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Monday, June 06, 2016

Does the Conflict of Interest statement in medical journal articles really mean anything?

 I am beginning to think that the answer to the question in the heading is no.Thinking about a article in the NEJM published at the time of the run up to the passage of Obamacare and who the authors are probably shaped my opinion.

In the August 1,2013 NEJM a special report is published entitled "Prescription for Patient-Centered Care and Cost Containment" The authors are Thomas Daschle, Pete Domenici,William Frist and Alice Rivlin.The article predictably is in favor of the Accountable Care Organization and opposes fee for service in medicine. The article is not remarkable  for its content.That could have been predicted from the names of the authors. What I find remarkable- but not unusual or atypical- is that one of the authors who is a principle in a venture capital firm that invests  in health care businesses states that he has no conflicts of interest and that his business interest would not even possibly be conceived as such.

Dr. Frist's credentials are well known as he is an accomplished cardiac and transplant surgeon and former US Senator.His family's association with Hospital Corporation of America is also well known and Dr. Frist is not now associated with that organization. A few minutes of effort on the web yields considerable information about his current business interests at the time of the article's publication.

He is a partner in a venture capital firm, Cressey and Company,which specializes in health care related investments.These following are listed under partnerships on their website: 1)equity partnership in US Renal Care,a large private dialysis enterprise,2)Encompass Home Health,a provider of hospice  and home health care with over 100 locations in 12 states 3)Jazz Pharmaceuticals 4)Select Medical which owns rehab and long care facilities, 5) Spine Wave Inc  6)Strategic Heath Care Program 7) Wound Care Specialists.

Section 5 of the ICMJE form , which authors of articles are obliged to complete and  which can be accessed for all of the authors on the NEJM website states:

"Are there other relationships or activities that readers could perceive to have influenced or that give the impression of potential influencing what you write in the submitted paper?" (my underlining)

Dr. Frist and the others all answered no to each of the questions.

At the very slight risk of appearing cynical I suggest that his relationship with Cressey just might " give the impression of potential influencing" to some readers.  The words potential and impression seems to make that question one that would be hard to answer in the negative if someone were involved in just about any aspect of health care.

 I wonder how many readers might consider the article in a different light if following the article there was a statement that Dr. Frist was a partner in a firm whose income stream is dependent  on various health care entities. I'll bet more than a few readers might just think about the potential of influencing even though Dr. Frist is not on the actual boards of the companies in which he invests nor is he likely to be involved in anyway with the day to day operations of these businesses.Is the ICMJE form and the manner if which the form is answered really provide any useful information to journal readers ?  Do the editors of medical journals need to have any oversight over the ICMJE form answers?Does the COI statements appearing regularly in medical journal mean anything at all?

I am not suggesting that Dr.Frist's views on the various topics covered in the NEJM article were determined or even influenced by considerations of what the author's  recommendations would have on the income streams of the various health care business entities in which he is invested.But it is certainty possible that readers of the article just might get the impression of potential influence if they were informed about them in the COI statement.

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