Introduction
It has been found that, in the medical field, there is the conflict of interests between individuals, pharmaceutical companies, and doctors. The question that has been constantly asked is; who gets to decide what the right thing is to do regarding health care; patients, pharmaceutical companies, and doctors? The aim of this paper is to look at the problems concerning the conflicts of interests regarding healthcare individuals, pharmaceutical companies, and doctors. Moreover, the paper will seek to answer the question above and to demonstrate that the answer solves the problems presented in the discussion.
Conflicts of Interests Among Healthcare Individuals, Pharmaceutical Companies, and Doctors
The present day influence of the market incentives within the United States of America is bringing in unique challenges to the medical professionalism's principles. The commitment of doctors to altruism, placing the patients' interests in the first place, scientific integrity, and a lack of bias in the medical decision-making process currently arises against the financial conflicts of interest. Reportedly, the most extensive and challenging of such conflicts come out from the relationships between doctors and the pharmaceutical companies and the manufacturers of the medical devices.
As being a part of the healthcare sector, the medical device manufacturers and pharmaceutical companies boost the patients’ welfare via their dedication to research and development of products. In this regard, the investments they make in the discovery, development, and distribution of new pharmaceutical agents, as well as medical devices, have offered benefits to many patients. A large number of companies as well support ongoing medical education. Nevertheless, their final fiduciary duty is to the shareholders who have expectations of the fair returns on the investments they make. Essentially, the manufacturers have an acute awareness of the conflict that arise between the patient susceptibility and the profit incentives. Latest congressional investigations, the federal prosecutions, and the class action litigations have revealed documents that demonstrate how corporate practices constantly cross the line between the profit-seeking conduct and patient welfare. The concerned journalists, doctors, and the federal prosecutors are revealing still other features of an unhealthy association between the medical profession and manufacturers. Such transgressions have made the pharmaceutical corporations to engage in regulating themselves in a stricter manner. Indeed, such effort is found to be commendable; however, the behavior of doctors is a huge part of the problem, and the industry efforts to this point have not served to resolve such crisis. The profession’s standing, as much as the medical and pharmaceutical industries’ integrity, is put in danger by permitting the clear conflicts to go on.
With no doubt, the grave threat, which such state of affairs poses for the professionalism, and for the patients' trust in doctors, causes the need for an effectual guideline on the doctor-industry relationships to be clear and urgent. The market values and marketing ought not to be permitted to undermine the commitment of doctors to their best interest of patients or the scientific integrity. To save the situation and prevent further compromises in the future to professional integrity, the academic medical centers have to more firmly regulate, and in some instances ban, many common practices, which bring about conflicts of interest with the medical devices and pharmaceutical companies.
Defining Conflicts of Interest
Conflicts of interest take place when doctors have intentions, or find themselves in situations for which rational observers could point out that the moral requirements of the roles of the doctors are or seem to be compromised. Regarding industry influences, the financial conflicts of interest take place when the doctors are lured to diverge or do diverge from their professional responsibility for financial or any other personal gain. Accordingly, the bias introduced breaches both the patients’ best interests and the scientific integrity standards. Apparently, policing these conflicts evidently lies with the professional responsibilities scope set forth within the “Physician Charter on Medical Professionalism”.
Under normal circumstances, marketing carried out by the medical device and pharmaceutical companies focuses on “detail persons” or representatives who pay a visit to the doctors and offer information on the new products. Indeed, such a practice has expanded in scale, and a large number of other marketing strategies are well utilized. About ninety percent of the twenty-one billion dollar marketing budget of the pharmaceutical sector goes on being directed at doctors, in spite of a vivid increase on the “direct-to-consumer advertising”. Additionally, the industry is contracted with several hundreds of doctors to be part of the advisory boards or the speakers’ bureaus. In this sense, the aim behind these industry contracts with doctors is found to be unmistakable; the pharmaceutical companies are making attempts to boost the utilization of their products.
According to National Academy of Sciences, researchers and doctors have to exercise judgment in complex situations, which are apprehensive with uncertainty. Patients, students, researchers, and the public have to trust that such judgments are not compromised by the financial ties of researchers and physicians to the biotechnology, pharmaceutical, and medical device companies. Clearly, ties with industry are found to be common in medicine; some have created significant benefits, especially through researcher partnerships, which lead to the improvement of the public and individual health. In the meantime, widespread relationships with the industry have led to the creation of considerable risks that institutional and individual interests may excessively lead to the judgment of professionals regarding the primary goals and interests of medicine. Apparently, these conflicts of interest pose threats to the scientific investigations' integrity, the quality of the patient care, and objectivity of medical education. Moreover, they jeopardize the trust of the public in Medicine.
