NYT and WaPo discuss medical-financial conflicts of interest

Medicine has become so replete with financial conflicts of interest, it becomes very hard to sort out what the ethical standards are these days.

Yesterday, the NY Times told us that the AMA put out a warning to doctors that doctors' primary responsibility is to the patient and not to their employer.  In other words, they should not necessarily use their employer's network of specialists, labs and radiology services if these are not the best for the patient.

"With hospitals buying up medical practices around the country and seeking to make the most of their investment, the American Medical Association reached out to doctors this week to remind them that patient welfare must always come first and not be overridden by the economic interests of hospitals that now employ doctors in ever-growing numbers. 

“In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority,” says a policy statement adopted by the association. 

“A physician’s paramount responsibility is to his or her patients,” the association said. At the same time, it added, a doctor “owes a duty of loyalty to his or her employer,” and “this divided loyalty can create conflicts of interest, such as financial incentives to over- or under-treat patients...”

Sounds good, but whether or not they were formally told what to do, every employed doctor knows who is and who is not in their acceptable referral network.  They know who the competition is and where not to send patients.  We need a lot more clarity than what the AMA provides.  Are we supposed to use the prescribed network unless we think it will kill the patient?  Where is the line being drawn?  And what did anyone expect when government incentives led hospitals to expand and buy up doctors' practices?

Yesterday's Washington Post notes that the American Psychiatric Association (APA) used to say that distress due to bereavement should not be diagnosed as major depression.  But an Association committee of 11 members (8 of whom had financial conflicts) voted to change that this month, paving the way for more antidepressant prescribing.  However,

The change in the handbook, which could have significant financial implications for the $10 billion U.S. antidepressant market, was developed in large part by people affiliated with the pharmaceutical industry, an examination of financial disclosures shows. 

The association itself depends in part on industry funding, and the majority of experts on the committee that drafted the new diagnostic guideline have either received research grants from the drug companies, held stock in them, or served them as speakers or consultants...

The financial ties between the creators of the APA handbook and the industry far exceed limits recommended in 2009 by the Institute of Medicine, a branch of the National Academy of Sciences. 

[So the Institute of Medicine has one set of standards and the American Psychiatric Association a very different standard.]

The IOM limits reflect the fear that patient health could be compromised when diagnostic and treatment guidelines, which are widely used by doctors, are written largely by industry-hired experts and issued by medical societies that depend on industry funding... 

Yet APA committee chair Jan Fawcett, who handpicked the other committee members, has a different take on things.  According to the WaPo, "He likened the financial restrictions to 'a financial colonoscopy,'” and "He was skeptical of efforts to reduce the financial ties to industry.

“It has gotten to be a witch hunt,” Fawcett said.