Conflicts of Interest Among Physicians

Business Week magazine has an interesting article regarding conflicts of interest among physicians, in particular cardiologists and those who publish clinical data regarding medicines or devices. I’ve alluded to such conflicts in previous posts, but it clearly is gaining national attention, particular in the fields of cardiology and orthopedics. The issue in cardiology is that many studies regarding stents are sponsored by stent-producing companies. Additionally, many cardiologists have a vested interest in the stent industry via board seats, stock, or consulting compensation in stent companies. The issue in orthopedics is that the federal government is investigating whether device companies have been compensating surgeons for device or implant use, a form of “kickbacks”.

At the heart of the issue is whether physicians are just being bought by companies and whether they are not looking out for their patient’s best interest. The device industry is a billion and trillion dollar industry and physicians are at the crossroads between patient’s wallets and device company revenue. Physicians have the power to choose the products and medicines that a patient’s insurance or the government will pay for. Thus, when a physician receives compensation from a company, it is actually doing so at the expense of the patient and the insurance company or the government.

My question is this:

Do patients really care what device or medicine is used as long as it is the best available?

I have heard from orthopedic surgeons that all knee and hip implants are basically the same, regardless of company. I have heard from cardiologists similar things about stents. If I require a joint replacement or a stent, do I really care if the surgeon or cardiologist is making money off of it? It seems that physicians earn their living treating patients or doing procedures. The more they do, the more they make. If all of the treatments or procedures they do are medically indicated, does it really matter where all the money is flowing back and forth or behind the scenes between companies and doctors? Do I really care if I need a drug and my doctor prescribes it, and if he owns stock in the company he might financially benefit from it?

Perhaps the answer is no, that is does not really matter. That is of course if the medical indications are sound for that treatment or procedure. Perhaps that is a big “if”.