better for patients.” But he wonders if doctors and patients can ever be sure whether these relationships influence the purity of our practice of medicine, “even a little.”