Conflicts of interest: Jack Abramoff and me

Dr. P's Pediatric Journal Club

Many of us are following the Abramoff case with a combination of horror and self-righteousness: Of course, I would never be corrupted by gifts and handouts if I were a congressman.

But are you really so sure? Are the congressmen who went down that slippery slope really all that different from you and me? After all, it's unlikely they entered Congress with the idea of influence-peddling for monetary gain. How did it come to pass? We are sure to find out as the trial progresses.

It turns out we physicians have been put in a similar position ( although with more subtlety and finesse) by the pharmaceutical industry. Here's my experience.

When I arrived at medical school, our friendly "drug rep" gave us all nice new stethoscopes - no strings attached. Gee, thanks! Later, she provided great lunches for our noon teaching conference. Yum, pastrami sandwiches! Need a new pen? Some note paper? A reflex hammer? You're a pal!

Why refuse? We were poor. She was nice. There was no pressure to do anything at all. What's not to like?

Later, in practice, drug reps would come to my office with their latest and greatest medications, armed with the latest research (carefully screened to only give results that supported their meds and/or discredited the competitors').

A few small freebie knicknacks wouldn't hurt (for some odd reason, there are few happier humans on this earth than a physician who has just gotten a free ballpoint pen). Better still, a fabulous free dinner at the most expensive restaurant in town to hear a talk on a subject of interest by a distinguished physician. Finally, the coup de grace: a free 3 day medical conference in a lovely vacation spot.

Now, the drug companies are anything but stupid. If they are willing to spend all this money to curry my favor, they must have determined that it pays off, that I will be more likely to prescribe their brand of medications. Yet I defy you to find a doc who believes his/her prescription practices have been biased by accepting their largesse.

This bias is unconscious, slow to evolve, and very subtle. We never knew what hit us and most still don't. It occurs to me that the congressmen tainted by Jack Abramoff probably have had a similar slow and unconscious evolution. Much as I'd like to think so, I'm not so sure we are really all that different from them.

What to do?

I'm going to assume that we are all corruptible to some extent and that human nature is unlikely to change. In the latest issue of the prestigious Journal of the American Medical Association (JAMA) the authors propose "stringent regulations" to eliminate or modify the practices I described, especially at academic medical centers.

I'm proud to say that is what has happened at my institution. We have these fabulous young pediatricians in training who will never have received any gifts, eaten any free lunches, nor even copped a ballpont pen from the drug industry. It is this next generation for whom the slow process of influence will be just a curious historical footnote. (Of course, they will think they would have resisted the temptation anyway, but I know better.)

Eat your heart out, Jack Abramoff.

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Article cited:"Health industry practices that create conflicts of interest". Brennan T, et al.JAMA. January 25, 2006

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