Conflict of Interest: What? Again?

Conflict of Interest:
What? Again?


Leonard Zwelling

         The Affordable Care Act-mandated federal report that lists
the money doctors received from big (and little) pharma and biotech companies
has been released. During the final five months of 2013, the total largess was
$3.5 B.  That’s a lot of free lunches, so
I am going to assume that this total also includes travel reimbursement, speaking
fees, research grants (a good thing), pads, pens, golf balls, donuts and free
drugs (legal kind, putatively) for a doctor’s poorer patients, but just as
likely used to get an established insured patient comfortable with the latest overpriced

         Given my self-appointed role as scold-in-chief, I need to
chime in on such matters. Thus, I will pick up where I left off 7 years ago when
I was a Vice President overseeing the conflict of interest committee or since
then when writing about Drs. Mendelsohn and DePinho and their dealings with the
private sector. Cease and desist!  There
is no way to manage a conflict of interest for if there were, it wouldn’t BE a
conflict of interest.

conflict by definition means one person trying to serve two masters: his
patients and his bank account, his lab and his bank account, his kid’s college
fund and his bank account. You get the picture, it’s the human mind that is in
conflict attempting to make more than one party happy with clinical decisions, therapeutic recommendations or lab
results when the interest of the two parties may be in opposite directions.

         This is all about money and its influence on the other
important things doctors do besides making money—trying to heal the ill and
trying to advance the cause of medical science. Money is supposed to be the
secondary by-product of patient care and research not the primary goal. If a
physician is employed by a for-profit company or has his or her own start-up company
free of academia, go for it! No conflict. Make a fortune. But, if the doc is
like most in the profession trying to heal and trying to peal back ignorance,
the profit motive is not supposed to enter into decision making and the only
way to make sure that’s the case is to get rid of that part of the conflict. It’s
not that a doc may be influenced to make the wrong call, it is that it might be
perceived that he or she was making a call based on their own personal
interests rather than those of the patients or research study.

         Conflicts of interest, particularly financial conflicts of
interest, have no place in academic medicine where the doctor’s primary
fiduciary responsibility is to the patient or research. That being said, I know
that I am in a very small and shrinking minority who believes this. That’s OK.
I am getting used to being alone. It’s much easier to be an outcast following

         Just say for me when the integrity of an individual or an
institution or the reliability of the word of a doctor, an investigator or an
academic center is questioned because of suspicions that the doctor’s or
center’s work product is tainted by the financial interests of people involved
in patient care and research, that reputation is not coming back. It takes
years to create a good one and minutes to lose it.

         So, at the risk of sounding like a broken record (that’s how
you used to play music. Records were large vinyl discs with a continuous groove
on each side into which music was magically pressed. They are making a come
back), STOP IT!

         MD Anderson has two great assets—its name and its faculty.
Conflicts taint both. Get rid of them! No exceptions; no waivers; no funny

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