South Florida Hospital News
Sunday May 26, 2019
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April 2008 - Volume 4 - Issue 10

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Healthcare Consulting and the Conflict of Interest Conundrum

Perhaps nowhere in the medical profession is the advice of "opinion leaders" more heavily sought after than amongst those engaged in leading-edge research. In fact, these very researchers may become involved in industry-sponsored studies in which particular companies may have a vested interest.

Here is the crux of the problem. I am a manufacturer of some medically-related product—perhaps a certain line of medications or devices. In order to make intelligent decisions, I need good information. I need to understand the medical problem I might potentially seek to address—its physiology and pathology; its clinical manifestations and prevalence. Is this a problem that has been well-addressed up to this point by the medical profession or not? Is there a real opportunity to make a significant contribution to patient care or not? Of course, the business correlate of these questions boils down to, is there a profit to be made here or not? Fortunately, to a certain extent, there is somewhat of an alignment of medical and business objectives. If a given product addresses an unmet and common need—such as the introduction of stents for coronary revascularization or the introduction of statins for hyperlipidemia—and it does it very safely and effectively, there is a good chance that a significant profit can be made. On the other hand, this profit incentive leaves less common and more complex medial issues as "orphan" issues, without a ready proponent or sponsor.

In any event, the question for the manufacturer then becomes how it obtains this information. Hopefully, the extent and subtlety of the information required extends well beyond what even the vigorous scouring of the literature can produce. At its very best, the literature tends only to publish successes, not failures, and runs a few years behind current available knowledge. What are needed are the keen insights of those most well-informed and experienced in the particular field of interest. Where would a wise person search for such information other than in the leading universities and research centers? Are we to expect that these very busy and highly-trained individuals give their precious time without compensation? And once they become "paid consultants" for such-and-such company, is their opinion now necessarily muddied by conflict of interest? Should they decide to pursue a given issue with a study funded by a manufacturer, is the information generated now so tainted by conflict of interest that we cannot learn anything?

On the other hand, it should certainly seem obvious that the questions being asked by industry, although perhaps medically valid, and even perhaps scientifically instructive, are nonetheless inevitably tied at some point to the bottom line. Issues that might prove to be very scientifically rewarding may not even be addressed. With nearly 80% of the clinical research in this country being funded by industry, we must wonder if we are even asking the right questions.

The solution. Yes, it would indeed be very nice if there were more institutions like the Florida Heart Research Institute which is completely independent and dedicated to research, education and prevention on a purely scientific basis. But the realities of our market-driven economy and its impact on medical information are not likely to change significantly in the near future. In fact, as money gets tighter, the ties between science and industry are likely to grow stronger, not weaker. In this environment, it seems to make little sense to insist on a level of "purity" which disregards reality. Rather, the key is full disclosure, by both professionals and institutions, regarding the relationships that do exist. This information can then be entered into the complex equation of evaluating medical research. No simple solutions, just level-headed and sober analysis of the information available. Ultimately, that is all we can ask of any research endeavor.

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or pak@floridaheart.org.
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