Conflicts of Interest in Healthcare

Conflicts of interest by medical providers directly affect your health in the following ways:

Your physician might have a financial incentive in a diagnostic facility that you are being referred to. This could lead to increase in unnecessary, often invasive and risky tests (MRI with IV contrast or CT with radiation exposure) or a bias towards the type of test that might not be optimal in a specific situation.

For example, one study showed that when doctors have a financial stake in an MRI facility, they referred their patients for knee MRI exam at least 30% more often, with resulting increased proportion of negative MRI results.

Wall Street Journal on conflicts of interest among doctors:

https://www.wsj.com/articles/SB10001424127887324263404578615971483271856

Doctors might also order a given type of treatment more often when they have a financial stake in a treatment facility.

For example, the report by the US GAO office found that urologists “referred a substantially higher percentage of their prostate cancer patients” to radiation therapy when the doctors owned the equipment — linear accelerators — or had financial ties to those who provided the treatment, the report said” (New York Times).

There is a huge amount of evidence that interventional cardiology procedures – angioplasty and coronary artery stenting – and open heart surgery are often overused without adequate clinical need. Multiple studies have shown that medical treatment of heart disease has similar benefits to angioplasty and stenting, without exposing patients to operative risks, placing a foreign body into their hearts, high costs of invasive angioplasty procedure and post-procedure medications, and risks of serious side effects of prolonged drug treatment with blood thinners.

Conflicts of interest also play a role in decision-making to approve or withdraw a medication for / from the market.

This is a New York Times article about financial conflicts of interest among members of US FDA drug-approval panels: “…over all, [FDA] committee members had a 52 percent chance of voting in favor of a sponsor of a drug. But members who had financial interests in only the company whose product was under deliberation were more likely to vote for its approval, with a probability of 63 percent.
If members served on advisory boards for only the company whose product was up for review, then the chance they would vote in favor of it shot up to 84 percent. (Members who had financial interests in, or served on advisory boards for, both the company whose product was being reviewed and at least one of its competitors were not more likely to vote in favor of any particular company’s drug, however.)

It’s hard to look at data like this and not be concerned about conflicts of interest. There’s a reason that 10-cent coupons exist; it’s because they work. Financial interests absolutely do influence our decision making.”

A more recent form of conflict of interest has appeared due to changes in financing of the US healthcare. Payments to hospitals and doctors are shifting from a fee-for-service model to “bundled payments” for entire hospitalization of patient. Overall, it’s a good thing, but it can create an incentive to underutilize diagnostic and treatment options for a given patient.

State-funded healthcare systems are not immune to conflicts of interest, both at individual provider level and at national standard-setting bodies, like NICE in the UK.

State-funded health systems, for example in the UK and Nordic countries severely restrict patient’s ability to be treated at the best facility and by best specialists for a given procedure. Instead, patients are subjected to “zip code lottery”, when their treatment quality depends on their geography of residence.

State-funded healthcare systems also tend to amplify intrinsic biases, for example, age discrimination when treating cancer patients, or underfund new breakthrough treatment methods, such as proton beam therapy for UK-based NHS patients.

When you come into contact with healthcare system, you absolutely have to be cognizant of hidden and open conflicts of interest among anyone who touches you as you move along “healthcare value chain”. Big bucks are involved and unsophisticated consumers are increasingly become products and not clients of the system.

Sources:

Surgeons Eyed Over Deals With Medical-Device Makers (WSJ)

Self-Referral Spurs Unnecessary MRI Exams for Patients (Radiological Society of North America)

Doctors Who Profit From Radiation Prescribe It More Often, Study Finds (New York Times)

Opening of specialty cardiac hospitals and use of coronary revascularization in medicare beneficiaries (JAMA, Journal of American Medical Association)

A Small Indiana Town Scarred by a Trusted Doctor (New York Times)

Hospital Chain Inquiry Cited Unnecessary Cardiac Work (New York Times)

What The New York Times Left Out Of The HCA Story (Forbes)

Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease (American Heart Association study)

Doctors’ Magical Thinking About Conflicts of Interest (New York Times)

How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves (Forbes)

NICE conflicts of interest: Call for MPs to investigate (BBC)