Wisconsin Medical Journal, March 1976: Vol. 75
Guest Editorial

A CONFLICT OF INTEREST

By Ann McCampbell
Sophomore Medical Student
Medical College of Wisconsin, Milwaukee

 
SEVERAL MONTHS ago, I read excerpts from the AMA president’s refutation of criticism that a conflict of interest existed concerning the AMA investing its retirement fund in a drug company.  He claimed that since physicians prescribe drugs by their generic names, the patient can purchase drugs from any company, i.e., is not restricted to buying from the company in which physicians may have an economic interest.  Therefore, the president claimed, physicians cannot push their own products, and hence, there is no conflict of interest.

Admittedly, according to the commonly accepted definition of the term, “conflict of interest,” he is right – physicians have no opportunity to compromise the care of patients by prescribing a drug from which they may profit.  However, I contend there exists a broader “conflict of interest” which does compromise health care and that it exists regardless of which company’s product a patient buys.  The conflict arises because the AMA (and the medical profession in general) has invested in one particular mode of therapy: pharmaceuticals.  This must bias physicians’ decisions regarding methods of treatment, and thereby must influence the quality of health care.

Most likely the everyday bias towards drug therapy does not represent a very great evil because in most cases it is probably the best therapy available.  But this is precisely the point; drugs are often the best therapy because it is the only therapy.  For example, alternatives such as dietary manipulation and psychological counseling – not to mention the entire area of preventive medicine – are (relative to drug therapy) under-used, under-understood, and under-explored.  Furthermore, I doubt that significant strides will be taken towards developing such alternatives while the overwhelming economic and psychological ties exist between the medical profession and drug companies.  I think that this unwillingness to explore new ideas (witness the hostile reaction of the Western world to acupuncture) is the real evil and at least in part is derived from the existence of a conflict of interest.

I used the AMA investment in drug companies as an example of how economic dependency reinforces the medical profession’s bias toward drug therapy, but there exists other situations where the influence is less economic and more psychological, although the results are similar.  One instance is the massive drug advertising in medical journals.  There is obviously an economic bond here, but the psychological influence of the advertising is more subtle.  Many physicians, I am sure, feel that they are not biased by advertising and can maintain their objectivity in being able to pick one drug over another.  But often they do not realize the extent to which they are succumbing to the overwhelming impact of drug advertising, and its message that some drug, rather than perhaps another therapy, will solve the stated problem.

A similar situation exists with regard to the promotional activities of drug companies towards medical students, and this relationship is primarily psychological.  The companies try to promote warm relations with the future physicians by giving them gifts; the students accept them thinking that they can see through the “game” and claim they will maintain their objectivity regarding drugs and their manufacturers.  Again, I contend that ultimately the drug companies will realize their goal because, like it or not, the students have had a positive experience with the companies and to some extent will feel more positively disposed towards them and their products.

It is generally accepted that drugs are overused, misused, and abused; yet, alternative therapies are only slowly being explored.  Clearly, the drug companies will not do or support such research.  The medical profession, on the other hand, is being seduced away from such pursuits by economic and psychological indebtedness to the drug companies.  I can only hope that a new awareness will arise in the medical profession and that there will be a realization of the bias towards drug therapy and how it deters from true objectivity in medicine.  Hopefully then the AMA and medical practitioners in general will seek to avoid the conflict of interest by extricating themselves from their present over-involvement with drug companies.