Friday, December 15, 2006

Conflicts of Interest--Part 1 of a continuing series

Interesting post on the Health Care Renewal blog about conflict of interest (COI) in continuing medical education (CME) meetings. Quoting a Wall Street Journal article, Roy M. Poses, MD, president of the Foundation for Integrity and Responsibility in Medicine, discusses a case where GlaxoSmithKline, the huge pharmaceutical company, paid a doc $1,000 to $2,500 per talk to appear at CME meetings. At those meetings the doc would advocate certain off-label uses for one of GSK's drugs, while neglecting to disclose that GSK was paying for him to speak.

I'll be discussing COI frequently in this blog. Today I'll make a few points about disclosure, which is often touted as a COI antidote.

  • More docs seem to be following the disclosure rules these days than in years past, but many still neglect to mention their potential conflicts. Often meeting programs will include a page of speakers' disclosures, which is very helpful. But on that page, after a short list of speakers who have disclosed their various advisory boards, equity interests, and sources of research funding, is a much longer list of "Speakers Disclosing No Conflicts of Interest." This heading is quite misleading, of course. Some folks in this list may have affirmed that they have no conflicts of interest, but others may simply have failed to return the COI form the meeting organizers sent them, and they may have COIs up the wazoo.
  • Sometimes a speaker's disclosures appear on his first or second PowerPoint slide, which he leaves up for about a microsecond.
  • Sometimes a speaker will simply say that he sits on every advisory board or speakers' bureau for every pharmaceutical company with drugs in his specialty, implying that he has no motive for touting one company's drug over another.
  • Sometimes a speaker will state regretfully that he has no disclosures to report, but then jokes that he'd be delighted to talk to anyone in the audience who is willing to help him change that sad state of affairs.
  • Always the implication of these disclosures is that the speaker is far too principled a scientist and clinician to let any of these financial conflicts cloud his Solomon-like wisdom.

As far as I can tell, the majority of audience members give virtually no weight to what disclosures there are, unless the conflict is so extreme that it can't be ignored. For example, they may give a talk a few mental demerits if the speaker discloses that he holds a patent on the drug or device he's talking about. Otherwise, I believe, they have faith that the speaker would never, no never, let these conflicts affect his judgement. I believe that that faith is often misplaced.


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