Wednesday, August 4, 2010

Reply to My Article on COI-Coke-AAFP

The "Policy and Medicine" blog has recently posted a lengthy rebuttal by Thomas Sullivan--

--to my own article on conflict of interest in the AAFP-Coca-Cola matter:

The rebuttal is carefully done, but you can get a sense of it from the last summary paragraph:

We need to build a culture of trust. To begin that culture, we need to trust that the leadership at the AAFP is motivated to conduct this program to help children and families. Trust the physicians participating in the program who are almost desperate for tools to help these children and families. In the end we are all trying to do what is best for patients; working with industry resources to accomplish this goal is good for everyone.
In the end, our efforts and energy should not be concerned “about the development of a corporate culture within a medical professional society,” because doctors and physicians are trained to avoid such motivations. For the overwhelming majority of doctors, especially those in family medicine, the only role corporate culture plays is helping physicians conduct the research, training and education needed to make families healthier. As such, we should be encouraging the funding from and collaboration with industry to help physicians carry out their moral duty to their patients, which includes working with industry to find new ways that can help treat diseases like obesity.

OK, let me see if I get it. We are supposed to trust the AAFP leaders, because we believe that they are trying to do what's best for patients and for the general public. What about the evidence that getting into bed with a for-profit company that has a financial interest in selling beverages that add to the risk of obesity might be contrary to those goals, and motivated less by what helps patients and more by AAFP's own financial bottom line? Well, don't believe that evidence. ("Who are you going to believe--me, or your lying eyes?") Why not believe it? Well, it cannot be true. Why? Because "doctors are trained to avoid such motivations." Even when they seem to have given into those motivations? Well, just trust us.

"For the overwhelming majority of doctors, especially those in family medicine, the only role corporate culture plays is helping physicians conduct the research, training and education needed to make families healthier." Oh, really? The only reason for-profit companies fork over those bucks is because they want to make families healthier? There is nothing in it about making more money by selling more drugs or other products? There is no evidence that drug company-sponsored research is tilted away from the true scientific questions about human disease, and toward whatever will give the company's marketing a leg up? There is no evidence that any company ever tried to hide important scientific data that might interfere with sales?

I was tempted to end this post with, "Just what world do these people live in, anyway? Because maybe I'd like to buy a condo there." But that would be a churlish response to a commentary which is, after all, written in a completely polite fashion. So in an attempt to offer an equally polite reply, I will say that it makes excellent sense, in assessing the ethics of medicine's relationship with industry, to weigh the pros against the cons. But in order to do so, one has to be willing to admit that there are both pros and cons. A group of defenders of the recent status quo, on the other hand, appear to be unwilling to admit that there are any cons at all. On their view, there is nothing but good that can come from a close financial relationship between medicine and industry. But that does not strike me as a rational way to conduct an ethical analysis.


Michael Kirsch, M.D. said...

Howard, do you have any mutual fund investments? If so, I wonder how many investments are from companies that you would find objectionable. You might be funding 'Big Oil', gun companies or even the pharmaceutical companies!

Howard Brody said...

Very good question, Michael! It so happens that I own a couple of mutual fund investments-- mostly in a TIAA-CREF account, with a smaller sum invested with Vanguard. The Vanguard funds are, I believe, solely in tax-exempt bonds. Being a goody-two-shoes, tea-and-cookies liberal of long standing, many years ago I switched my CREF investments from the regular fund to their "socially responsible" fund. I hope that means that I am not funding guns and ammo for guerilla warfare in the Congo, for example; but last time I glanced at the list of companies that ARE in that fund, I saw that pharmaceutical companies are considered by CREF to be "socially responsible." So there you have it.

And your point is...?

Best regards, Howard