Shining Light on Conflicts of Interest

Craig Klugman
The American Journal of Bioethics 
Volume 17, 2017 - Issue 6

Chimonas, DeVito and Rothman (2017) offer a descriptive target article that examines physicians' knowledge of and reaction to the Sunshine Act's Open Payments Database. This program is a federal computer repository of all payments and goods with a worth over $10 made from pharmaceutical companies and device manufacturers to physicians. Created under the 2010 Affordable Care Act, the goal of this database is to make the relationships between physicians and the medical drug/device industry more transparent. Such transparency is often touted as a solution to financial conflicts of interest (COI). A COI occurs when a person owes featly to more than one party. For example, physicians have fiduciary duties toward patients. At the same time, when physicians receive gifts or benefits from a pharmaceutical company, they are more likely to prescribe that company's products (Spurling et al. 2010). The gift creates a sense of a moral obligation toward the company. These two interests can be (but may not be) in conflict. Such arrangements can undermine a patient's trust with his/her physician, and more broadly, the public's trust of medicine.

(cut)

The idea is that if people are told about the conflict, then they can judge for themselves whether the provider is compromised and whether they wish to receive care from this person. The database exists with this intent—that transparency alone is enough. What is a patient to do with this information? Should patients avoid physicians who have conflicts? The decision is left in the patient's hands. Back in 2014, the Pharmaceutical Research and Manufacturers of America lobbying group expressed concern that the public would not understand the context of any payments or gifts to physicians (Castellani 2014).

The article is here.

The Best-Selling, Billion-Dollar Pills Tested on Homeless People

How the destitute and the mentally ill are being used as human lab rats

by Carl Elliott
Matter
Originally posted on July 27, 2014

Here are two excerpts:

If you’re looking for poor people who have been paid to test experimental drugs, Philadelphia is a good place to start. The city is home to five medical schools, and pharmaceutical and drug-testing companies line a corridor that stretches northeast into New Jersey. It also has one of the most visible homeless populations in the country. In Philly, homeless people seem to be everywhere: sleeping in Love Park, slumped on benches in Suburban Station, or gathered along the Benjamin Franklin Parkway, waiting for the free meals that a local church gives out on Saturdays.

(cut)

Not long ago, such offers would have been considered unethical. Paying any volunteer was seen as problematic, even more so if the subjects were poor, uninsured, and compromised by illness. Payment, it was argued, might tempt vulnerable subjects to risk their health. As trials have moved into the private sector, this ethical calculus has changed. First came a hike in the sums that volunteers could be paid: Many clinical trial sites now offer over $6,000 for an inpatient drug study. Eligibility requirements have changed, too. For years, trial sites paid only healthy volunteers, mainly to test new drugs for safety. These days people with asthma, diabetes, kidney disease, liver disease, and other conditions can be paid take part in trials.

The entire article is here.

UC OKs paying surgeon $10 million in whistleblower-retaliation case

By Chad Terhune
The Los Angeles Times
Originally published April 22, 2014

University of California regents agreed to pay $10 million to the former chairman of UCLA's orthopedic surgery department, who had alleged that the well-known medical school allowed doctors to take industry payments that may have compromised patient care.

(cut)

The seven-week trial in downtown Los Angeles offered a rare glimpse into those potential conflicts at a time when there is growing government scrutiny of industry payments to doctors.

Starting this fall, the federal Physician Payments Sunshine Act, part of President Obama's healthcare law, requires public disclosure of financial relationships between healthcare companies and physicians.

The entire article is here.