The code of conduct for United States federal judges, says the following: “ the judge shall avoid all impropriety or appearance of impropriety in all activities”.
I am not naïve enough to think that corruption and bias are not present in every human being (reference- see all of human history). However, replacing the word judge with the word doctor (spouse?!?) should be an ideal to strive for.
I think the judicial system has a much better track record of this than the healthcare system.
One big factor that is easy to identify is probably money.
Excellent discussion with many accurate and cogent observations. Unfortunately as usual, the massive elephant in the room was not brought into the discussion. I refer, of course to government involvement and takeover of the health care system. With government involvement, of course, corruption follows as night follows day. Decisions become politicized and those with a lot to gain will overwhelm the fractionalized and generally completely unknown interests of the public at large. It might be that truly privatized insurance companies could provide a countervailing force to the lobbyists and other vested interests. Unfortunately the insurance industry has elected to abdicate this position and, instead, just follow the Medicare guidelines. It might be that the insurance industry would go too far to the other side but, at least, this might put the brakes on to the overwhelming influence of the medical device manufacturers.
That of the "Conflicts of Interest" isn't "a medical problem" or "a problem". It's THE socio-political problem.
Why people take the decisions they take? Because they think that decision is in their best interest given their view of the world and the available information.
Practically no one decides simply based on the contracts he has signed or the oaths he has made.
Disclosure of (some) interests serves the only purpose of raising awareness on the issue - which is still required given the appaling naivety of many still believing/claiming that they aren't influenced by CoI.
But it won't do anything to solving it.
Solving the problem of the CoI requires a reshaping of all the socio-economical and political dynamics and equilibria; it can't be achieved in single sectors through niche policies: those will probably only serve the goal of hiding existing CoI or even let people certify that they have no CoI.
There is a recent field of research called "Mechanism design" that offers the most promising framework to analyze and possibly deal with the problem of CoI by designing systems with low vulnerability to known CoI.
PS: Why people take the decisions they take? I think it's well up for debate that "money" is the main rationale. IMO it unduly simplifies the problem and leads to wrong solutions.
When I hear that a government agency is seeking public comment before deciding on a policy, I always picture the "public" as the little guy who will be affected by that policy, not the big guy who can make a lot of money off of a particular policy. When I read that the Alzheimers Association endorsed coverage of aducanumab, despite no evidence of clinically meaningful benefits and good evidence of significant harms, I was shocked. Only then did I research them to find out their ties to Big Pharma, and that's when I stopped giving them money. It's depressing to have to always be a cynic these days. The "little guy" doesn't generally make comments on government agency websites because they don't know they exist, much less understand the research that would allow them to make an informed comment. So somebody else needs to step up for them.
Too funny you mention the steak dinners. As I was listening I thought, I experienced the live version of that as a fly on the wall. When I was in college, I worked at a restaurant that would host them every Weds in a basement banquet room. As staff, we were instructed to keep wine glasses full and bring anything and everything guests asked for, no limit. Fat tip guaranteed. It was initially bizarre. A presenter would give the slide show sales pitch followed by a Q&A. The crazy part was how the Doctors attending would play along and pretend they were having an intellectual, professional conversation instead a big product promotion hoopla with a bunch of free stuff. As a 20 yr, I observed in disgust, smiling politely as I served the surf and turf. One was for Prozac weekly. During the Q&A, the answer to everything was Prozac weekly. Shortly after, when I decided to try therapy, I went running out of the office when in the first 10 minutes, before I had a chance to say much more than my name, the therapist suggested I try Prozac weekly.
I now realize that I should write comments for NCDs. I am usually not aware about requests for comments. If I do get find out about request for comments, I don't know where I should submit my comment. Does anyone have suggestions on how I and my colleagues overcome these obstacles?
