Medical Ethics
Bias in “scientific studies”:
Properly done “and properly reported” scientific studies are the major source for “evidence based medicine” and are the main drive in medicine progress, however the impartiality of these studies are being eroded by the increasing effect of Pharmaceutical “Drug” companies and their money on “studies” and “researchers”, since these companies pay the researcher to do the study on their medicine, the researcher may become in many cases biased towards showing favorable outcome that help these companies sell more of their medicine, and may tend to hide negative outcome that can harm the patients but protect the interest of the company that paid for his/her study.
Unfortunately there are a lot of instances of this bias, including an interesting well known phenomenon called “file Drawer” in which if the results of the study do not favor the company paying the money to the researcher, then the researcher just do not publish these results to protect the financial interest of the Drug company, which results in these medicine continued use improperly because doctors are not ware of these negative results of the study.
In December/2012 issue of “Scientific American” magazine an investigative report titled “is drug research trustworthy” (changed later to “How Drug Company Money Is Undermining Science”) By Charles Seife looked into this issue, one of the most disturbing findings was that some members of “supervising committees” or “ethics committees” that are supposed to monitor for such inappropriate relationships were themselves receiving significant amounts of money from pharmaceutical industry that raise questions about how impartial they are.
It is our responsibility as doctors to sift through the studies and identity which ones are properly done and offer real science and apply it to our practice and patients, and which ones are trying to push the companies’ interests above our patients’ health and interest and protect our patients from possible harm due to these “biased” studies.
Drug companies “marketing” and patient’s health:
Again, Pharmaceutical companies have contributed immensely to the advancement of medicine through developing new drugs for many diseases, and they continue to invest in important research. We will always need them to continue such developments, however, recently there has been increased concern of the influence of these companies’ money on the results of medicines trials or at least how these results are interpreted.
In addition there has been recently more scrutiny of the relationship between these companies and practicing doctors. These companies sponsor many activities for doctors where they pay for doctors to attend meetings or conduct research or other activities, and the trick is how to make sure that such sponsorship is really aimed to advance medicine for the benefit of patients rather than crossing the line to become a cozy relationship where the pharmaceutical company is buying loyalty of the doctor by providing him/her benefits for his/ her personal pleasure/entertainment rather than improving science for the benefit of patients.
A serious “side effect” of such inappropriate relationship is an increase in the use of VERY expensive medicines in cases were much less expensive medicines could have THE SAME therapeutic effect and benefit.
Some countries like the United States are looking into the issue on how to make sure that doctors are practicing a real ethical medicine where the interest of the patient is really above anything else, rather than the doctor falling under the influence of certain company’s special interests and putting these companies financial interest above patients’ interest.
If this is happening in the United States a country that already has several systems to protect against that, the situation in other countries may be worse.
To be fair, it should be mentioned that some pharmaceutical companies have a strict “code of ethics” to make sure they themselves are adhering to ethical standards, but not all companies have such codes and even when they have it, not all of them adhere to it.
The ultimate responsibility falls on our shoulders as doctors to adhere to the highest ethical standards in our practice, and to make sure we have an ethical relationship with the Pharmaceutical industry where we cooperate for one goal only, and that is to get the best for our patients, and put the patient’s interest above any other interest.
Things overdone without significant benefit:
There are things done sometimes in medicine without enough evidence of benefit which can increase the cost without need. There are also medicines used without real benefit, and while that also increases the cost without need, it could also put the patient at increased risk of side effects while not providing additional therapeutic effect.
The ACR (American College of Rheumatology) published recently a list of 5 things to be avoided due to the above reasons.
While these guidelines may not apply in every case, we the rheumatologists and our patients should be aware of them and avoid doing them unless really needed.
To check the list, please visit this link: http://www.choosingwisely.org/doctor-patient-lists/american-college-of-rheumatology/
To learn more, check the “four principles” of medical ethics on this link:
Unfortunately there are a lot of instances of this bias, including an interesting well known phenomenon called “file Drawer” in which if the results of the study do not favor the company paying the money to the researcher, then the researcher just do not publish these results to protect the financial interest of the Drug company, which results in these medicine continued use improperly because doctors are not ware of these negative results of the study.
In December/2012 issue of “Scientific American” magazine an investigative report titled “is drug research trustworthy” (changed later to “How Drug Company Money Is Undermining Science”) By Charles Seife looked into this issue, one of the most disturbing findings was that some members of “supervising committees” or “ethics committees” that are supposed to monitor for such inappropriate relationships were themselves receiving significant amounts of money from pharmaceutical industry that raise questions about how impartial they are.
It is our responsibility as doctors to sift through the studies and identity which ones are properly done and offer real science and apply it to our practice and patients, and which ones are trying to push the companies’ interests above our patients’ health and interest and protect our patients from possible harm due to these “biased” studies.
Drug companies “marketing” and patient’s health:
Again, Pharmaceutical companies have contributed immensely to the advancement of medicine through developing new drugs for many diseases, and they continue to invest in important research. We will always need them to continue such developments, however, recently there has been increased concern of the influence of these companies’ money on the results of medicines trials or at least how these results are interpreted.
In addition there has been recently more scrutiny of the relationship between these companies and practicing doctors. These companies sponsor many activities for doctors where they pay for doctors to attend meetings or conduct research or other activities, and the trick is how to make sure that such sponsorship is really aimed to advance medicine for the benefit of patients rather than crossing the line to become a cozy relationship where the pharmaceutical company is buying loyalty of the doctor by providing him/her benefits for his/ her personal pleasure/entertainment rather than improving science for the benefit of patients.
A serious “side effect” of such inappropriate relationship is an increase in the use of VERY expensive medicines in cases were much less expensive medicines could have THE SAME therapeutic effect and benefit.
Some countries like the United States are looking into the issue on how to make sure that doctors are practicing a real ethical medicine where the interest of the patient is really above anything else, rather than the doctor falling under the influence of certain company’s special interests and putting these companies financial interest above patients’ interest.
If this is happening in the United States a country that already has several systems to protect against that, the situation in other countries may be worse.
To be fair, it should be mentioned that some pharmaceutical companies have a strict “code of ethics” to make sure they themselves are adhering to ethical standards, but not all companies have such codes and even when they have it, not all of them adhere to it.
The ultimate responsibility falls on our shoulders as doctors to adhere to the highest ethical standards in our practice, and to make sure we have an ethical relationship with the Pharmaceutical industry where we cooperate for one goal only, and that is to get the best for our patients, and put the patient’s interest above any other interest.
Things overdone without significant benefit:
There are things done sometimes in medicine without enough evidence of benefit which can increase the cost without need. There are also medicines used without real benefit, and while that also increases the cost without need, it could also put the patient at increased risk of side effects while not providing additional therapeutic effect.
The ACR (American College of Rheumatology) published recently a list of 5 things to be avoided due to the above reasons.
While these guidelines may not apply in every case, we the rheumatologists and our patients should be aware of them and avoid doing them unless really needed.
To check the list, please visit this link: http://www.choosingwisely.org/doctor-patient-lists/american-college-of-rheumatology/
