We have previously written about financial conflicts of interest and whether physicians can disseminate impartial scientific information if they have a conflict of interest, or if the conflict of interest negates anything the physician (or other medical professional) says. With the introduction of Open Payments and other copy-cat systems around the world, this idea continues to get more dangerous as days go on.
In February 2018, the Baltimore Sun published an article by a family physician who drew pause at the fact that the new blood pressure guidelines published by the American College of Cardiology and the American Heart Association were authored by a handful of physicians who had financial relationships with corporations that were not disclosed in the publication. He noted that the financial relationships the author-physicians held with the for-profit companies made him doubt the new guideline, as it recommends broader diagnosis and treatment of hypertension, which he believes will benefit the corporations.
He cited several of the authors and their links to companies that may stand to profit from increased prescribing of medications. However, as he also notes, the guideline was not written just by those physicians with a “conflict of interest,” as it was “developed over a 3-year period by a multidisciplinary team, including 2 lay participants, all of whom had no relationships with industry involving diagnosis or treatment of hypertension.”
Milton Packer, MD, more or less responded to these concerns in a blog post on MedPageToday, noting that Dr. Romano’s concerns and attack may have had good intentions, but was ill-informed. He noted that Dr. Romano “assumed that these 4-year-old relationships (regardless of the amounts or purposes) led the members of the guideline committee to dramatically widen the use of antihypertensive drugs, simply to promote the profits of the pharmaceutical companies that had previously funded them.”
Dr. Packer notes that the Open Payments website uses certain definitions on which to base the inclusion of information and only “reports the date when payments were made, which may not correspond to the dates that the relationship took place.” He further notes that payments may be delayed by years or months after a contract is completed.
Dr. Packer also mentioned the cost of most antihypertensive drugs these days – noting that they tend to be “generic and very inexpensive” and that hypertension is not a “source of revenue growth nor an area of innovation.”
Then, Dr. Packer gets into an interesting argument about how long financial conflicts of interest should be considered “valid.” He mentions the incredulity that any prior financial interaction – regardless of amount, purpose, or time period – could disqualify a very qualified person from giving advice on a particular topic. He believes that such a move would actually hurt the ability to receive solid advice because those giving it would not actually know what the real world is like – they would not have had the opportunity to interact with the world and understand its limitations. He mentions an argument that we have made before,
I certainly do not want to hear people analyze trials that have been supported by industry if they have never been involved in an industry-supported trial. How would they ever know what they are talking about?
He then closes his article by making a statement that “Trust should be based on the integrity of individuals, not on their ability to pass some arbitrary test of ‘purity.’” Transparency and conflicts of interest likely to continue to receive scrutiny, but placing your trust in someone should depend on their integrity and personal experiences, not necessarily on whether they have accepted money on behalf of a particular organization.