The code of conduct for United States federal judges, says the following: “ the judge shall avoid all impropriety or appearance of impropriety in all activities”.
https://www.uscourts.gov/judges-judgeships/code-conduct-united-states-judges
I am not naïve enough to think that corruption and bias are not present in every human being (reference- see all of human history). However, replacing the word judge with the word doctor (spouse?!?) should be an ideal to strive for.
I think the judicial system has a much better track record of this than the healthcare system.
One big factor that is easy to identify is probably money.
Excellent discussion with many accurate and cogent observations. Unfortunately as usual, the massive elephant in the room was not brought into the discussion. I refer, of course to government involvement and takeover of the health care system. With government involvement, of course, corruption follows as night follows day. Decisions become politicized and those with a lot to gain will overwhelm the fractionalized and generally completely unknown interests of the public at large. It might be that truly privatized insurance companies could provide a countervailing force to the lobbyists and other vested interests. Unfortunately the insurance industry has elected to abdicate this position and, instead, just follow the Medicare guidelines. It might be that the insurance industry would go too far to the other side but, at least, this might put the brakes on to the overwhelming influence of the medical device manufacturers.
That of the "Conflicts of Interest" isn't "a medical problem" or "a problem". It's THE socio-political problem.
Why people take the decisions they take? Because they think that decision is in their best interest given their view of the world and the available information.
Practically no one decides simply based on the contracts he has signed or the oaths he has made.
Disclosure of (some) interests serves the only purpose of raising awareness on the issue - which is still required given the appaling naivety of many still believing/claiming that they aren't influenced by CoI.
But it won't do anything to solving it.
Solving the problem of the CoI requires a reshaping of all the socio-economical and political dynamics and equilibria; it can't be achieved in single sectors through niche policies: those will probably only serve the goal of hiding existing CoI or even let people certify that they have no CoI.
There is a recent field of research called "Mechanism design" that offers the most promising framework to analyze and possibly deal with the problem of CoI by designing systems with low vulnerability to known CoI.
PS: Why people take the decisions they take? I think it's well up for debate that "money" is the main rationale. IMO it unduly simplifies the problem and leads to wrong solutions.
When I hear that a government agency is seeking public comment before deciding on a policy, I always picture the "public" as the little guy who will be affected by that policy, not the big guy who can make a lot of money off of a particular policy. When I read that the Alzheimers Association endorsed coverage of aducanumab, despite no evidence of clinically meaningful benefits and good evidence of significant harms, I was shocked. Only then did I research them to find out their ties to Big Pharma, and that's when I stopped giving them money. It's depressing to have to always be a cynic these days. The "little guy" doesn't generally make comments on government agency websites because they don't know they exist, much less understand the research that would allow them to make an informed comment. So somebody else needs to step up for them.
Too funny you mention the steak dinners. As I was listening I thought, I experienced the live version of that as a fly on the wall. When I was in college, I worked at a restaurant that would host them every Weds in a basement banquet room. As staff, we were instructed to keep wine glasses full and bring anything and everything guests asked for, no limit. Fat tip guaranteed. It was initially bizarre. A presenter would give the slide show sales pitch followed by a Q&A. The crazy part was how the Doctors attending would play along and pretend they were having an intellectual, professional conversation instead a big product promotion hoopla with a bunch of free stuff. As a 20 yr, I observed in disgust, smiling politely as I served the surf and turf. One was for Prozac weekly. During the Q&A, the answer to everything was Prozac weekly. Shortly after, when I decided to try therapy, I went running out of the office when in the first 10 minutes, before I had a chance to say much more than my name, the therapist suggested I try Prozac weekly.
This is grim but you tell it in a way that had me laughing. Your gig as a waitress was a valuable education.
😁 Life. So good to laugh at it all. 😆
... otherwise you might need Prozac weekly
I now realize that I should write comments for NCDs. I am usually not aware about requests for comments. If I do get find out about request for comments, I don't know where I should submit my comment. Does anyone have suggestions on how I and my colleagues overcome these obstacles?
I need to look if these were a cardiologist, ACC needs to whack them
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