Abstain, disclose, or step aside? The answers can be as complicated as
the ethical questions they address.
COLUMBIA, 7/11/11 (Beat Byte) -- The old practice of
taking pens and coffee mugs from pharmaceutical sales representatives
has disappeared from many clinics, as physicians worry about the appearance of
impropriety -- taking gifts, no matter how simple, in exchange for prescribing
certain medications. Ethical
concerns are driving a nationwide
debate about the need for full disclosure anytime drug companies
fund or otherwise support research in human medicine.
Animal doctors are taking
note.
"Dr. George Glanzberg, like many veterinarians, reads human as well as
veterinary medical literature," reported a January 2010 Veterinary
Information News Service story, Scrutiny
emerges concerning conflicts of interest in veterinary
literature. "Glanzberg, a small-animal practitioner in
Vermont, surmises that if unreported conflicts are of concern in human medical
literature, they're likely to be a problem in veterinary literature as well,
even if the stakes are not as high."
Disclosure and avoidance
Although the Nathan Voris-Pfizer issue (see Pharma Fright) involves
policy-making rather than research, "there is indeed potential for a conflict of
interest," said Lisa Cosgrove, Ph.D., a fellow at the Edmond J. Safra Center for Ethics
at Harvard University whose research on conflicts of interest has
been cited and discussed in The New York Times, Washington
Post, USA Today, U.S News and World Report, New
Scientist, the Boston Globe, NPR, and the BBC.
Citing a 1993
definition in the New England Journal of Medicine, a conflict of
interest is a set of conditions in which professional judgment could be unduly
influenced by a secondary interest, such as financial gain, said Cosgrove -- who
authored a recent article for the American Association of University Professors
about Big
Pharma's role in psychiatric research.
"Conflict-of-interest rules, informal and formal, regulate the disclosure
and avoidance of these conditions," Cosgrove told the Heart Beat.
Though Voris is almost certainly not directly benefitting from the new cat
testing mandates -- he's an equine, or horse medicine specialist -- full
disclosure, as a Board of Health director making legally-enforceable,
community-wide animal care policy, serves transparency, explained animal health
journalist and San Francisco Chronicle pet columnist Christie
Keith.
"Any legislator should disclose his or her own conflicts, potential or
actual, financial or simply relationship-based," said Keith, who recently explored
Big Pharma-driven conflicts of interest in veterinary medicine and
veterinarian
trustworthiness. "Conflicts of interest should be disclosed in all
areas of legislation, including human or veterinary medicine, landlord/tenant
law, or the zoning of the local ice cream store," she told the Heart Beat.
An offer from Voris to step out of Board deliberations and votes on the new
feral cat ordinance would have been an "antidote" to the potential conflict of
interest issue, veterinarian Paul Pion explained. At this point, however, "if
Dr. Voris believes in the feral cat program – and moreso if Pfizer believes
in it, and isn't looking to profit from it – then I suggest they agree to either
not participate in the sale of any of the supplies for it, or they should donate
them," Pion told the Heart Beat.
Sunshine complexity
Often-discussed elements of the Missouri Sunshine Law, transparency and
disclosure are important -- but also complicated. It's never a given that
potential conflicts will be disclosed, and blaming people for lack of disclosure
isn't always fair. For instance, Nathan Voris makes no secret of his
employment with Pfizer. It appears on at least one version of his
blog, and on Linked
In.
But his employment came part way into his term on the Board of Health, and
midway into the feral cat debate. Should he have disclosed it officially and
publicly at the time, then stepped aside, or at least, out of Board votes and
ordinance deliberations?
SNAP board member Christina McCullen thinks so. "We expect judges,
physicians and attorneys to recuse themselves in similar legal matters,"
she said. "Why is he exempt from these accepted practices?"
Other experts say the answer can depend on complex considerations and
individual understanding.
"The problem is not getting people to agree that transparency and
disclosure are important; it's getting them to understand the pervasive nature
of influence," Christie Keith said.
Most colleagues, Paul Pion told the Heart Beat, "do not intend to
deceive or let their bias affect their judgment. But time and again,
studies show that, while we all think we are immune, we are all subject to these
biases."
Biases in favor of potential pocketbook interests can be so powerful that
often, "transparency is not enough," Harvard's Cosgrove said. This March, she
explained, the National Academy of Sciences Institute of Medicine issued a report
stating that industry-affiliated individuals should not be creating treatment
guidelines -- period -- regardless of how much they disclose their industry
relationships.
"Everyone says they are against conflicts of interest going undisclosed,"
the Chronicle's Keith explained. "The problem is everyone defines
'conflict of interest' differently, and very often, believes they are not being
influenced by their relationships, nor even by who signs their paychecks."
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