Debates about Conflict of Interest in Medicine: Deconstructing a Divided Discourse
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The pharmaceutical industry plays an increasingly dominant role in healthcare, raising concerns about “conflicts of interest” (COI) on the part of the medical professionals who interact with the industry. However, there is considerable disagreement over the extent to which COI is a problem and how it should be managed. Participants in debates about COI have become entrenched in their views, which is both unproductive and deeply confusing for the majority of medical professionals trying to work in an increasingly commercialized environment. We used a modified meta-narrative review method to analyse debates about COI in the academic and grey literature. We found two Discourse Models: The Critical Discourse Model sees COI in health and biomedicine as a major problem that both can and should be addressed, while the Defensive Discourse Model argues that current efforts to control COIs are at best unnecessary and at worst harmful. Each model is underpinned by profoundly differing views about how society should be organized—in particular whether market forces should be encouraged or curtailed—and how the dangers associated with market forces should be managed. In order to make any headway, academics and policymakers must recognize that these debates are underpinned by profoundly differing worldviews.
KeywordsConflict of interest Pharmaceutical industry Health policy Meta-narrative review Discourse analysis
- Angell, M. 2009. Drug companies & doctors: A story of corruption. The New York Review of Books 56(1): 8–12.Google Scholar
- DeMartino, J. 2012. The physician payment sunshine act. Journal of the National Comprehensive Cancer Network 10(3): 423–424.Google Scholar
- Gee, J.P. 1999. An introduction to discourse analysis: Theory and method. London: Routledge.Google Scholar
- Jeff Hayes Films. 2015. Bought: The truth behind vaccines, big pharma and your food. http://www.boughtmovie.com/ . Accessed November 14, 2015
- Little, M., and W. Lipworth 2007. Focused discourse: An exploratory essay. Sydney: Centre for Values, Ethics and the Law in Medicine.Google Scholar
- Lo, B., and M. Field 2009. Conflict of interest in medical research, education, and practice. Washington (DC): National Academies Press.Google Scholar
- Okie, S. 2001 Missing data on Celebrex: Full study altered picture of drug. Washington Post, August 5. http://www.washingtonpost.com/wp-dyn/articles/A33378-2001Aug4.html. Accessed November 14, 2015.
- Rasko, J., and C. Power. 2014. What pushes scientists to lie? The disturbing but familiar story of Haruko Obokata. The Guardian, February 19. http://www.theguardian.com/science/2015/feb/18/haruko-obokata-stap-cells-controversy-scientists-lie. Accessed November 14, 2015.
- Rosenbaum, L. 2015a. Beyond moral outrage—Weighing the trade-offs of COI regulation. New England Journal of Medicine 372(21): 2064–2068.Google Scholar
- ———. 2015b. Reconnecting the dots—Reinterpreting industry–physician relations. New England Journal of Medicine 372(19): 1860–1864.Google Scholar
- ———. 2015c. Understanding bias—The case for careful study. New England Journal of Medicine 372(20): 1959–1963.Google Scholar
- Shaywitz, D., and T. Stossel. 2009. It’s time to fight the “pharmascolds.” The Wall Street Journal, April 8. http://www.wsj.com.ezproxy2.library.usyd.edu.au/articles/SB123914780537299005. Accessed October 13, 2015.
- Washington, H. 2012. Flacking for big pharma. http://www.darkpharma.nl/uploads/7/3/2/8/7328594/flacking_for_big_pharma.pdf. Accessed October 25, 2015.
- Westphal, K.R. 2005. Dialectic. In The Edinburgh dictionary of continental philosophy, edited by J.L. Protevi, 147–148. Edinburgh: Edinburgh University Press.Google Scholar