On the same note, surveys indicate the diversity and breadth of the relationships between doctors and industry, researchers, and educators within the community and academic settings. For instance, gifts from the pharmaceutical companies to doctors are pervasive. Moreover, visits to the doctors' offices by the medical device and drug company representatives and sample drug provision are widespread. Additionally, a large number of faculty members acquire research support from the industry, and the industry finances the most of the biomedical research in the United States of America. Furthermore, many members of the faculty and community doctors offer marketing and scientific services among other consulting services to corporations; and some operate on the company board of directors. Finally, commercial sources offer about fifty percent of the overall funding for the accredited ongoing medical education programs.
However, even if certain of such financial relationships may be found to be constructive, the news reports presented recently, the legal settlements, institutional announcements, and research studies have documented various disturbing instances that could serve to undermine the public trust in medicine. In this regard, such situations include doctors and researchers failing to reveal significant payments from the pharmaceutical companies as required by the government agencies or universities, settlement with the United States Department of Justice by the drug and medical device companies to evade prosecutions for the alleged unlawful payments or gifts offered to doctors, and academic investigators and companies failing to publish negative results from the industry-sponsored medical trials or delaying the publication for more than one year after the trial is completed. Moreover, another situation results from the academic researcher inserting their names on the manuscripts, even if they initially got involved in the collection and analysis of data and after the initial drafts were put down by the individuals paid by the industry, and professional societies among other groups, which develop the clinical guidelines making a choice not to reveal their industry financing and not to disclose the conflicts of interest of those experts that drafted the guidelines.
Even if the causes of such situations are many, and their scope is not clear, they serve to highlight the tension, which exist between the financial relationships with the industry and the main missions of education, medical research, and practice. On top of such examples, research carried out about the industry gifts among other financial relationships has created upsetting findings. For instance, systematic reviews of evidence sponsored by a drug company have a higher likelihood than other reviews to give conclusions that favor the company, even when the real findings of such analysis are found not to be favorable. Additionally, articles that are based on the company-sponsored medical trials are more likely to give conclusions that favor the products of the company than articles trials, which are not sponsored by the industry. Nonetheless, even if such findings do not essentially indicate that there is bias in research, and other explanations are provided, they do not bring about legitimate questions regarding potential unwarranted influence.
Besides the information that brings about concerns regarding the extent and consequences of the industry financial ties in the medicine field, other studies and surveys have reported discrepancies in the taking up and implementation of the conflict of interest policies by the medical institutions. Unluckily, the empirical evidence linked to financial relationships and the conflict of interest is found to be limited. In this regard, on several topics linked to the conflict of interest, there are no systematic studies. Notably, for other topics, the available data are found to be suggestive instead of being definitive. The researches that have been carried out have been observational instead of being interventional, largely because issues cannot be examined by utilizing randomized controlled trials of the effects of various types of the relationships or various approaches to the identification and management of conflicts of interest. In this line, various professional associations and medical centers among other institutions have taken initiatives to make their policies related to the conflict of interests become stronger; however, few data, which can be utilized in assessing consequences of such changes are available. Observably, some famous researchers and doctors have presented an argument that concerns regarding conflicts of interest are far much out of proportions to evidence that they are present or are injurious, and among them, there are those who contend that initiatives designed to deal with the conflicts of interest have served to interfere with gainful collaborations with the industry. Indeed, those who criticize the conflict of interest policies have as well charged that a larger number of individuals that have not behaved in an unethical way may be exposed to burdensome regulations and clear conclusions that they are guilty of misbehavior until proven innocent. Responding to these concerns and situations, the Institute of Medicine selected a committee to carry out an investigation and come with a report on the conflicts of interest in education, medical research, and practice in developing clinical practice guidelines. In line with its charge, this committee evaluated conflicts of interest in the education, medical research, and practice in developing clinical practice guideline, and developed the analyses and the recommendations with an intention of informing the design and implementation of policies, which identify and control conflicts of interest within such contexts without destroying constructive partnerships with the industry.
