Friday, May 06, 2011

Conflict of interest in medicine: negative consequences of the inquisition

An opinion piece in Nature Medicine by Thomas Stossel and Lance Stell deals with the mounting public pressure and increasingly burdensome regulations against the medical profession's interaction with industry. They argue that the movement has gone too far and its proponents have no evidence to back up their claims. I don't have access to the full text but Thomas Sullivan parses it pretty well in a recent blog post. Concerning the lack of evidence he cites from the article thus:


Drs. Stell and Stossel assert that, “insinuations of corruption by those who call for increased oversight and regulation of the interaction between academia and industry require quantitative evidence—for a start, providing a denominator as well as a numerator.”...
While many critics can easily compose the numerator by mentioning “the same cases alleging corruption due to industry influence, many laced with hindsight wisdom, dredged up repeatedly and assembled into a narrative framework,” a denominator is almost always missing. In fact, “the storytelling suffers from serious ‘denominator neglect’—the non-nefarious, noncorrupt, beneficial collaborations, over decades that dwarf the comparatively few cases that populate the numerator.”
As the authors point out, “when attending to the numerator, the misconduct rate is negligible. The numerator of supposedly substantive adverse outcomes due to industry relationships (excluding relationship disclosure lapses discussed below) barely adds up to two digits. Surveys reporting that over 90% of physicians have some type of financial interaction with industry, with 18% of them engaged in consulting arrangements, indicate that the denominator is orders of magnitude greater.”


In the words of the authors the inquisitors' judgments lack “quantitative rigor.”

1 comment:

The Notwithstanding Blog said...

What bothers me the most about this issue is the holier-than-thou attitude that's pervasive in many academic centres; they assume that by virtue of being in academia, they can do no wrong, and that their intrinsic moral superiority can only be saved by avoiding "dirty" industry contact.

At least that's the attitude where I am. Galling.