conflict of interest in the healthcare industry

Conflict of interest in the health care industry occurs when the primary goal of protecting and increasing the health of patients comes into conflict with any other secondary goal, especially personal gain to healthcare professionals, and increasing revenue to a healthcare organization from selling health care products and services. The public and private sectors of the medical-industrial complex have various conflicts of interest which are specific to these entities.

Trends

There is a lack of empirical evidence to describe the impact of conflict of interest in the health care industry.{{cite journal|last1=Malina|first1=Debra|last2=Rosenbaum|first2=Lisa|title=Understanding Bias — The Case for Careful Study|journal=New England Journal of Medicine|volume=372|issue=20|year=2015|pages=1959–1963|issn=0028-4793|doi=10.1056/NEJMms1502497|pmid=25970055|doi-access=free}}

Business interests influence the direction of cancer research and the adoption of new practices in therapy.{{cite journal|last1=Friedberg|first1=M|last2=Saffran|first2=B|last3=Stinson|first3=TJ|last4=Nelson|first4=W|last5=Bennett|first5=CL|title=Evaluation of conflict of interest in economic analyses of new drugs used in oncology.|journal=JAMA|date=20 October 1999|volume=282|issue=15|pages=1453–7|pmid=10535436|doi=10.1001/jama.282.15.1453|doi-access=}}

University projects which receive industry funding are more likely to produce research outcomes which favor their funders.{{cite journal|last1=Blumenthal|first1=D|last2=Gluck|first2=M|last3=Louis|first3=KS|last4=Stoto|first4=MA|last5=Wise|first5=D|title=University-industry research relationships in biotechnology: implications for the university.|journal=Science|date=13 June 1986|volume=232|issue=4756|pages=1361–6|pmid=3715452|doi=10.1126/science.3715452|bibcode=1986Sci...232.1361B}}

A 2017 systematic review by the Cochrane Collaboration found that pharmaceutical and medical device industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship.{{cite journal|last1=Lundh|first1=A|last2=Lexchin|first2=J|last3=Mintzes|first3=B|last4=Schroll|first4=JB|last5=Bero|first5=L|title=Industry sponsorship and research outcome.|journal=The Cochrane Database of Systematic Reviews|date=16 February 2017|volume=2017|issue=2|pages=MR000033|doi=10.1002/14651858.MR000033.pub3|pmid=28207928|pmc=8132492}}

The trend toward treating clinical research as a business has coincided with a range of problems which are likely the result of business connections.{{cite journal|last1=Rettig|first1=RA|title=The industrialization of clinical research.|journal=Health Affairs|date=2000|volume=19|issue=2|pages=129–46|pmid=10718027|doi=10.1377/hlthaff.19.2.129|doi-access=free}}

Funders seek and court scientists to author papers and lend their person reputations to add credibility to research findings.{{Cite journal |last=Wilkes |first=M. S. |year=2001 |title=Sponsorship, Authorship, and Accountability |journal=New England Journal of Medicine |volume=345 |issue=11 |pages=825–827 |doi=10.1056/NEJMed010093 |issn=0028-4793 |pmc=1071574 |pmid=11577056}}

Physicians in general practice also face potential conflicts of interest.{{cite journal |last1=Palmer |first1=N. |last2=Braunack-Mayer |first2=A. |last3=Rogers |first3=W. |last4=Provis |first4=C. |last5=Cullity |first5=G. |title=Conflicts of interest in divisions of general practice |journal=Journal of Medical Ethics |date=2006 |volume=32 |issue=12 |pages=715–717 |doi=10.1136/JME.2005.014811|pmid=17145912 |pmc=2563353 }} For example, the Physician Payments Sunshine Act of 2010 requires that financial relationships of physicians and teaching hospitals with manufacturers be reported and made publicly available via the [https://openpaymentsdata.cms.gov/ Open Payments Program website].

Using this Open Payments database, it was found that about 64% of US-based physician-editors of highly cited medical journals received industry-associated payments (i.e., payments from medical drug and device companies) during a period spanning August 1, 2013 to December 31, 2016.{{cite journal|last1=Wong|first1=VSS|last2=Avalos|first2=LN|last3=Callaham|first3=ML|title=Industry payments to physician journal editors|journal=PLOS ONE|year=2019|volume=14|issue=2|page= e0211495|doi=10.1371/journal.pone.0211495|pmid=30730904|pmc=6366761|bibcode=2019PLoSO..1411495W|doi-access=free}}

Medical journals have varying requirements what should be published and people who fail to follow them face few repercussions.[https://www.nytimes.com/2018/12/08/health/medical-journals-conflicts-of-interest.html What These Medical Journals Don't Reveal: Top Doctors' Ties to Industry] The New York Times, 2018

The medical-industrial complex describes the conflict of interest present between physicians and the healthcare industry.Wohl, Stanley. The Medical Industrial Complex / Stanley Wohl. First edition. New York: Harmony Book, 1984: 85-98 Physicians who invest in medical device companies may be biased towards certain medical devices or treatments, creating a conflict of interest between doing what is best for a patient versus what is in their best financial interest.Xu, Amy L BS; Jain, Amit MD, FACS; Humbyrd, Casey Jo MD, MBE. Ethical Considerations Surrounding Surgeon Ownership of Ambulatory Surgery Centers. Journal of the American College of Surgeons: September 2022 - Volume 235 - Issue 3 - p 539-543 doi: 10.1097/XCS.0000000000000271 Conflict of interest in continuing medical education is also present, where physicians learn how to use certain medical devices during their board-certification courses that affect their patients.Relman, Arnold S. "Doctors as the Key to Health Care Reform." The New England journal of medicine. 361, no. 13 (2009): 1225–1227.

conflict of interest in the healthcare industry

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Further reading