Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Conflicts of Interest Disclosure: A Proclamation of Greed or Reward? Does America have it backwards?May 3, 2009 16:42 EDT
Current U.S. Definition of Reward: 25-30 million dollar contract for one year of play for the Chicago Bulls in 1996 provided by Michael Jordan for his “expert” athleticism.
Current U.S. Definition of Greed: Dr. X provides endless hours of consultation for device development with SinTronic and brings “expert” new V-fib prevention technology to the US in the year 2100, receiving 3.2 million in personal profit over 5 years.
Debate: Michael Jordan doesn’t influence what you put into your body “for profit” whereas the actions of physicians can directly result in increased utilization of devices and compounds for human consumption.
Counterpoint: Image of Michael Jordan guzzling a huge bottle of ice cold Gatorade, smiling and refreshed, beads of enthusiasm dripping from his forehead. Millions of young athletes subsequently refresh themselves to the tune of a billion dollar profit margin.
So is COI disclosure a proclamation of Greed or Reward? Is it the lay public that is more interested in this debate or fellow physicians who are truly concerned about the preservation of honesty and integrity among the members of our sacred society? Are some of the seemingly concerned physicians and scientists driven by the green-eyed monster or just driven period? I’d say it’s a little or a lot of all of these issues.
Firstly, we have to toss around the term Greed a bit, and don’t get me wrong, I do believe that greed potentially exists in every area of profiting , but I think we should be very careful about how we define it. We also must admit that sometimes we can’t tell the difference between Greed and Reward. Now for the most difficult pill to swallow; sometimes, except in matters of conscience, it really won’t matter what motivates us as long as the results are beneficial to the masses.
To further complicate matters, greed is not concrete. You cannot touch it or see it, but like the wind, it can well up suddenly from no where. The noise of greed can be as quiet and unnoticed as the rustling of leaves, or as deafening as the sound of a roaring freight train screaming out from the eye of a tornado. Greed can be as subtle as demanding payment “up- front” from an impoverished but ailing patient with no other options, or it can be as obvious as the physician who takes payment to promote a device that he knows could be harmful but didn’t admit it. Greed unfortunately is not confined to the board room. It is sometimes found in the exam room, so we must be very careful toward whom we are pointing our finger. The pay scale may be different, but the motivation is always the same.
Since Greed is abstract, we cannot put our arms around it, but still we admit that we are intrigued at the possibility of being able to harness it for good. Like the product of giant hillside wind farms where turbines turn slowly, methodically, even eerily capturing what we cannot see but transforming an invisible destructor into enough energy to drive a nation, greed could be put to similar good use. For instance, a “greedy” but brilliant physician has an innovative idea that could save millions of lives and provide unimaginable reduction in suffering over a 100 year period. I don’t think many would argue that he should be paid for the idea. However, should he hold off on publishing his idea until it can be sold to the highest bidder while thousands suffer? Can he speak about it on the lecture circuit? Can he implement it? Can he hold stock in its company?
By the most current and widely accepted definition, it could be said that “greed” has infiltrated the every day practice of medicine, the inner sanctum that previously held only the promise of healing, comfort and longevity. However, thanks to “greed”, the practice of medicine holds the promise of health for those subject to it and wealth for many who enter into it, at least on a relative and materialistic scale. But is one man’s greed another man’s simple prosperity? Am I not wealthy if I have three square meals while citizens of 3rd world countries lay dying of hunger? Just as wealth is relative, so is the term “greed”.
Before any of us sanctimoniously rend our clothing, declaring our complete immunity from any tendency toward today’s definition of “greediness”, consider this: Gone are the days when physicians would provide medical care or advice in exchange for a hen, a warm meal or a service. The culture of care- giving and advice- giving has become a commodity and the change in this culture has been rapid, unimpeded, embraced and even promoted in America. In most instances, viewing medicine as a commodity has not been a bad thing. The promise of a comfortable life style for our families despite a life of complete and utter chaos on a daily basis attracts highly motivated, intelligent and dedicated individuals to its ranks. It has produced advances in medicine that would have never occurred if we were still receiving a mere dozen eggs for our innovations. Throughout our culture, humans have died from the lack of innovation and consequently, as scientists, we are now handsomely rewarded for it. We SHOULD be rewarded but there should be regulations, stipulations, and checks and balances put into place so that some of us don’t go too far and fall prey to the “enough is never enough” mentality.
I’ve tried to wrap my head around any meaningful suggestion that might help untangle greed from reward. I’ve gone back and forth a million times. I’ve even sworn off any remuneration from pharmaceutical companies years ago, but like other physicians, I’ve continued to speak for them because I believe in their products and I like to furnish and receive assistance from my fellow physicians by sharing what I know and implementing what I learn. For me, it’s been a personal choice, but it shouldn’t have to be universal.
I’ve finally come to the following conclusion: Just as American as apple pie, the idea should hold that the person with the best ideas and the hardest work should be rewarded the most. We should not stifle creativity and innovation in the name of propriety. A marriage of the Physician Payment Sunshine Act of 2009 to the Rob Califf idea of a publicized and accessible website where physicians are “outed” with regard to company ties is the ideal. This marriage demands much needed stipulation and regulation, provides the opportunity for investigation and tracking as well as the much needed requirement of publication of industry ties.
Finally, in accepting that greed is an abstract entity ,we also must accept that we cannot legislate it out of existence. It’s an attitude, a feeling, a desire and for some, a blueprint for our obsessions. Maybe some of us harbor it and some do not, or maybe all of us possess it within the far reaches of our own dark DNA. Some of us are governed by a moral compass that would never let us profit at the expense of human safety and others become lost in it forever, taking blood money and never looking back .
To most that benefit from the technologies whose birthing places can either be named “Greed” or “Reward”, it will not really matter. Let progress continue under the watchful eye of government regulators and give all of humanity a front seat to monitor who is doing what, and then in the end, as with all things, let God sort it out.