734 Conflict of Interest

This is something that has been bothering me quite a bit lately. I've always been crazy about my doctor -- he spends a lot of time with me and is very thorough -- but sometimes I wonder if he's prescribing me specific medications or sending me to specific specialists because he gets something from it.

Some of the conditions I have could be treated by cheaper, generic or over-the-counter medications, but he prescribes the most expensive ones. I had to have a sleep study a while back and wanted to go to a particular doctor and particular sleep lab. My doctor was adamant that I use the specialist he recommended, and that doctor's sleep lab.

I hope there's really nothing to my suspicions, but I hate it that it's even a possibility. Doctors should not be able to profit financially in any way from the drugs they prescribe, or facilities and specialists they refer people to. Those are conflicts of interest in which everyone comes out well but the patient.

Thank you for summarizing Dr. Stossel's resume of medical products board memberships and other commercial medical activities at the end of this show.

Following Dr. Stossel's assertion that his conflicts of interest included only his little pharmaceutical startup, this glaring discrepancy between that assertion and his actual resume seems to me to raise a significant question for Harvard Medical School, for Dr. Stossel, and for the American Cancer Society which underwrites his activities at Harvard Medical. Is Stossel actually capable of recognizing a potential financial conflict of interest, and if so, is he even remotely inclined to do so?

My impression of Dr. Stossel throughout the interview was that he regards patients as guinea pigs on whom doctors should be entitled to foist whatever treatment they "think is right." Apparently he regards the practice of medicine in the same light as a laboratory science, rather than as a profession obligated to rest soundly on treatments demonstrated to be effective. He appears to have no issues with some extreme riff on free-market practice -- letting treatments sicken and kill enough people before they are properly regulated. When doctors use unproven treatments without explaining to the patient the treatment's experimental status and its potential risks, they violate professional trust.

I find it disheartening that one of the best medical schools in the country has found room for this pharmaceutical cowboy to whoop about his discredited point of view.

What ever happened to "Avoid impropriety and even the appearance of impropriety?"

One hears many comments in this regard, which is certainly disturbing. I am an orthopaedic surgeon and I can truthfully say that I have never been approached by any company or other practioner regarding any kind of financial remuneration.
Of course, we do see salesmen who try to convince us that their products are the best, but on the other side we have an opportunity to ask questions and learn about new products this way. Similarly, any professional meeting one attends will have representatives from commercial interests with displays of their products - but again, this can be of value also in actually being able to handle new instruments and decide what value they may have.

Some meetings and functions are sponsored by medical vendors, including some of our educational programs for our residents and interns. They often will have a display or some small presentation, but although I have been involved in our teaching program at our hospital for many years, there have been only very few instances that I can remember in which they tried to influence the content of our programs (which none of us ever agreed to in my memory).

Finally, we do form rather close relationships with some of the vendors of surgical devices we use, and they often will have a representive present during surgery which can be helpful with use of some of the complex devices, and they also assist the surgical personell in making certain that everything needed will be present when we need it. Some of the companies will provide discounts to hospitals if they will use thier products exclusively, but that only happens if all the surgeons involed agree to it; and it is never (at least at the hospitals I have worked at) been totally exclusive if in a particular case we decide a different product is indicated.

I don't doubt that their are some of the kind of unethical business arrangements that you suggest in existence, but I think they are the exception and not the rule. Most of us are too busy trying to provide the best care we can for our patients to be bothered by such restrictions. Medicine, like any science, changes rapidly and it is a major challenge just to keep up on what is best for our practice, and where we can get reliable service in referrals to other physicians and services.

Thank you for having Dr. Stossell (spelling?) on the program to balance the discussion. I noticed that his rationality and evidence based approach made you a bit uncomfortable since your sympathy lies with the usual leftist bias against business. However, his presentation was compelling and I'm glad you allowed "the other side" to be shared. By the way, I have benefitted from drug company reps giving samples to my doctors since I've been spared several expenses that really helped our finances at times.

SRC

In my opinion, I want a Doctor working on me that his number 1 priority is healing. In the process of healing he has the right to make money as long as it does not conflict with his number 1 priority. If a doctor has any conflict of interest I want to know that information when I enter his office on the 1st visit!

Listening at this time to Dr. Stossell I am appalled at his attitude. He is making many statements, which are of a kind described as criminal thinking. He is most often minimizing; some times he is taking a mild version of the victims stance. Clearly that is the case as he discredits all those who dare criticize doctors receiving any kind of remuneration. He completely rejects the many studies showing how even the smallest item produces a more favorable opinion of the giver.

He only spoke for a few moments when I was saying “WHAT A CROCK OF CRAP.”
Joe and Terry were great to try to have a countering opinion on the show. They were even greater in their questions, which in a more polite way than I could ever manage demonstrated his extreme bias, or to be honest his conflict of interest.
In my late teens my father warned me about the dangers of accepting anything from anybody, as it would influence me. He said do so with that understanding and be aware of my feelings.

Wouldn’t it be nice if as a defendant we could serve the members of the jury a beer as the trial began. Of course it wouldn’t be nice for true justice. For Dr. Stossell to say otherwise is disingenuous in the extreme.

Several comments miss the point, which is not necessarily that M.D.'s and others get paid by corporate medicine, but that their relationships with corporate medicine:
a) are typically not disclosed to patients, and
b) often appear to influence therapies and even diagnoses.

The typical honest physician's response is, "Trust me, I know a conflict of interest when I see one, and -- behold!! -- I haven't seen one in my busy, busy twenty years of practice." Where are the doctors who are saying, "Wait a minute, here's this research that says potential conflicts of interests are REAL conflicts of interest, and a lot more often than I thought. Maybe I should check this out a little further."

Doctors are smart people, and with extremely rare exceptions are people who strongly believe their patients' needs come first -- setting aside the physician's own immediate needs of course. But few would argue against the observation that doctors also tend to be people with big egos who are all too often resistant to questioning their own judgments, except when a treatment goes wrong. Maybe the saying, "The unexamined life is not worth living," might carry a grain of truth for medical practice as well.

Unlike SRC, I did not find Dr. Stossell's appeal "rational." Having no particular prior opinion of my own on this interesting subject one way or the other, I found his replies dismissive and evasive--appealing to blind authority ("my forty years of experience") and ridicule the cute "pharma-scolds"), refusing to address questions about the validity of the concept of idea of conflict of interest by demanding "evidence" (while minimizing evidence offered, and failing to offer counter-evidence of his own). His position may in fact be a defensible one, but his weak arguments made him seem to me a poor spokesman for it.

At one time in my life I felt the doctors were to be trusted, in fact more trusted than anybody. Unfortunately, I have learned the hard way that doctors are nothing more than the "guy next door" except they have a higher IQ, a white coat, they make more money. They have the same flaws of character, flaws of personality, flaws of decision-making, flaws of ego, and the biggest flaw of all is the fact that many believe their own press clippings -- this is also the deadliest flaw of all!

I know this information 1st hand, you see, I was disabled by Dr. when I was 38 years old and the doctor was telling everyone he was a Neurosurgeon when he was not! I received the doctor's name from another doctor who thought he had an excellent reputation. I sued the doctor for Malpractice.