Conflict of interest in the healthcare industry

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Conflict of interest in the health care industry occurs when the primary goal of protecting and increasing the health of patients comes into conflict with any other secondary goal, especially personal gain to healthcare professionals, and increasing revenue to a healthcare organization from selling health care products and services. The public and private sectors of the medical-industrial complex have various conflicts of interest which are specific to these entities.

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There is a lack of empirical evidence to describe the impact of conflict of interest in the health care industry. [1]

Business interests influence the direction of cancer research and the adoption of new practices in therapy. [2]

University projects which receive industry funding are more likely to produce research outcomes which favor their funders. [3]

A 2017 systematic review by the Cochrane Collaboration found that pharmaceutical and medical device industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. [4]

The trend toward treating clinical research as a business has coincided with a range of problems which are likely the result of business connections. [5]

Funders seek and court scientists to author papers and lend their person reputations to add credibility to research findings. [6]

Physicians in general practice also face potential conflicts of interest. [7] For example, the Physician Payments Sunshine Act of 2010 requires that financial relationships of physicians and teaching hospitals with manufacturers be reported and made publicly available via the Open Payments Program website.

Using this Open Payments database, it was found that about 64% of US-based physician-editors of highly cited medical journals received industry-associated payments (i.e., payments from medical drug and device companies) during a period spanning August 1, 2013 to December 31, 2016. [8]

Medical journals have varying requirements what should be published and people who fail to follow them face few repercussions. [9]

The medical-industrial complex describes the conflict of interest present between physicians and the healthcare industry. [10] Physicians who invest in medical device companies may be biased towards certain medical devices or treatments, creating a conflict of interest between doing what is best for a patient versus what is in their best financial interest. [11] Conflict of interest in continuing medical education is also present, where physicians learn how to use certain medical devices during their board-certification courses that affect their patients. [12]

Related Research Articles

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Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.

A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.

Continuing medical education (CME) is continuing education (CE) that helps those in the medical field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications, online programs, audio, video, or other electronic media. Content for these programs is developed, reviewed, and delivered by faculty who are experts in their individual clinical areas. Similar to the process used in academic journals, any potentially conflicting financial relationships for faculty members must be both disclosed and resolved in a meaningful way. However, critics complain that drug and device manufacturers often use their financial sponsorship to bias CMEs towards marketing their own products.

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.

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<span class="mw-page-title-main">Arnold S. Relman</span> American internist, professor and journal editor (1923–2014)

Arnold Seymour Relman — known as Bud Relman to intimates — was an American internist and professor of medicine and social medicine. He was editor of The New England Journal of Medicine (NEJM) from 1977 to 1991, where he instituted two important policies: one asking the popular press not to report on articles before publication and another requiring authors to disclose conflicts of interest. He wrote extensively on medical publishing and reform of the U.S. health care system, advocating non-profit delivery of single-payer health care. Relman ended his career as professor emeritus at Harvard Medical School in Boston, Massachusetts.

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Choosing Wisely is a United States-based health educational campaign, led by the ABIM Foundation, about unnecessary health care.

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<span class="mw-page-title-main">Peter Bach</span> Medical researcher

Peter B. Bach is a physician and writer at Memorial Sloan-Kettering Cancer Center where he is Director of the Center for Health Policy and Outcomes. His research focuses on healthcare policy, particularly as it relates to Medicare, racial disparities in cancer care quality, and lung cancer. Along with his scientific writings he is a frequent contributor to The New York Times and other newspapers.

The Physician Payments Sunshine Act is a 2010 United States healthcare law to increase transparency of financial relationships between health care providers and pharmaceutical manufacturers.

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Nancy Keating is an American physician who works at the Brigham and Women's Hospital and is a professor at Harvard Medical School. Her research considers the factors that influence quality care for people suffering from cancer.

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References

  1. ↑ Malina, Debra; Rosenbaum, Lisa (2015). "Understanding Bias — The Case for Careful Study". New England Journal of Medicine. 372 (20): 1959–1963. doi: 10.1056/NEJMms1502497 . ISSN   0028-4793. PMID   25970055.
  2. ↑ Friedberg, M; Saffran, B; Stinson, TJ; Nelson, W; Bennett, CL (20 October 1999). "Evaluation of conflict of interest in economic analyses of new drugs used in oncology". JAMA. 282 (15): 1453–7. doi:10.1001/jama.282.15.1453. PMID   10535436.
  3. ↑ Blumenthal, D; Gluck, M; Louis, KS; Stoto, MA; Wise, D (13 June 1986). "University-industry research relationships in biotechnology: implications for the university". Science. 232 (4756): 1361–6. Bibcode:1986Sci...232.1361B. doi:10.1126/science.3715452. PMID   3715452.
  4. ↑ Lundh, A; Lexchin, J; Mintzes, B; Schroll, JB; Bero, L (16 February 2017). "Industry sponsorship and research outcome". The Cochrane Database of Systematic Reviews. 2017 (2): MR000033. doi:10.1002/14651858.MR000033.pub3. PMC   8132492 . PMID   28207928.
  5. ↑ Rettig, RA (2000). "The industrialization of clinical research". Health Affairs. 19 (2): 129–46. doi: 10.1377/hlthaff.19.2.129 . PMID   10718027.
  6. ↑ Wilkes, M. S.; International Committee of Medical Journal Editors (2001). "Sponsorship, Authorship, and Accountability". New England Journal of Medicine. 345 (11): 825–827. doi:10.1056/NEJMed010093. ISSN   0028-4793. PMC   1071574 . PMID   11577056.{{cite journal}}: |author2= has generic name (help)
  7. ↑ Palmer, N.; Braunack-Mayer, A.; Rogers, W.; Provis, C.; Cullity, G. (2006). "Conflicts of interest in divisions of general practice". Journal of Medical Ethics. 32 (12): 715–717. doi:10.1136/JME.2005.014811. PMC   2563353 . PMID   17145912.
  8. ↑ Wong, VSS; Avalos, LN; Callaham, ML (2019). "Industry payments to physician journal editors". PLOS ONE. 14 (2): e0211495. Bibcode:2019PLoSO..1411495W. doi: 10.1371/journal.pone.0211495 . PMC   6366761 . PMID   30730904.
  9. ↑ What These Medical Journals Don't Reveal: Top Doctors' Ties to Industry The New York Times, 2018
  10. ↑ Wohl, Stanley. The Medical Industrial Complex / Stanley Wohl. First edition. New York: Harmony Book, 1984: 85-98
  11. ↑ Xu, Amy L BS; Jain, Amit MD, FACS; Humbyrd, Casey Jo MD, MBE. Ethical Considerations Surrounding Surgeon Ownership of Ambulatory Surgery Centers. Journal of the American College of Surgeons: September 2022 - Volume 235 - Issue 3 - p 539-543 doi: 10.1097/XCS.0000000000000271
  12. ↑ Relman, Arnold S. "Doctors as the Key to Health Care Reform." The New England journal of medicine. 361, no. 13 (2009): 1225–1227.

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