Thursday, July 12, 2012

"Dualities of Interest"-- the Latest Fig Leaf?

Medical anthropologist Joan E. Paluzzi has written a study (subscription required) on the incestuous relationships between drug companies and disease-specific patient advocacy organizations, often mediated by physician experts ("key opinion  leaders") with major financial interests in the drug firms. She looks particularly at three disease areas-- osteoporosis, diabetes, and restless leg syndrome.

There's not a whole lot new for readers of HOOKED but she uses as her title one interesting phrase which I had not heard before. The American Diabetes Association published in 2010 (in the journal Diabetes Care) an update to their "Diabetes Standard of Care." The committee that wrote these guidelines had 15 members, and a separate document lists 77 separate relationships these docs had with pharmaceutical firms and other industry folks. Now, simple-minded people like me would have imagined these relationships to be conflicts of interest, but the ADA hastened to assure readers that no such thing could possibly be the case. Instead, they headed the list "Dualities of Interest."

As Paluzzi comments, "That these relationships were explicitly characterized as 'dualities' (implying a state of complementarity) rather than the long-accepted representation of 'conflicts' of interest (which highlights the potential for vested self-interest) is understood here as an attempt to normalize or, at least, to minimize perceptions of potentially unethical conduct."

As I say, this particular manner of applying lipstick to a pig is one I had not previous been aware of--no doubt just showing how far out of the loop I am.

Paluzzi JE. "Dualities of interest": the inter-organizational relationships between disease-specific nonprofits and the pharmaceutical industry. International Journal of Health Services 42:323-339, 2012.


Anonymous said...

"No man can serve two masters." Matthew 6:24

Anonymous said...

Duality... shmuality.

Bernard Carroll said...

“There are many fine points to medical ethics, and some difficult puzzles, but the most rudimentary morality is the line between the guardian and commercial (traditions). It’s as crucial that physicians understand it as it is that lawyers recognize that when they go into guardian service they can’t morally also be in service to clients seeking to influence legislation or regulatory decisions.” [Jane Jacobs. Systems of Survival, Random House 1992]