Conflicts of Interest: Eroding Trust in the Profession

On September 10, the New York Times and ProPublica published an article about Dr. José Baselga, a leading cancer researcher and chief medical officer who failed to disclose millions of dollars in payments from pharmaceutical companies, and omitted these ties from research articles. Rita Redberg, editor of JAMA Internal Medicine, was quoted in the article and got to the root of the issue that the profession needs to address. On the request from journals to authors to disclose any conflicts of interest, Dr. Redberg said, “We rely on trust and integrity. It’s kind of an assumed part of the professional relationship.” Exactly… it’s about trust and professionalism.

The Physician Charter states clearly:

“Physicians have an obligation to recognize, disclose to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities. Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.”

Unfortunately, Dr. Baselga’s alleged egregious behavior is just the tip of the iceberg; such conduct is widespread in the profession. It has been over 10 years since the ABIM Foundation, AAMC, ACP, AMA and others published strong recommendations regarding conflict of interest policies that recognize how the smallest of gifts can influence decision-making. Yet in 2017, Chimonas et al. published findings on physicians’ views on the Sunshine Act, in which the authors report a broad “unawareness of basic COI concepts and principles. Most participants seemed unfamiliar with or unconvinced by the considerable scholarship on gifting, reciprocity, and influence. With few exceptions, they dismissed and took offense at the notion that industry promotions could shape practice decisions, particularly their own. Denying the potential for influence, they welcomed company ‘perks.’ ” In an article on her findings in ACP Internist this past March, Chimonas went on to say, “When I spoke to physicians [for the study] it wasn’t that different from when I did focus groups 10 years ago about denial that [conflicts of interest] could affect a physician… I was taken aback by this lack of progress.“

Why aren’t all of those recommendations published a decade ago standard practice at this point?

Per the Physician Charter, managing conflicts of interest is about maintaining trust. The empirical evidence on how a person’s relationships may influence decision-making may be limited, but what cannot be trivialized is the effect that even perceived conflicts of interest can have on public confidence in medicine. At a time when trust in institutions and science is at an all-time low, it is imperative that the profession address any issue that may erode it further. Regardless of its effects on decision-making, if patients perceive a quid pro quo between a physician and a pharmaceutical company (for example), trust has already been chipped away.

As a self-regulating profession, I view this piece as a public shaming. We need to be more vigilant in this area and demand full transparency from everyone in the profession. We need to educate clinicians about the effects and public perception of conflicts of interest.  I am interested in the profession’s reaction to this transgression. I hope it will serve as a wake-up call for us to do better in eliminating conflicts of interest.

Lisa Miller & Daniel Wolfson