Since the evidence on a large number of issues is found to be limited, the Institute of Medicine's committee had to depend on its judgment and experience in examining the arguments and analyzes presented in the literature, as well as in the statements that were submitted to the committee. In the course of its work, this committee bore in mind the main goals of education, medical research, and practice, which encompass serving in the patients’ and society’s best interest via creation of valid scientific knowledge, the autonomous evaluation of the evidence, and applying critical thinking, and generation and utilization of evidence-based recommendations for the patient care. Making a reflection on the concerns raised in the course of the project planning and the core issues in policies and debates on the conflicts of interest in the medicine field, the committee put focus on the financial relationships involving biotechnology, medical device, and pharmaceutical companies. Even though the committee did not make an in-depth investigation of the conflicts of interest linked to various doctor payment arrangements or the doctor referral of patients to the facilities where they have ownership interest, it had had recognition of the seriousness of such kinds of conflicts and the hardships, which policy makers have come across while attempting to manage or eliminate them. The committee came to recognize other origins of conflicts of interest; for instance, desires for recognition and professional advancement.
After the committee evaluating a broad range of evidence, perspectives, and analyzes of the conflicts of interest, it drew some conclusions. For instance, this committee pointed out that the objectives of conflict of interest policies in the medicine field are fundamental to offer protection to the professional judgment integrity and maintain public trust instead of trying to remediate mistrust and bias after they happen. Moreover, the revealing of the institutional and individual financial relationships is crucial but limited initial move in the process of making identification of conflicts and responding to them. Additionally, the procedures and policies related to conflicts of interest can be made stronger by engaging researchers, doctors, and the medical institutions in the development of conflict of interest consensus and policies standards. Furthermore, a variety of supporting organizations, both private and public, can serve to promote adopting and implementing conflict of interest policies and assist in the creation of accountability, which sustains the professional norms and public trust in the professional judgments. Besides, research on the conflicts of interest, as well as conflict of interest policies, can offer a more powerful evidence base for the policy making and implementation process. Finally, in case medical institutions are found not to act in a voluntary manner with an intention of strengthening the conflict of interest procedures and policies, the pressure for the external regulation is likely to intensify.
Who gets to decide what the right thing is to do regarding health care, patients, pharmaceutical companies, and doctors?
Although each party plays a significant role, doctors are in a better position to decide what the right thing is to do concerning healthcare. Indeed, this is because they are the ones that associate with almost all parties in health care including the patients and pharmaceutical companies.
Solving the Problems Associated with Conflicts of Interest
The doctors’ conduct forms a larger part of the problem of the conflicts of interest in the healthcare field. The profession’s standing, as much as the medical and pharmaceutical industries’ integrity is put in danger by permitting the clear conflicts to go on and it is majorly the responsibility of the doctors to act in an ethical manner to effectively eliminate the conflicts of interest. Undoubtedly, the danger, which such state of affairs poses for the professionalism, and for the patients' trust in doctors, causes the need for an effectual guideline on the doctor-industry relationships to be clear and urgent. Apparently, the market values and marketing ought not to be permitted to undermine the commitment of doctors to their best interest of patients or the scientific integrity. As seen considered earlier, the conflicts of interest take place when doctors have intentions, or find themselves in situations in which it could be seen that the moral requirements of the roles of the doctors are or seem to be compromised. Regarding industry influences, the financial conflicts of interest take place when the doctors are lured to diverge or do diverge from their professional responsibility for financial or any other personal gain such as professional development. In this regard, the doctors ought to act ethically when dealing with the pharmaceutical companies by ensuring that the companies give all the right drugs, which meet the required standards. Moreover, they should ensure that the patients get the drugs that they need. Precisely, the doctors should not allow themselves to be given favors and should act in a professional manner.
Conclusion
In summary, there exist the conflict of interests between individuals, pharmaceutical companies, and doctors in the healthcare field. However, it has been seen that doctors are in a better position to decide what the right thing is to do concerning healthcare to avoid the conflicts of interest as they deal directly with the different parties including the patients and pharmaceutical companies. There is the need to put in place the right procedures and policies to deal with the problems related to conflicts of interest in healthcare.
Works Cited
Angell Mohen. The Truth About Drug Companies. New York: Random House; 2004.Print.
Brennan, Troyen A. “Health industry practices that create conflicts of interest.” JAMA, 295 (2006): 429-433.
National Academy of Sciences. Conflict of Interest in Medical Research, Education, and Practice, 2009. Web. 7 Jan. 2016. <http://www.ncbi.nlm.nih.gov/books/NBK22926/#_ncbi_dlg_citbx_NBK22926>.
