Conflict of Interest in Today's Health Care Market

Conflict of interest (COI) has become a contentious topic in the medical world over the past two to three decades. The meaning of the term has become synonymous with dark connotations including greed, compromised, hidden agendas, sold-out and money-oriented. The true meaning of conflict of interest is really any scenario in which a party may have a personal interest in a decision being made by another party or group. This is in fact, a noble cause, and one that should be adhered to. We certainly do not want personal gain to influence how a decision is being made. On the other hand, it is unrealistic to expect people not to have conflicts of interest in medicine. This is especially true for physicians. In general, physicians as a group do practice medicine, but by their personal drive and nature, are often involved in other innovative initiatives. Some of these initiatives may be on their own, in corporate America, with physician societies, within a physician practice or within a hospital system. The idea behind conflict of interest rules is disclosure. Disclosure allows everyone to be aware of a conflict when a decision is being made, such that a party can recuse themselves. However, currently the COI rule is usually applied only to industry relationships, or personal business relationships. That is where the COI rules fall apart and are not applied equally across the board.

Here is an example: I work for my University’s Medical Center… I may be President of a specific medical association. If I advertise that I am president of that association on my CV or any other public document and it influences a patient’s decision to come to my University’s Medical Center for care as opposed to another, that is a conflict. If as the President, I am asked to speak at conferences because of that position and I am paid to attend, that is a conflict. If as a committee member of an organization, a physician writes a paper and that paper leads to him or her being identified as an expert in an area and then being compensated for consulting time, or attracting a research grant or more patients to his or her practice, that is a conflict of interest. However, these conflicts are part of normal life. It would be impossible to perform daily functions without them. On the contrary, if a physician serves as a consultant for a company, or runs his or her own company, then they are identified as having a “real” conflict of interest. In reality, there is no difference between the different scenarios I have provided.

Academic medicine, physician societies, physician practices and industry are all intertwined in the same objective – improving patient care. Most specialty societies would not exist if it were not for the funding of grants by industry, in addition to support of yearly societal meetings by renting vendor exhibiting space. I am sure some of these relationships have gone wrong; however I would venture to say that it is the minority of these relationships that have turned out bad. There is also a marginal number of times that researchers tell “fibs” about their data to get more research grants or health care systems protect physicians practicing sub-par medicine or physicians overprescribe procedures and testing to make more money. However, the majority do not behave in this manner.

I believe it is time for reality to set in and for physicians from “diverse” backgrounds to be linked together. Only with collaboration between academia, private practices, physician societies and industry can we truly look at major decisions from all perspectives. Declaring a conflict of interest is the right thing to do. Managing a conflict is imperative. However, having a conflict in one area should not eliminate a person from contributing, or even leading, if they have declared and acted on their COI sufficiently and with integrity. Conflicts of interest exist in all walks of life. It is the organization that realizes how to appropriately use all of their physician resources effectively and has “diverse” representation amongst their members and leaders that will be the ultimate winners. We owe that to ourselves, our patients and our healthcare delivery system.