1 / 27

Conflict of Interest: What does the science say about industry influence on health care providers?

Conflict of Interest: What does the science say about industry influence on health care providers?. Kerry Harwood, MSN, RN. Where’s the Science?. Social Science research Anthropologic research Research on Health Care Provider – Industry Relationships.

taniel
Download Presentation

Conflict of Interest: What does the science say about industry influence on health care providers?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Conflict of Interest:What does the science say about industry influence on health care providers? Kerry Harwood, MSN, RN

  2. Where’s the Science? • Social Science research • Anthropologic research • Research on Health Care Provider – Industry Relationships

  3. Would you change your behavior for a free trip to the Bahamas?

  4. Would you change your behavior for a free dinner at the Angus Barn?

  5. Would you change your behavior for a free stethoscope?

  6. Would you change your behavior for a free mug and pen?

  7. The Power of ‘Free!!’

  8. Anthropologists who have studied gift exchange…agree that gift giving is always understood as an exchange. Day L. Amer J Crit Care 15(5):510-515, 2006

  9. Any gift, however small, places an obligation on recipients, resulting in unwanted debt. Day, L. Am J Crit Care 5:510-513, 2006 Gift giving is a way of creating and maintaining relationships of power between groups and individuals. Bergquist & Ljungberg. Info Systems J 11:305-320, 2001

  10. What we believe…. • The ‘other guy’ might be influenced by promotions but not me • Information from drug companies doesn’t influence my decisions • ‘Small’ gifts don’t influence health care providers

  11. What industry knows… • ‘Detailing’ is effective in changing prescribing behaviors • Strategically rationed doses of gifts, services, samples, and flattery ensure that physicians most susceptible to marketing prescribe the most expensive, most promoted drugs to the most people possible

  12. Drug Reps • 1995 to 2005, number increased from 38,000 to 100,000 • 1 drug rep for every 6 physicians • 1 drug rep for every 2.5 targeted physicians

  13. Medical Residents • 61% report ‘promotions don’t influence my practice’ • 16% report ‘promotions don’t influence other physicians’ practice’ Steinman MA, et al. Am J Med 110:551-557, 2001

  14. Medical Students • 85% believe it is improper for politicians to accept a gift • 46% believed it would be improper for them to accept a gift of similar value from a pharmaceutical company Palmisano P & Edelstein J. J Med Educ 55:453-455, 1980

  15. Medical Residents • Retrospective study tracked house staff who attended Grand Rounds given by pharmaceutical company speaker • Those who attended were more likely than their colleagues to indicate the company’s drug as the treatment EVEN WHEN THEY DID NOT RECALL WHAT COMPANY SPONSORED THE GRAND ROUNDS Spingarn R, et al. Acad Med 71:86-88, 1996

  16. Outcomes of Industry-Physician Interaction • Knowledge: • Inability to identify wrong claims about medication • Attitude: • Positive attitude toward pharmaceutical representative • Awareness, preference and rapid prescribing of new drug

  17. Outcomes of Industry-Physician Interaction • Behavior • Making formulary requests despite lack of benefit over existing formulary • Non-rational prescribing behavior • Increasing prescribing rate • Prescribing fewer generics and more expensive, newer medications at no demonstrated advantage Wazana A. JAMA 283(3):373-380, 2000

  18. The importance of developing loyalty through gifting cannot be overstated. Michael Oldani, anthropologist and former drug rep

  19. It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurant, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange. Shahram Ahari, former drug rep

  20. Provision of samples influences prescribing behavior and increases, rather than decreases, costs. Klein, CA, Nurs Pract 31:15, 2006

  21. Bias as a deliberate choice… • Limit gift size • Educational initiatives • Mandatory disclosure of interests

  22. Bias – unintentional & unconscious Limit gift size… • Small gifts may be surprisingly influential by subtly affecting the way the receiver evaluates claims made by the gift giver • Individuals are generally unaware of the bias so do not make efforts to correct for it or avoid conflicts of interest. Dana & Lowenstein. JAMA 290(2):252-255, 2003

  23. Bias – unintentional & unconscious Educational initiatives… • Individuals are not aware of their own bias, even when taught about it • Even when conflict of interest situations are clearly illustrated through case studies, few will exactly replicate the situation enough to mitigate self-serving interpretations. Dana & Lowenstein. JAMA 290(2):252-255, 2003

  24. Bias – unintentional & unconscious Mandatory disclosure of interests… • Can reduce legal liability and forestall more substantial institutional change • May help recipient when they have extensive professional experience & an accurate idea about how the COI will affect their advisors • Can increase the bias in advice due to moral license & ‘need’ to overcome weight of disclosure Cain, DM et al. J Legal Studies 34:1-25, 2005

More Related