• Editorial - Our Ethical Responsibility

    Letter From the Editor

    One of the important changes that you and I have witnessed in the medical profession during our careers has been a better appreciation of the relationship between medicine and industry.

    When we began practicing several decades ago, there wasn’t a great deal of concern about how industry’s promotion of medical products influenced the way we cared for our patients. We seemed to be convinced that no favor a drug company could shower on us would ever mislead us from our sacred duty of always putting our patients’ best interests first. Maybe we were naive or trusted too much in the integrity of our profession. But looking back on it through the perspective of time, it is clear that we were at least putting ourselves at risk of being inappropriately influenced.

    For me, it began the week I graduated from medical school, when a drug company gave all 100 of us a handsome, black leather “doctor’s bag” with our names engraved in gold. Of course, lest we forget, the drug company’s name was also on the bag. I still have that old bag, and I’ll bet many of you have one also.

    In later years, as my career was developing, the pressure intensified, as some companies seemed to think my opinions might influence those of my colleagues. This led to the dinner talks and other industry offerings that we all remember. Somewhere in the 1980s, a drug company asked the late Dr. Thom Zimmerman and me to give a series of weekend programs at resorts for which the physician attendees would have all expenses paid for themselves and their spouses. We agreed only with the caveat that our talks would not promote their product. But that hardly assuages the uncomfortable feeling I have today of participating in those events.

    In 1985, the ophthalmologist and author Robin Cook published “Mindbend,” a medical thriller that dealt, in his inimitable fashion of intrigue, with the concern about how the pharmaceutical industry may influence the practice of physicians. It was a time when our collective conscience was beginning to question the ethics of our interaction with drug and medical device companies.

    Today, the landscape of our interaction with industry is far different from that described in my early experiences, as our profession, the pharmaceutical industry and government have attempted to establish ethical guidelines. And yet, the risks are still apparent.

    There was, for example, a disturbing story just last year in which a prominent clinician-scientist resigned from a leading medical center after admitting to accepting millions in industry payments (“Medicine’s Financial Contamination,” The New York Times, Sept. 16, 2018). Few of us, of course, were ever in a position to be tempted on such a large scale, but it serves to emphasize the potential influence that drug and medical device makers may still have on our profession.

    In fairness, we must acknowledge the positive role that industry plays in continuing medical education and in major philanthropic donations that benefit programs like ONE® Network and the Museum of Vision, not to mention the advances in drugs and devices that help our patients. But we must also recognize that pharmaceutical industry’s inherent mission is to further its business enterprise, while ours is to serve our patients, and we must not be fooled into thinking that the actions of drug and device companies have no influence on us.

    Although most of us are now retired and hopefully no longer susceptible to the influence of industry, we can’t help being concerned about the future of our profession and the pressures our younger colleagues will face. So what can we do? Some of us may still be in a position to influence policy within the medical profession or in our government. The Times article cited above suggests several considerations for future policy change: ban paid appointments to outside boards; create uniform reporting standards; establish real consequences for violations; and build a culture of transparency, for example taking disclosure rules seriously.

    For those of us who are no longer in a position to influence policy, we may still have the opportunity to interact with our younger colleagues who represent the future of our profession. Perhaps by sharing with them the experiences we have had in our careers and the concerns we have regarding the influence that the pharmaceutical industry could have on their practices, it may guide them through the ethical dilemmas that they will face. And, at a minimum, we can encourage our next generation of physicians to strive to perpetuate the venerated integrity on which our profession is founded.