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?
“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 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 cancer therapies there are many safeguards:
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The standard of care, which is based
on evidence-based clinical research:
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Evidence from controlled clinical
trials assessed independently (not by the drug company).
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Outcomes that have been reproduced by independent groups.
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High ethical standards and
training within the medical profession |
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The peer review system
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Institutional Review Board (IRB)
oversight of clinical trials |
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FDA oversight of clinical trials
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When is conflict of interest most likely to become a factor in
medical advice?
When there is no standard of care, particularly in a close call
it (no clear best decision), we may expect even expert
recommendations to sometimes default to what is more profitable in individual
cases.
Such as:
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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) |
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Do the test
(if the consulted provider
owns and interest in the imaging company) |
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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 can be unconsciously influenced by financial
interest. |
How do we protect against conflict of interest in medical
decisions?
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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) |
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Do your homework in order to ask
informed questions.
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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
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