The Hippocratic Oath, first written in the late 5th century B.C., is taken by many physicians and other health care professionals as they begin their careers. The oath covers a number of things physicians need to do, but in short, it requires that they practice medicine honestly and ethically. In this issue of Neurology Now, we have a story about the effects of conflicts of interest on a physician's ability to practice medicine according to the principals of the Hippocratic Oath. (See page 34.)
According to the website businessdictionary.com , a conflict of interest is defined in two ways. I have modified these definitions slightly to more clearly apply them to a physician's ability to provide honest and ethical care to his or her patient: 1. A situation that has the potential to undermine the impartiality of a physician because of the possibility of a clash between the physician's self-interest and his professional or public interest; and 2. A situation in which a physician's responsibility to a company limits her ability to fulfill her ethical responsibility to a patient.
As our story points out, most of this (real or perceived) conflict of interest centers around physicians' relationships with pharmaceutical and medical device companies. The main issue is that these relationships could influence physicians in which treatments to offer for reasons that are not necessarily in the patient's best interest. New legislation called The Physician Payment Sunshine Provision of the Affordable Care Act, which is set to be implemented by 2013, requires that money received by physicians from pharmaceutical and medical device companies is made public. That means anyone can access this information and decide for themselves whether they think their physician might have a conflict that could influence the care they receive.
It is important to mention that collaborations between physicians, scientists, and companies to develop new drugs and devices can greatly benefit individual patients and improve public health. So it is not inherently bad for physicians to have relationships with industry. However, the exact type of relationship needs to be closely monitored and very transparent.
In 2009, the Institutes of Medicine produced a 440- page report entitled Conflict of Interest in Medical Research, Education and Practice. The authors reviewed available evidence on the extent of industry relationships with physicians and researchers and their consequences. They also looked as the current policies in place to identify, limit, and manage conflicts of interest. Some of the recommendations in the report include: create a national program for reporting industry payments to physicians and scientists; restrict researchers with a conflict of interest from participating in research studies involving human participants; and reform industry interactions with physicians.
Academic medical centers, medical journals, and the National Institutes of Health all have very strict policies about allowable financial relationships between physicians and researchers with industry. The American Academy of Neurology has such policies for all of its publications and programs, including Neurology Now. The importance of this for me, and I suspect for you as well, is that I want to be able to trust what I read and the advice I get from my physicians.
Although the issue of conflicts of interest is not always straightforward, I always go back to the principles of the Hippocratic Oath. My job as a physician and researcher is to always practice medicine in an honest and ethical manner. If I do that, my patients, their families and the public at large will be able to trust my advice.
Take good care,
Robin L. Brey, M.D.