Conflict of interest has officially arrived as a buzzword. I know that because it now has an acronym: COI. However, there is nothing coy about the folks bandying the term about.
COI in medical marketing refers to the fact–deemed an embarrassment at best and a transgression at worst–that people who publish on certain topics often tend to have an interest in that topic. And since medical people are all grown men and women with careers, that interest may be considered a vested one, that is, attached in some way, directly or indirectly, to remuneration if not outright gain and profit.
If editors and publishers feign surprise at the realization of COI, it’s an act. Writers and publishers have been “interested” in their topics ever since Johannes Gutenberg peeled the first pages off his movable type press in Mainz, Germany, back in the 16th century. Even old man Gutenberg had an interest in his work; he was a deeply religious man and intended to use his press to publish Bibles recently translated into his native German language by Martin Luther.
Today, medical people have complicated relationships with the companies that develop drugs, therapies, devices, and other products. The idea that all of these groups operate in a plastic bubble discreet from the influences of the others is ludicrous. It’s not doctors over here, medical inventors over there, drug companies in this corner, hospital administrators in that. These groups all work together. No drug company can develop a new drug without the help, no the active participation, of many physicians. And it is only natural that physicians involved in the creation of a new drug will want to talk about it, which is something most doctors only do with slide decks or by writing articles.
That’s a simple example, but the fact is that most journal articles are written because somebody cares about something and that “care” often involves some sort of business tie.
Those who warn about COI would propose a different example for medical communication. In this COI-free world, only those utterly disinterested in a topic would ever be allowed to publish on it.
The fact is that the disinterested are, well, disinterested. Academic doctors are pressured to teach, prescribe, practice, educate, train, and publish; there are not enough hours in the day to meet all of their responsibilities at high levels. Now add to that the chore that they ought to be publishing not on matters that interest them enough to work on, but they ought to publish about things they do not care about at all.
COI right now is handled mainly by disclosures. If Doctor A writes about a particular drug, he or she is obligate to share all relevant business or commercial associations. This method does not really work well because most academic physicians have a whole slew of commercial associations. It is hard to be a key opinion leader and not have spoken on behalf of this company or consulted over that or taken an honorarium for a project somewhere else. Let’s face it, the world’s foremost authority on a particular drug or therapy is going to have associations with the companies and industries involved in that drug or therapy. So the COI disclosures do not surprise industry insiders, but they do come as a dreadful surprise to the purists who thought that only disinterested third parties wrote medical articles.
I don’t think there are disinterested third parties who know enough to write an article. By the time an author achieves enough expertise to write well to his or her peers on a complicated medical topic, he or she has got some associations with industry.
The fact is, the world of medical publications is already in crisis. According to JAMA, only about half of all NIH-funded studies ever get results published. Most doctors write far less than they ought to. There are many topics, insights, and ideas that are known to a handful of insiders but are not published because publishing medical articles takes a great deal of time. And with the added monkey wrench of acting like a person with industry ties is somehow unfit to publish on a medical topic of keen interest, doctors are increasingly less interested in dealing with the rigamarole to get ideas into print.
And that is the real conflict–that medical information that is useful and valuable does not get published because of this whole COI fiasco.
I mean think about it this way: let’s say a fiendish man set out to get rich. Would he get his M.D., invest heavily in a drug company, and then publish an article about a drug marketed by that company in the hopes that his article would push the stock sky-high? No. That is the dumbest get-rich-quick scheme ever. The fact is that medical articles may be persuasive proof sources among physicians but they aren’t passports to riches. An unscrupulous physisican might take money from a drug company in order to publish an article favorable to a particular drug, but there is not a lot of money in that “racket.” In fact, it is pretty hard to persuade an overbooked doctor to do things he ought to do–how difficult would it be to get a doctor to spend 20 or 30 of his hard-earned free time hours to publish an article for a drug company in return for a couple of thousand bucks?
The real danger of COI is that physicians are being actively dissuaded from doing what they ought to be doing, namely publishing on topics they know and care about.
