When doctors prescribe, when universities conduct research and when hospitals take referrals from doctors, the public has a right to know what the conflict of interest polices should be. In recent months, Senator Chuck Grassley of Iowa has sent letters out to various institutions requesting their conflicts of interest policies. Unfortunately, some institutions have not replied.
Why is this question so important? The answer is simple: patients have a right to the best procedure, the best drug or insulin, the best advice rather than what is most profitable for the industry and what is most profitable for the local hospitals and drug sales representatives. In the past research had been funded by the federal government, and now about 50-60 percent of the research comes from profit oriented businesses.
In as National Institute of Health Article, Comparsion of conflict of interest policies and reported practices in academic medical centers in the United States, Machaela A. Dinan and co-investigators concluded that although policies have been written, not all were being enforced.
"In this study, we compared academic medical centers’ written policies on conflicts of interest with the practices described by officials charged with oversight of conflicts of interest. One of the most striking findings was the extent to which institutional policies did not seem to guide actual practice as reported by IRB and COIC officials. We often found that, in the absence of explicit language in formal policies, oversight officials did not always agree about the actual practices of the institution. This finding conflicts with the 2001 recommendation of the Association of American Medical Colleges (AAMC) that “institutional policies governing financial interests in human subjects research should be comprehensive, unambiguous, well-publicized, consistently applied, and enforced through effective sanctions.”
Of ever increasing concern in drug company sales people known as detailers come to doctors offices and influence the doctor's decision making process. Because physicians feel a sense of discomfort known as cognitive dissonance, they found themselves influenced by these sales people.
"Although physicians understood the concept of conflict of interest, relationships with detailers set up psychological dynamics that influenced their reasoning. Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician–detailer interactions will be effective," according to the Journal of Internal Medicine. In the article Physicians and drug representatives exploring the dynamics of the relationship, author Susan Chimonas and associates reviewed this problem in the 2007 copyrighted article.
"One of the most pressing problems in American health care is conflict of interest. Medicine is now a $2-trillion industry, and conflicts frequently arise when physicians’ “interests or commitments compromise their independent judgment or their loyalty to patients...Among the most prevalent conflicts of interest are those arising from physicians’ interactions with drug company sales representatives, or “detailers.” Pharmaceutical companies employ about 90,000 detailers and spend over $7 billion annually to market their products to physicians, averaging $15,000 per year per physician. Prescribing decisions can become conflicted by free gifts, meals, travel, and other benefits. Because physician–detailer interactions bias medical decision-making, undermine public trust, and increase healthcare costs, the medical profession is now under unprecedented pressure to “recognize, disclose to the general public, and deal with conflicts of interest.”
Chimonas and her co-investigators explored the idea of cognitive disonnance, which was originated by Leon Festinger. This concept indicated that dedicated members of a group will seek to interpret and reaffirm their beliefs. Only fringe members will acknowledge errors. People tend to find themselves sticking to previously held beliefs.
So when a drug sales person
arrives at the doctors office, everyone known s the representative is
there to sell the doctor on a particular drug. In any sales contact a
discomfort arises between the two parties. Eliminating the discomfort
could me altering one or more conflicting attitudes or behaviors. If a
drug has a complication, naturally the drug representative will say it
is not that bad. Then the doctor could rationalize with the drug sales
person. Finally, the doctor could deny the real risk or forget
about his or her original concern.
"Given physicians’ techniques for managing dissonance, it appears that only the prohibition of physician–detailer interactions will be effective. This position is now gaining popularity. Some HMOs (including Kaiser Permanente) and a growing number of medical centers are restricting detailers’ access to staff and are devising strategies to control conflicts of interest. Government regulation is also increasing. The Office of the Inspector General at the Department of Health and Human Services endorsed the PhRMA Code in 2003 and, going further, now requires companies to separate medical education grant-making from their sales and marketing departments. At the state level, California compels companies to declare an annual dollar limit on gifts to individual providers.
In the end, it would be preferable were individual physicians, mindful of the principles of medical professionalism, to reduce or eliminate interactions with drug representatives. Our findings, however, suggest that physicians’ techniques for managing cognitive dissonance render this prospect unlikely. Because physicians are not prone to policing themselves, the growing likelihood is that they will be policed by others."
