I recently traveled from San Francisco to Boston for a meeting about new developments in HIV treatment and prevention—and I found myself confronting a delicate ethical dilemma. The community-based healthcare center that organized the gathering was covering the costs through a grant from a major producer of HIV medication. For the out-of-town participants, that included airfare and a room at a nearby hotel.
I’m both a journalist and a public health professional, and I toggle frequently between the two. Operating in journalism mode, I turned down the pharma money and paid my own way ($358 roundtrip on JetBlue; I crashed in the guest room at my sister’s place).
I have written extensively about HIV for mainstream news organizations and had recently interviewed an executive from the drug company paying for the meeting. Would taking the funding, even indirectly through the community health center, have made me deliberately slant an article in favor of the company? Of course not.
But would it have influenced me in some more subtle way, just because I’m human? Perhaps. And taking the money would have left me open to legitimate criticism of having a serious conflict-of-interest—especially if any article I subsequently wrote appeared to promote the use of the company’s drug for HIV prevention or treatment.
I mentioned my decision to turn down the funding to a colleague, who is both a doctor and public health expert. He chuckled and expressed surprise. “I probably wouldn’t have thought about it,” he said ruefully.
Now it’s true that, absent the funding from the drug company, the informative discussions that took place over two days in Boston would not have occurred, or at least many of those attending from non-profit organizations would not have been able to participate. So the drug company funding, in that sense, definitely helped spark community dialogue.
And it’s not that journalists are so pure. Many, of course, have their own conflicts-of-interest. News organizations, whether old or new, are not flush with cash these days and are constantly seeking ways to trim costs—often cutting ethical corners in the process. But in theory if not always in practice, accepting major gifts (and airfare-plus-nice-hotel counts) from those you’re covering crosses a big red journalism line.
Not so in the medical field. The extensive web of financial ties between drug companies and other industry groups, doctors, academic researchers and medical institutions has for decades remained largely hidden from public view. In recent years, public and political pressure toward greater transparency has led to far more disclosure of conflicts of interest in the medical profession, and in particular the large consulting fees, free trips and other goodies that drug companies sprinkle among physicians in a position to prescribe their products.
For their part, peer-reviewed medical and public health journals have promulgated increasingly stringent disclosure policies for authors, although how strictly they enforce the policies is a separate question. But does disclosure alone offer the reader sufficient protection from any influence the funder might try to wield? In academic publishing, the answer is considered to be “yes.” In a non-academic publication, such sponsored material would simply be called advertising.
Despite a wealth of studies raising concerns about such financial ties, many doctors and researchers do not feel themselves implicated by having a drug company pay their way to a meeting. Last year, in an article called “Effect of Financial Relationships on the Behaviors of Health Care Professionals” in the Journal of Law, Medicine and Ethics, three Harvard scholars reviewed the body of research. The available evidence shows that financial relationships clearly bias physician decision-making, they wrote, and “should go some distance to dispelling the sense of denial that continues to infect the thinking of physicians.”
That last bit—about dispelling physicians’ “sense of denial”—sounds like wishful thinking to me. So until that happens, patients themselves can play their own part in pushing for greater disclosure.
Although most patients might feel uncomfortable asking their doctors if they receive financial compensation or free goods from pharmaceutical companies, medical-device makers or other commercial interests, they have a right to know whether their treatment could possibly be influenced by non-medical considerations. Patients can also ask, for example, which drug sales reps, if any, drop off free samples as well as branded mugs, pens and notepads.
Such direct questions, in fact, might do more to dispel that widespread “sense of denial” among physicians than further research.