I heartily agree with the observation that conflicts of interest are beginning to become all too prominent in the debate over thrombolytic therapy for stroke. (“Conflicts of Interest on Guidelines Ramp Up tPA Controversy,” EMN
.) The arguments cited are compelling and well stated, needing no further addition here, but I fear the issue goes deeper than is appreciated.
Normally, the conflict of interest is dealt with in the present tense, what interests exist now, without consideration of future potential relationships, but an individual who advocates practices that are valuable to corporations will be more likely to be offered advancement or potential financial benefits in the future.
This does not suggest any dishonesty or conspiracy; it is simply inherent in the system as it exists now. The tremendous power, financial and political, that is wielded by the medical industries makes this outcome inevitable. In the strongly market-oriented economic system that dominates the United States, we should not be surprised that health care is also dominated by market considerations. It would be foolish to expect the manufacturer of computer software to promote any solution that does not utilize their software, and so a pharmaceutical corporation is naturally going to favor those who advocate the treatment that that corporation provides and attempt to minimize the influence of those who oppose that treatment.
The spider web in which the health care system and our own health is ensnared is so pervasive that any movement causes the whole to move — and to be restrained by that web as well. We should not be surprised that conflicts of interests seem to arise so frequently in an issue with so much financial risk. It is not surprising that they are ordinarily so well concealed either. Alas, the solution might require far greater adjustments than simply “disclosing” who is currently being paid by whom. Investigators are very capable of seeing where the future is going.
Paul Janson, MD