competing interests jaideep a gogtay md conflict of interest employee of cipla ltd
TRANSCRIPT
Appetite suppressant drugs and the risk of primary pulmonary hypertension
Although physicians and patients need to be informed, the possible risk of pulmonary hypertension associated with dexfenfluramine is small and appears to be outweighed by benefits when the drug is used appropriately.
NEJM 1996;35:609-16 NEJM 1996;335:659-660
OR:23.1 (6.9-77.7)
What does competing (conflict of) interest mean?
• Set of conditions in which professional judgment concerning a primary interest (e.g. patient’s welfare or validity of research)
• tends to be unduly influenced by a secondary gain (e.g. financial gain)
Condition, not behaviour
Who has competing interests?
• Physicians• Scientists/Resarchers• Teachers/Scholars• Reviewers• Editors• Conflicts of interest are universal
Professional interestsProfession 1o interest 2o interest
Physician Patient care Monetary, Prestige
Researcher Generation Publication of knowledge and funding
Companies New therapies Trust
Monetary Acceptance
Journals Dissemination Impact factor of authentic Subscription
information
Professional interestsProfession 1o interest 2o interest
Physician Patient care Monetary, Prestige
Researcher Generation Publication of knowledge and funding
Companies New therapies Trust
Monetary Acceptance
Journals Dissemination Impact factor of authentic Subscription
information
Conflicts of interest are universal• Doctors– Investigations– Admission to a particular hospital– Carry out treatments (drugs, procedures)– Own a hospital
• Doctors and Pharmaceutical/Biotechnology companies– Paid consultants to a company– Received research grants/travel grants– There are very few doctors who have not been
given anything by a pharmaceutical company
Conflicts of interest are universal
• Scientists– Idea/Patents
• Journals– Reprints e.g. VIGOR study showed that Rofecoxib had less GI
adverse events; 1 million reprints purchased by the sponsor (profits of 600,000 USD)
– Advertisement revenue
• Personal (non-financial)– Relationships with individuals involved in submission of a paper
(Friend, spouse, ex-boss/mentor, adversary)– Convictions (religious, political, ideological or other)
• Opposed to emergency contraception
Declaration of interest
Nicholas Wald and Malcolm Law have patents for the Polypill (in EU countries and pending in USA and Canada. Priority date 10 April 2000)
Conflicts of interest are universal
• Scientists– Idea/Patents
• Journals– Reprints e.g. VIGOR study showed that Rofecoxib had less GI
adverse events; 1 million reprints purchased by the sponsor (profits of 600,000 USD)
– Advertisement revenue
• Personal (non-financial)– Relationships with individuals involved in submission of a paper
(Friend, spouse, ex-boss/mentor, adversary)– Convictions (religious, political, ideological or other)
• Opposed to emergency contraception
Conflicts of interest are universal
• Scientists– Idea/Patents
• Journals– Reprints e.g. VIGOR study showed that Rofecoxib had less GI
adverse events; 1 million reprints purchased by the sponsor (profits of 600,000 USD)
– Advertisement revenue
• Personal (non-financial)– Relationships with individuals involved in submission of a paper
(Friend, spouse, ex-boss/mentor, adversary)– Convictions (religious, political, ideological or other)
• Emergency contraception
Is it a bad thing?
• Conflict of interest per se is not intrinsically bad
• Represent situations in which interests of partners may not fully overlap
• Not judging moral character
Critics
• Questions their ‘scientific integrity’• Physicians say that decisions about patient
care are not influenced by financial incentives• Unfairly punish ethical physicians and
researchers for the misdeeds of a few
Purposes of regulations regarding conflict of interest
• Maintain integrity of professional judgment– Minimize the influence of secondary interests
• Maintain confidence in professional judgment– People should continue to have faith in decisions– Distrust of the profession
• Failure to avoid conflict of interest may be wrong even when one is not influenced by secondary interests
The most important health-care development of the day is the recent, relatively unheralded rise of a huge new industry that supplies health-care services for profit. • Hospitals and nursing homes, • Diagnostic laboratories, • Home-care and emergency-room services, • Dialysis
This new "medical-industrial complex" may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and "cream-skimming," and it may also exercise undue influence on national health policy.
In this medical market, physicians must act as discerning purchasing agents for their patients and therefore should have no conflicting financial interests.
NEJM 1980;303:963-70