Random musings…
This morning’s post is a bit of a jumble of ideas, coming from reflections on a range of stories that I’ve been reading over the last few weeks, but which I haven’t yet had time to write about in more detail.
Payment for service
Health reform in the US has been the source of a lot of popular press about COI in recent weeks, in part turning on the story of the AARP lobby group (Conflict Of Interest For AARP In Health Bill Debate?). But see also this article in the NY Times (Maybe a New Day for Doctors’ Pay) about a more fundamental issue, and one that’s also common in countries — such as Canada — that have universal health insurance, but where MDs are paid on a fee-for-services basis.
Disclosure as remedy
Disclosure of COI to scientific journals, a voluntary act, is maybe too permissive (Physicians’ disclosures to UW, journals inconsistent). Journals do not have in hand any mechanisms to actually verify that contributing authors are being truthful in their declarations. But what are the alternatives, to not trust academics at all? See also: Medical Journal Conflict of Interest Disclosure and Other Issues
The use of disclosure requirements in institutional policies (e.g., at Universities, medical schools) is a common mechanism for preventing or managing COI (U panel proposes conflict-of-interest policy). The problem is that, like with scientific journals, these are voluntary disclosures and thus subject to manipulation, being ignored, etc. More problematic, in my mind though, is the fact that most academics probably have little idea of what actually constitutes a COI, and many disclosure forms do not help matters, being vague, punctual (once a year?), and with little in the way of education or other resources to encourage ethical behaviour.
Drug development
With the global press coverage of the H1N1 “pandemic” and concerns about sufficient access to vaccines, there’s also been a fair amount of conspiracy theory-type critiques of Big Pharma for creating a market for its products. Now, while I think most conspiracy theories are based on misplaced fears (and an unrealistic belief in the power of large bureaucracies to actually keep secrets!), stories like the following should make us pause a moment: Conflicts of interest? Dr. Mehmet Oz owns 150,000 option shares in vaccine technology company.