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Advocacy > Conflict of Interest in Medical Decision Making

Last update: 04/05/2013

TOPICS:
Conflict of Interest in Medical Decision-making | Related Articles
When is conflict of interest most likely to become a factor in medical advice?

What is a conflict of interest?

Excerpt from "The Dirt on Coming Clean:

“Conflicts of interest occur when individuals’ professional responsibilities diverge from their personal interests (or when different professional responsibilities clash).

Attorneys often face conflicts of interest when they advise clients on whether to pursue legal action.

Doctors face conflicts of interest when they advise patients on whether to get procedures that they will profit from performing.

Stock analysts face conflicts of interest when they are in a position to benefit financially from promoting a stock on which they are supposed to provide an impartial evaluation.”

Is biased advice from professionals often intentional?

“While most people think conflicts of interest are a problem of overt corruption, that is, that professionals consciously and intentionally misrepresent the advice they give so as to secure personal gain, considerable research suggests that bias is more frequently the result of motivational processes that are unintentional and unconscious." 

Source: The Dirt on Coming Clean:
The Perverse Effects of Disclosing Conflict of Interest cbdr.cmu.edu/ 


Conflict of Interest in Medical Decision-Making

What are the safeguards against unintentional biased advice?

For medical therapies there are many safeguards:

bullet

Best practice is typically based on clinical research:

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From evidence from controlled clinical trials assessed independently
(not provided exclusively by the drug company).

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From the outcomes of trials that have been reproduced by independent groups.

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The high ethical standards and training within the medical profession

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The peer review system

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The use of scientific methods and standards, such as prospective study design and randomized controls
to minimize the impact of reporting bias and patient selection bias.

A prospective design predefines the number of patients that will take part in the study.

Randomized selection of participants to the compared therapies ensures that the participants in the two study arms have similar risk factors.

The key standard for medical evidence is reproducibility - that other independent scientists achieve similar results when the therapy is tested in a similar population.

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Institutional Review Board (IRB) oversight of clinical trials

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FDA oversight of clinical trial design and the rigorous review of data for drugs that are submitted by the sponsor for marketing approval.
 

When is conflict of interest most likely to become a factor in medical advice?

When there is no standard of care or proven best practice  ... we may expect even expert recommendations to more commonly favor what is more profitable (self referral).

Such as:

bullet

Do not do that trial (if the consulted provider is not the investigator of the trial)

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Do the trial
(if the consulted provider is the investigator or owner of the idea)

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Do the test
(if the provider owns an interest in the imaging company, or the provider doesn't want to be found negligent - even if the test is unlikely to be informative)

bullet

Do maintenance therapy
(if the consulted provider administers it)

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Does not discuss Radioimmunotherapy
(if the consulted provider does not administer it)

Again, NONE of the above examples are unethical when there is no standard of care,
but the opinions we receive can be unconsciously influenced by financial interest.

How do we protect against conflict of interest in medical decisions?

bullet

Seek multiple opinions and ask also for rationales and supporting evidence
(do all your providers agree and why not?)

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Seek opinions from non-treating, independent experts
(who will not be involved in administration of therapy)

bullet

Do our homework in order to ask informed questions.
 


Related Articles and Resources

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Conflict of Interest commentary - hmohardball.com 

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The Dirt on Coming Clean: The Perverse Effects of Disclosing Conflict of Interest cbdr.cmu.edu/  

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Evaluating Medical Claims and Data - PAL

 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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