Conflicts of Interest: Not Just an Entrepreneur's Problem

Conflicts of interest abound in the practice of medicine, and not just when money changes hands. Rather than ignoring the problem, physicians need to recognize and manage potential conflicts.

Physician entrepreneurs are viewed with suspicion because patients often think those doctors have conflicts of interest (COI), i.e. they place something else, most often financial again, ahead of the patient's interest. There are many sources of conflicts of interest that are less apparent than doctors receiving money from digital pharma/medtech companies, such as cultural or religious beliefs, political affiliation, or even the teams they support on Sundays.

Attribute substitution is a mental shortcut we all use. When a doctor says to do something based on the medical evidence, we tend to listen, attributing knowledge and judgment to him or her instead of reading articles or doing the research ourselves.

When it comes to evidence based medicine and clinical trials, it works both ways. Good studies are downgraded by doctors when they are industry sponsored. At the same time, poorly designed studies get backing when the perceived industry bias is removed, even when done poorly or when the negative results are not reported.

But it does not stop with FDA-mandated drug and device trials. Attribution substitution is creeping into digital health, where, in many instances, robust efficacy trials are few or trials are not done at all. Patients think if the doctor says it works, it is good enough for them.

Conflicts of interest are part and parcel of being a physician entrepreneur. The possible or perceived conflicts are intensifying because of employer entanglements and expectations, resource scarcity and payer mandates that place rationing over the patient's interest, personal involvement in entrepreneurial ventures, and many more. Conflict of interest cannot be ignored or denied, but rather must be minimized, mitigated, or managed. When you ignore that mandate, you lose the trust of patients and cross the line separating the ethics of medicine from the ethics of other businesses.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org.