Can a doctor’s prescription be bought for a tuna sandwich?
Whether it’s a tuna sandwich, steak dinner or a four-figure payment, there’s always the possibility of influence. And that’s how conflicts of interest begin in the medical field.
That was the message this morning from reporters Peter Whoriskey of The Washington Post and John Fauber of the Milwaukee Journal Sentinel during their panel on reporting on medical and financial conflicts of interest during AHCJ’s Health Journalism 2013 in Boston.
“Their job is to sell as much product as they can and maximize profits,” Fauber said of the pharmaceutical companies. “One of the ways they do that is by creating financial relationships with various stakeholders, which can be doctors, medical societies or medical schools. While this may be good for the bottom line of the drug companies, it may not work out for the patients.”
Fauber advised journalists to be on the watch for several things: promotional speaking gigs by physicians; participation in continuing medical education (CME) events; financial relationships between medical journal editors and drug companies; and royalties that come back to hospitals and physicians.
“It struck me very quickly that all the cynicism the media brings to politicians or companies, anybody, is held in abeyance for doctors and anybody that wants to heal you,” Fauber said.
Before setting out to investigate such relationships, the Post’s Whoriskey said reporters should first determine what exactly bias is and how it gets created.
“For a reader, I want to provide them with more than a tuna sandwich for bias,” he said.
So identifying bias, he said, simply isn’t a black and white issue. Most people don’t start out thinking they’re actually going to be biased in the first place, especially by something like a pen, pencil or a sandwich.
“I didn’t find what I would call ‘great evil’ or that as a system it created great evil, but you have people all the time throughout the system that are just slightly twisted off the track,” he said.
And that, unfortunately is the problem, according to panelist Dr. Adrienne Fugh-Berman of Georgetown University and director of PharmedOut, said things like tuna sandwiches, or free pens for physicians, can actually do more harm than a large financial payment.
“No one wants to think of themselves as being bought off by something small,” Fugh-Berman said. “Nobody likes to think of themselves as being bought out for $5, so you change your thinking.”
The issue runs deep into the medical industry such as ghostwritten medical articles as well as sparse financial disclosures on studies that promote off-label drug prescribing.
Fugh-Berman and Harvard Medical School’s Dr. Jerry Avorn both pointed to resources online developed by medical watchdog groups like PharmedOut, and online databases PCORI and rxfacts.org and disclosures about physician payments made possible by the Sunshine Act. Both pointed to the importance of including information about physician conflicts of interest in published stories both online and in print, and about finding independent epidemiologists and other experts.
But Avorn also reminded the group that not all physicians are out to do harm, and not to discount any study or report funded by the pharmaceutical industry.
“We are at risk of not believing anything even when it is valid,” Avorn said. “My work has been on can we wrest back from industry some control for patients on the part of doctors, and how can we transmit information that is not about spin or product placement or sales.”
“I think we have to worry less about the people who are willing to sell their opinion for money, and need to pay attention to the subconscious, unintentional bias it brings to our stories,” she said. “That has more of an effect than people taking cash for opinions.”