Why this matters to patients
Patient Dave deBronkart sees it as his responsibility to look for conflicts of interest involved with anyone making health care claims.
Scientist’s perspective on why stories must follow conflicts of interest
Karen Sepucha, PhD, HealthNewsReview.org expert editor
Why This Matters?
- We think that claims about new treatments, tests, products and procedures should be based on evidence, not on beliefs, not on intuition, not on business hopes.
- In health care journalism, we consider it essential that second opinions be sought – from independent experts who have no vested interest in the approach being discussed.
- Over-enthusiastic claims are not made solely by drug companies or medical device manufacturers. Promotions of progress in research by academic medical centers are often questionable.
- When you hear hyperbole about health care claims, also consider the source. And then ask yourself the next question, “Do they have something to gain?”
- Do they have a conflict of interest?
- Frequent examples of potential conflicts of interest in people making claims about new treatments, tests, products or procedures include:
- A trial paid for by the drug manufacturer.
- Researchers employed by or getting fees from a drug company.
- A spokesman for a device manufacturer.
- Doctors who are early adapters and true believers in a new device.
- An inventor.
- All of these people want their product or their idea to look as good as it can.
- Just because a study was funded by industry, it doesn’t mean the findings lack integrity.
- But in recent years there have been so many highly-publicized examples of troublesome conflicts of interest in medical research and in health care that we think it is always fair and smart to ask questions about potential conflicts.
- A few states now publicly report industry’s payments to doctors. Drug companies have begun to report their payments to doctors. A wide-ranging U.S. Senate investigation is looking at various aspects of potential conflict of interest in health care and research.
- Think about this: when your doctor offers you a sample of a new drug, is that ever a lower-cost generic drug sample? No. He/she was given brand name samples to give away by a drug rep. Is there a conflict of interest at play? Maybe not. But it’s one small example of industry’s influence on health care.
- When an orthopedic surgeon does a procedure, he/she could be using devices from one company or another that could cost more than $50,000. A representative of a device company may be in the operating room as the procedure is done. Is there a conflict of interest at play? Maybe not. But it’s another example of industry’s influence on health care.
- Is your doctor’s office cluttered with drug company promotions and with visiting drug reps? Does that bother you?
- It may be awkward but it is entirely reasonable for you to ask your doctor if he/she has any financial relationship with the makers of the drugs or devices or tests being recommended for you.
- The website NoFreeLunch.org posts “a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information.”.
- Be wary of news stories that:
- Fail to identify the source of the story (news release, journal article, editorial, scientific meeting presentation, etc.) and fail to make obvious the extent to which that source is likely to be conflicted (e.g., .a PR consultant working for the company said.. or .Dr Smith, who received a company grant to perform the study said..)
- Fail to include the input of a trusted independent source with expertise on the subject to comment on the claims made. (Ideally, more than one such independent source would be used.
- Only consult sources who have a dog in the hunt
- Only use a single source. There’s a conflict of interest around every corner in health care and you need to be aware of that and seek independent perspectives. See our “List of Independent Experts”.
- Use vague phrases such as: “Experts believe….” or “Doctors think…” Who? How many? All of them? Is the story increasing the smell of authority by being vague?
Thumbs Up Examples
The story provides many clinical perspectives on the computer-aided detection (CAD) technology. The reporter interviews not only the study author and the author of an accompanying NEJM editorial, but also clinicians and radiologists who talk about use of CAD in practice. Interviews with clinicians who provide their rationale for not using the CAD technology provide excellent balance to the story.
The producers earn extra points for using three well-selected sources:
- the author of one of the studies
- an authoritative advocate of evidence-based treatment with knowledge of these studies
- the U.S. President
Most importantly, an independent clinician who does the surgery a lot, considers it useful and isn’t quite sure what to make of the results.
Several independent sources were interviewed for this story. The writer also points out that both trials were paid for by Amgen, the manufacturer of denosumab, and nearly all the researchers were employed by the company or received consulting or advisory fees from them.
While the sourcing favors supporters, the reporter discloses or implies the conflicts of interest the clinic operators have. The two skeptical medical sources are highly credible.
Three different sources fill out this compact story – a spokesperson for the medical society representing the nation’s orthopedists, a spokesperson for knee implant manufacturer Zimmer, and chief of the knee service at one of the busiest joint replacement centers in the world (who has consulted for one of Zimmer’s chief competitor, the story notes) – a balanced group whose potential conflicts readers can judge for themselves.
Thumbs Down Examples
No individuals with expertise in prostate cancer, prostate cancer treatment, or prostate cancer patients appear to have been interviewed as part of this story.
Interview comments from a single patient without reference to the evidence or perspectives of experts in the field is not first-rate journalism.
The sources for the story are just 2 people – a woman whose facelift successfully relieved her migraines and the surgeon who performs these procedures and wrote the study about facelifts for migraine headaches cited in the story (clearly not a disinterested party). The story fails to represent the points of view of the 43% of people who did not experience migraine pain relief after their facelifts or of experts who could place this research into the much broader context of the migraine literature.
The reporter talks to one source, a man whose job is to sell more of the machines in question.
The only sources contacted for this story are representatives of two companies involved with development of female sexual satisfaction products, including the one studied in the journal report. The viewpoints of independent clinicians and researchers would have been valuable.
The segment draws exclusively on the inventor and three credible but potentially self-interested supporters, one of whom is dead.
This is unsatisfactory: One or more independent cancer researchers should have been interviewed, including one who is currently doing other research with nanoparticles and one expert radiologist.
These sources could have provided necessary context for this history and outcomes of previous promised “breakthroughs,” the implications of novelty and the many things which remain unknown.
The segment should have reported whether the researchers interviewed have a financial or other interest in the procedure.