Conflicts of Interest: A Thorny Issue for Physicians and Health Leaders

What constitutes conflict of interest (COI) for physicians?

In general, COI exists in a situation where a person is — or appears to be — at risk of acting in a biased way because of personal interest. Physicians who engage in paid consulting and speaking arrangements, who conduct research studies to help develop new pharmaceuticals or medical devices, who invest in biotechnology companies, or who own testing facilities or treatment centers that provide healthcare services may do so to improve patient care; however, these activities come under scrutiny when physicians benefit financially.

Even when they take care to avoid it, physicians’ judgments and actions may be influenced by COI. In subtle ways, monetary payments from pharmaceutical companies may affect how physicians report results of research studies, what they teach residents about particular drugs, or what treatments they recommend for patients. Those who own or invest in treatment centers may give preference to these facilities when referring patients for care, thus benefiting financially.

On the flip side, relationships between physicians and other entities are not all bad — they actually have value in terms of physician education and new drug and medical device development. The most common way of averting problems is for physicians to clearly state their relationships with all individuals, companies, or organizations. Transparency about COI allows healthcare institutions, patients, and the public to judge whether a particular relationship may be influencing a physician’s actions. To that end, there are multiple public reporting programs listing payments physicians received from pharmaceutical and medical device companies and many medical centers provide information on their websites about staff physicians’ COI.

Why has COI become an important issue? During the lazy days of summer, dozens of physicians from some of Boston’s prestigious Harvard-affiliated hospitals signed a petition aimed at prohibiting hospital CEOs from working on corporate boards — extracurricular activities that may earn them millions of dollars but also create serious COIs.

What set off the COI tempest in Boston? A Boston Globe investigative report found that Boston hospital CEOs hold exceptionally lucrative board positions in publicly traded companies at a much higher rate than other major U.S. cities. According to the Globe report, five of seven CEOs and presidents of Boston’s major teaching hospitals also receive compensation for serving on boards of publicly traded companies – often in the form of company stock potentially worth millions of dollars.

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