Reading labels and fine print is increasingly a common practice, but it still isn't enough to keep special interests out of the medical field.
Professionals continue to wade through study upon study and try to determine the validity of research that can potentially save their patients’ lives.
“That information is used by health care practitioners in advising patients. It’s used by patients, by the general public, in deciding what they purchase. What activity they will allow their children to participate in. It helps shape public policy,” said Linda Farber Post, director of bioethics at Hackensack University Medical Center.
Post was joined by a number of medical professionals at Hackensack, as well as guest speakers, to discuss the topic at the 20th Biomedical Ethics Symposium on Tuesday evening.
Though the public is increasingly aware of the role special interests have played in research publications over the years — the latest examples being that of the effects of concussions on the brain, and the effects of sugar on the body compared with fats — the problem of untrustworthy and sometimes conflicting information exists.
That was most recently highlighted in John Oliver’s segment on scientific studies.
There is a lot at stake, Post said in a phone interview Wednesday. “I know I sound like a conspiracy theorist. But it is a serious risk.”
“It is one thing to promote a product or activity — and marketing departments exist for that reason. But that’s very different from outcome-oriented research, where scientists are hired and told what the desirable outcome is,” she said, “the outcome that favors the industry — financially or ideologically — and work backwards from there to design research for an outcome, that’s very dangerous. That erodes trust in science in general.”
Ronald Bayer, professor and co-chair of the Center for the History and Ethics of Public Health of the Mailman School of Public Health at Columbia University, cautioned that not everything corporations fund should be considered tainted.
One example of that is the alcohol industry, according to Barron Lerner, professor in the departments of medicine and population health at New York University Langone Medical Center.
Lerner highlighted the “drink responsibly” comments at the end of every alcoholic beverage ad. Though the ads don’t have an effect on drunk drivers, the alcohol and beverage industry can claim corporate social responsibility.
One potential solution to reducing the risk of misinformation is having more active medical professionals involved in lobbying and public policy, according to the panelists.
An example used by the panelists Tuesday was gun policy. Studies have shown that better storage of, or outright removal of, guns in homes was directly correlated to a discussion with a physician. But because of the (well-documented) power of gun lobbyists, the health industry hasn’t had a chance to expand the concept into a public health policy.
Brendan Parent, instructor in the Division of Medical Ethics at Langone Medical Center, said there are some individuals — such as himself — becoming more active in trying to push the needle on certain topics like pharmaceutical transparency and professional sports’ corporate social responsibility.
“I think part of the issue is that financial incentives are shifting, making it harder for academics and clinicians to make the ‘right’ choices,” Parent said. “Physicians are getting paid substantially less due to shifting insurance schemes, academics have to bring in bigger grants than ever before to have any chance at tenure. As such, it makes sense that when docs get offered major kickbacks from pharma to prescribe their drugs, or when researchers are offered good salaries to produce data that supports the industry's position, these professionals with hearts in the right place get their heads in the wrong place.”
Of course, one of the biggest pushbacks to having physicians involved in a topic like gun control is the perceived non-correlation between guns and health.
But Parent argues that, just as food consumption, sports activities and other external factors indicate the patient’s risk factors, so, too, does gun ownership. It can flag a patient for likelihood of an injury, as well as paying attention to mental health.
But until more active steps are taken, the increased awareness, especially in the younger generation, is helping.
“I absolutely believe there is a shift taking place. We are an increasingly aware generation of consumers, and we hold our producers more responsible for good practices beyond making products we like,” Parent said. “We want our sports teams to fight cancer, our restaurants to feed the homeless and our shoe manufacturers to outfit children in impoverished communities. Businesses are beginning to recognize that their authenticity in these efforts might actually affect their bottom lines, because consumers develop loyalties on these bases.
“Now, the question is, does the burden of holding industry responsible for being honest, clean and safe shift away from government and the manufacturers themselves to the consumer? I think the answer is, ‘slightly.’ Despite the rise of consumer intelligence, consumers will never have certain tools and access to certain information. Powerful business will still be able to hide facts and manipulate data.”
There will also continue to be at least one barrier in the peer-review journal process, Parent said. “For example, when the NFL hired academic researchers to study concussions and the data produced was rejected by peer reviewers for leading academic journals, which published the findings anyway, media investigated and the public found out. This kind of industry control will not be tolerated.”
“Accordingly, research communities hired by industries like alcohol, tobacco, sports, will have greater impetus to produce thorough, valid, objective studies. These studies should, in turn, hold industry more accountable for ethical production practices and products. “