The Unintended Consequences of Conflict of Interest Disclosure

By George Loewenstein, PhD, Sunita Sah, MD, PhD, & Daylian M. Cain, PhD.

The Journal of the American Medical Association

Conflicts of interest, both financial and nonfinancial, are ubiquitous in medicine, and the most commonly prescribed remedy is disclosure. The Medicare Payment Advisory Commission and the Accountable Care Act impose a range of disclosure requirements for physicians, and almost all medical journals now require authors to disclose conflicts of interest (although these requirements may be imperfectly heeded). Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Disclosure has appeal across the political spectrum because it acknowledges the problem of conflicts but involves minimal regulation and is less expensive to implement than more comprehensive remedies.

More importantly, even if disclosure is rarely seen as providing a complete solution to the problem, it is broadly perceived to have beneficial effects.

There are, however, reasons that disclosure can have adverse effects, exacerbating bias and hurting those it is ostensibly intended to help.

<snip>

ENHANCING THE EFFECTIVENESS OF DISCLOSURE

Despite its potential pitfalls, disclosure is almost certainly a good thing.

It should be a patient's right to know whether his or her physician is receiving financial benefits from prescribing a particular drug or will personally benefit if the patient accepts recommended tests or procedures.

The question for policy should not be whether to disclose but how to ensure that disclosure has its intended effects.

Research has revealed ways of making disclosure more effective.

<snip>

Even if disclosure is crafted in a fashion that increases effectiveness and minimizes potentially adverse consequences, it is no panacea.

Disclosure is simply not applicable to many serious conflicts of interest affecting medicine in the United States.

Although payments from pharmaceutical and device companies have received most of the attention in the literature on disclosure, other conflicts, such as financial arrangements that give physicians (and their institutions) incentives for providing high-cost services of dubious value, may be more consequential.

It is difficult to imagine how disclosure could even be applied to, let alone undo, those problems.

However, perhaps the most significant likely pitfall of disclosure is not its effects on the quality of advice received by individual patients or its inapplicability to many serious conflicts of interest, but the likelihood of a kind of moral licensing on the part of the profession as a whole--the rationalization that, with disclosure, the profession has dispensed with its obligation to deal with conflicts of interest.

Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in health care costs in the United States, and transparency is no substitute for more substantive reform.

The entire article is here.

Special thanks to Ken Pope for this information.