Where Do Conflicts of Interest Exist in the Medical Profession?

By | May 13, 2021

We hear about conflicts of interest on the news all the time. And in medicine, we have addressed this topic in relation to the pharmaceutical industry and its interactions with physicians. As a result, one can now review these connections as part of the ever-increasing desire for transparency.

However, as technology progresses, we must also be attuned to other potential conflicts that are damaging to consumers by creating incentives that increase costs or decrease the quality. Device-related payments to physicians have been growing and now represent 1.7 % of device industry revenue compared to 0.24% of drug industry revenue. According to recent data published by Bergman et al., this is a sevenfold difference. This payment comes in the form of training, royalties, and other services. None of these are necessarily nefarious; however, it behooves us to be aware of the situation and monitor it for possible undue influence and biases.

Admittedly, devise manufacturers need input from the end-users and, clinicians require training on how to use new technology. So the question becomes, how does this occur without the perceived and real conflicts that might arise? If policies are devised to prevent such interactions, we run the risk of slowing down innovations and/or decreasing quality when new techniques are introduced into mainstream care. However, we must balance these needs against the unintended consequences of a for-profit entity exerting that control over the end-user.

The question is, who is positioned to manage this polarity best? Is it our government? Is it the manufacturers themselves? As medicine is a profession, it falls to us to govern ourselves for the betterment of those we serve. Our medical societies are best situated to weigh-in and create guardrails that are then enforced by others. We must police ourselves and our colleagues if we wish to maintain the trust of those that entrust us with their lives. If we abdicate that responsibility, it will be taken from us. When this occurs, we scream and yell that others control our profession – a very true statement, but a self-inflicted one.

We must help science and industry progress in a manner that decreases conflict as much as possible. Our time is valuable, as well as our need to be trained optimally. Let us come together and co-create models that allow for enhanced care in a manner that is above board and absent of financial incentives that might create unintended consequences.