Thursday, March 29, 2012

When Is COI Actually a Bribe?

Thanks once again to Dr. Roy Poses over at the Health Care Renewal Blog for this account--
--of recent judgments against two medical device firms for international corruption in violation of US laws. (The post includes links to supporting documents and media accounts.)

What most impressed Dr. Poses was an issue I've addressed here before:
To summarize quickly, those who defend current industry practices that people like me attack as inappropriate conflicts of interest (whatever the device industry equivalent is of "pharmapologists") note that physicians who get things like royalties and consulting fees make important intellectual contributions to improved patient care. But, as the legal documents reveal in the two companies' cases, when the industry elects to pay flat-out bribes to docs for using their devices, they don't exactly take out an ad in the local paper. Instead they deliberately conceal the bribe, and the most usual way to conceal it is to call it a consulting fee or a royalty or something that sounds legit. So you could imagine you have a straightforward COI, which raises red flags but does not (as I explained in HOOKED) necessarily convict the doc of actual wrongdoing--and only later discover (if you ever do) that what was going on was actually out-and-out corruption.

A basic ethical pearl that was circulated way back at the beginning of the debate over medicine and industry was that if you don't want people to know about what you're doing, then there's a high likelihood that what you're doing is ethically questionable. As simplistic as that sounds, it remains pretty good advice. A spinoff of that is that when you've been caught several times before (both companies are repeat offenders as Dr. Poses lists) hiding your corrupt behavior, then protestations that we need to trust you because you've reformed tend to ring hollow.


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A primary moral gem that was distributed way returning at the starting of the controversy over remedies and market was that if you don't want individuals to know about what you're doing, then there's a higher chances that what you're doing is legally doubtful.