Tales from the Task Force: Conflict of Interest Is Trickier than You Think

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J. David Haddox, DDS, MD, vice president, Health Policy, Purdue Pharma LP, was asked to be controversial in his opening keynote at the 23rd Annual Conference of the National Task Force on CME Provider/Industry Collaboration, held last week in Baltimore. I'd say he did a bang-up job of it, starting off with this doozy:

"I am human. Therefore I am biased." His own resume could be construed as hinting at his potential for bias, he said, listing everything from his current position to his being the past president of a pain-management association. "Conflicts are so pervasive—they can't be avoided," he said.

And should they be? He talked about a medical society that asked him to speak about extended release/long-acting opioid REMS at its meeting, but later rescinded the offer because it couldn’t allow a person employed at a pharmaceutical company to speak at its meeting, period. That’s how it decided to resolve any potential for conflicts of interest.

But who better to talk about it, Haddox asked? “Opioid REMS focus on brand names and specific products, and there’s intricate stuff in there that could cause errors of omission or commission. Who knows the product safety profiles best? I know my products better than the FDA does.” Perhaps industry should be the ones to review REMS CME content, he proposed as a “radical idea.”

Haddox also pointed out that it’s not just for-profits that have financial relationships, either. While nonprofits and academics often are thought to be pristine if they don’t have financial relationships with commercial interests, clinicians working in academic clinics make up to four times the median salary of physicians overall. “Just because profits are called ‘operating surpluses’ doesn’t mean you don’t need full disclosures,” he added.

And, while the lack of potentially bias-inducing financial relationships may clear someone in Accreditation Council for CME’s eyes, that doesn’t mean the person doesn’t have a bias. “It’s easy to judge financial relationships,” he said. “But what about the other types of conflicts that may exist?” For example, he said, what about a surgeon who touts a device that has his name on it? Or his friend’s name? Or the name of someone she doesn’t care for? What about those who espouse preferences for what they’ve been using for years over what the evidence shows is best? What about those who are in it for the ego boost of getting their 15 minutes of fame? What about those who are looking to boost their referrals by setting themselves up as experts?

Should the whole concept of conflicts be broken up into two buckets, one for financial and another for nonfinancial COI?

He asked a lot more questions than he answered, but it was a provocative, interesting way to kick off the meeting.

My two favorite quotes from his talk, (other than Mark Twain’s “It ain’t what you don’t know that gets you into trouble—it’s what you do know that ain’t so”):

“I contend that there is such a creature as an ethical capitalist.”

“If they see something in two patients, they call it a series. When they see it in three patients, they say, ‘I see it in patient after patient after patient.’”

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