Conflicts of Interest: Why Doctors Are So Drug Happy

Who funds most of the studies that show drugs are safe and effective? The drug companies themselves. This is the topic of my video Eliminating Conflicts of Interest in Medical Research.

“It is self-evidently absurd to look to investor-owned companies for unbiased evaluations of their own products…One result of the bias in this literature is that physicians learn to practice a very drug-intensive style of medicine. Even when lifestyle changes would be more effective, physicians and their patients often believe that for every ailment there is a drug.” It’s gotten so bad that “[p]hysicians can no longer rely on the medical literature for valid and reliable information.” That’s quite an accusation. Says who? Says a long-time editor of the New England Journal of Medicine, one of the most prestigious medical journals in the world.

To help expose some of the conflicts of interest corrupting the medical profession, the Drug Company Gift Disclosure Act was introduced in Congress where it died year after year until it was successfully integrated into the Affordable Care Act. Now, there’s a database detailing which doctors get the billions of dollars that are dished out, “permit[ting] patients to make better informed decisions when choosing health care professionals and making treatment decisions.” (I explain how you can easily look up your own doctor in my video Find Out If Your Doctor Takes Drug Company Money.)

In 2008, medical groups endorsed a version of the Act that didn’t require public disclosure unless doctors got at least $500 in gifts, but the 2009 version got stricter, requiring disclosure if you pocketed even $100, leading groups like the American Academy of Family Physicians to start to get a bit nervous. The final wording in Obamacare, however, requires disclosure of even a $10 meal, leading countries around the world to look to the United States for leadership in healthcare ethics. You don’t see that every day!

Now that we have this massive public record, we can really see how honest doctors have been. The financial disclosures by the authors of all the American College of Cardiology and American Heart Association guidelines were matched to the public disclosures of the hundreds of thousands of dollars they received from Big Pharma. The result? “The overall agreement between author and company disclosure was poor.” Nationally, female physicians each received thousands of dollars less than male doctors on average from drug companies each year, though it’s not clear if this is because the women were more ethical or the industry was sexist.

What about conflicts of interest for online clinical support websites? “Point-of-care evidence-based medicine websites allow physicians to answer clinical queries using recent evidence at the bedside” of a patient. Clinicians caring for patients are increasingly reviewing treatment recommendations on these sites to make clinical decisions in real time. For instance, if you’re with a patient, you can just whip out your phone and check one. It’s important that “[m]embers of groups developing formal clinical guidelines are discouraged from interacting with the health industry in a manner that may create a conflict of interest.” Researchers examined one such website called UpToDate, which seemed to provide the most comprehensive diagnoses. Did they find any conflicts of interest? Yes, in every single UpToDate article they examined.

So what do we do with this information? Let’s say we see an article claiming that candy consumption is not associated with health risks and the authors disclose that their research was supported by the National Confectioners Association, a group that used to run ads that said things like: “Put candy in their school lunch. It’s good for them.” We may want to take the results of that article with a grain of salt.

“The problem with financial COIs [conflicts of interest] is that you simply don’t know what to believe.” Maybe this “preoccupation with disclosure hijacked the debate…” Maybe, as Dr. Kassirer, the former chief editor of the New England Journal of Medicine, critiqued, the focus instead should be on eliminating commercial conflicts, not just disclosing them. It’s like campaign finance reform, where the issue is managed more by public disclosure rather than getting money out of politics. Indeed, he writes that “the vast attention paid to failure to disclose conflicts of interest is misplaced, and that more attention must be focused on the financial conflicts themselves.”

After Dr. Kassirer effectively resigned from the New England Journal of Medicine, disillusioned with the direction they were taking, Dr. Marcia Angell took over. She was the first female chief editor in the journal’s hundred-year history and lasted about a year. Medical journals “consistently refer to ‘potential’ conflicts of interest,” she wrote, “as though that were different from the real thing, and about disclosing and ‘managing’ them, not about prohibiting them. In short, there seems to be a desire to eliminate the smell of corruption, while keeping the money. Breaking the dependence of the medical profession on the pharmaceutical industry will take more than appointing committees and other gestures. It will take a sharp break from an extremely lucrative pattern of behavior.”

Why do funding sources matter? See my video Disclosing Conflicts of Interest in Medical Research.

The shameful practices of supposed science-based medicine websites, like UpToDate, are the very reason I started NutritionFacts.org in order to share the best available evidence without corrupting commercial influence. If you value my work, please consider becoming a supporter by making a recurring monthly donation to the 501c3 nonprofit that keeps NutritionFacts.org growing and thriving.

In health,
Michael Greger, M.D.

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