He may not have been breathing fire and brimstone, but industry collaboration advocate and director of the Division of Translational Medicine at Brigham and Women’s Hospital, Boston; and Harvard Medical School Professor Thomas Stossel, MD, gave what amounted to a secular sermon on the benefits of commercial investment in healthcare at the 15th Annual Global Alliance for Medical Education Meeting in June. His central question: “Is commercialization a good thing or not (with ‘good’ being an increase in longevity and quality of life)?”
Stossel ran down a list of healthcare-related innovations that have come down the pike in the past 30 years with the help of commercial interests, from ACE inhibitors to statins and portable defibrillators. Compare that, he said, to the evidence that commercial collaboration corrupts the system. You’ll find it to be “the most impressive case of the emperor’s clothes in recent history,” he told the 140 attendees who came from around the globe to the Montréal conference. Many of the allegations of corrupt practices are not evidence-based, he said, because companies settled rather than face the possibility of being debarred from doing business with the government—the claims weren’t proven.
Stossel said he believes that the term conflict of interest is meaningless, because interests are never perfectly aligned except “in an anthill.” Charges of COI, however, have resulted in what he called the “toxic policies” of organizations including the Accreditation Council for CME, the American Association of Medical Colleges, and the Institute of Medicine. Their policies are toxic because they entail “a massive confession of all connections with industry, the inhibition of freedom of speech, the inhibition of the freedom to associate, and the inhibition of the freedom to be rewarded for excellence.” The costs of these regulations, he said, are impaired risk-taking, investment, and innovation; less and less diversified training and education; the empowerment of secondhand expertise for education; and a wasteful diversion of time and resources to disclosure and compliance instead of education.
“We somehow have come to the idea that doctors should be educated in a monastery wearing hair shirts that they pay for themselves,” he quipped. And industry is shooting itself in the foot by putting out “lame ethics exercises” such as the PhRMA and AdvaMed codes on interactions with healthcare providers, and by “outing” MDs on Web sites for taking pharma money. He added, “We need to fight the perception that only those who are ‘untainted’ can provide quality education. Those who are the best and brightest get the most support from industry.” Ultimately, he concluded, it’s about patient care, and the rewards of industry collaboration improving it far outweigh any potential risks.