Conflict of interest concerns misdirected: JAMA report

Another of the articles in JAMA’s theme issue on COI makes a case that the focus of concern has been wrong:

Much current research and debate involving conflicts of interest in medicine focus on the appropriate level of physician interaction with firms in industries related to health care, such as pharmaceutical and medical device companies. The influential article by Brennan et al1 that led academic medical centers to take the lead in tackling problems caused by conflicts of interest focused almost exclusively on interactions between physicians and pharmaceutical companies. The 2009 Institute of Medicine report Conflict of Interest in Medical Research, Education, and Practice also limited its coverage of conflicts to interactions between physicians and pharmaceutical, medical device, and biotechnology companies. The American Medical Student Association “scorecard” grades conflict of interest policies at medical schools purely on the basis of how they regulate physician-industry relations.

Although these interactions may influence physicians in ways unrelated or even detrimental to patient care, only a small percentage of physicians have substantial financial relationships with pharmaceutical or device companies.2 In contrast, every physician is paid for providing patient-directed services via a system set by the physician’s practice group and supported by insurers, government, individuals, and others who reimburse for care. While a minority of physicians receive direct payments from industry, the average primary care physician sees roughly 2000 patients per year who are, directly and via insurance, billed an average of $5000…

The nearly singular emphasis on physician-industry relationships has been way out of proportion, a point I have been making for years on this blog and in other forums.