Doing the Right Thing

It’s time to take a strong stand on conflicts of interest

By John D. Stobo

Conflicts of interest in the medical profession are once again the focus of public attention in the wake of two well-publicized incidents. First was the news that a number of senior scientists at the National Institutes of Health had received large sums of money from pharmaceutical and biotechnology companies with whom they had official scientific relationships. Second was the discovery that some members of the Food and Drug Administration Advisory Panel that voted to keep Vioxx and Bextra on the market had financial ties to the companies that make these drugs. Indeed, real and even perceived conflicts of interest strike at the very foundation of medicine and biomedical research—the trust that society places in us to do the right thing—to always act in their, and not our own, best interest.  Just the appearance of impropriety erodes this public trust.

The actions of those delivering patient care or conducting biomedical research must be guided by putting the health and well-being of those we serve first.
No exceptions.

Scientists who own stock in firms that make the drugs they test prompt an obvious question: Are they working for the patient’s health or for personal gain? Doctors who garner lavish pharmaceutical consulting fees—or who go on drug company junkets and then expect the public’s trust—expect too much.

When one focuses on what’s best for the patient, the proper path becomes clear. How would you, as a patient, feel about your doctor owning ten thousand shares in the company that makes the pill you’ve just been prescribed? Even if the drug is helpful, you may wonder whether another, perhaps less expensive, drug would have worked just as well.

Consider the many doctors who have partial ownership in specialty hospitals to which they refer patients, or those who offer costly ancillary services out of their offices. At some point, patients may question this practice. The actions of those delivering patient care or conducting biomedical research must be guided by putting the health and well-being of those we serve first. No exceptions. Anything less risks the autonomy and self-regulating authority accorded the medical profession.

Some suggest that conflict-of-interest issues can be managed by capping how much investment a doctor may have in a drug company, medical device manufacturer or private hospital. But there’s no magic cut-off point. How can owning twenty shares of a pharmaceutical company be “safe” while owning twenty-one is not? How can earning 20 percent of one’s base salary in consulting fees be less risky than earning twice one’s base salary? Real or perceived, conflicts of interest erode confidence. It’s up to each of us to conduct ourselves in ways that foster confidence.

At UTMB, we try to encourage that confidence through our “Conflict of Interest” policy. An eleven-member committee ensures adherence to the policy, providing faculty with objective guidelines and addressing potential areas of conflict as they arise. This group examines all reported conflicts and evaluates whether they adhere to university guidelines. In the wake of increasing national concern over conflicts of interest, I have asked the committee to review all our policies related to conflicts of interest, including consulting relationships with industry, to determine their appropriateness.

To put matters in perspective, consider Arthur Andersen. In 2002, the world’s largest accounting firm was revealed to have failed to ensure the financial integrity of its client Enron. Eroded by greed and conflicts of interest, Arthur Andersen lost its clients and public trust and imploded. Subsequently, Congress began to replace the accounting profession’s self-regulation with outside regulation—the Sarbanes-Oxley Act of 2003. Accounting as a self-regulated profession is no more. If we don’t address conflict of interest in medicine and biomedical research, we may suffer a similar fate.

John D. Stobo, M.D., is president of UTMB.