Conflict of Interest 2.0 

CP Snow famously described art and science as the “two cultures”.  As much as doctors talk about the art of medicine, it is firmly aligned with the latter.  In the medical subculture, the unit of currency is publication of academic papers in peer-reviewed journals. The authors of these papers have traditionally had by-lines describing their academic and clinical affiliations as applicable.  However, over time, as eminence-based medicine has lost ground to evidence-based medicine, this has become decreasingly important.  What has become of greater interest is what potential conflict of interest an author may have.  It may seem trivial if a doctor has been taken out for dinner by a pharmaceutical rep from a drug company, but the literature suggests that it if researchers are in the pockets of Big Pharma the results of their research is more likely to be what their paymasters are looking for. 

Guidelines of every medical journal now stress that authors must also declare any conflict of interest.  Even if they claim to have none, this will be stated as a signed statement.  Andrew Wakefield’s famous 2003 paper in the Lancet stated he had no conflict of interest in stating a potential link between MMR and autism.  Later it was found that he was running a special clinic selling novel treatments for autism in Texas with another doctor who has authored similar papers.  There are currently few guidelines on declaring conflict of interest outside the sphere of research.

The BBC ran an article promoting some aspects of complementary medicine by Dr Michael Dixon.  This was reported just by using his name.  In the article, Dr Dixon’s byline describes him a GP with no mention of his trusteeship of The Prince of Wale’s Foundation for Integrated Medicine.  He is a visiting professor of Integrated Medicine at the University of Westminster.  The term integrated medicine in this context refers to treatment including complementary or alternative medicine.  Although some would say there is no such thing as alternative medicine, only that which works, and that which doesn’t. 

Of course, people have a right to free speech, and in the media it often makes sense to provide speakers for both sides of a contentious issue.  However, where relevant, authors should state any conflict of interest, even if the publication does not make this request.  Broadsheet newspapers already do this to a certain extent.  When a Member of Parliament writes an article defending or attacking the government’s record, their constituency and party membership is rightly mentioned. 

All in all, this comes down to not misleading the reader.  Advertisements are clearly demarcated in newspapers as they are not stating facts, nor have they come from a neutral point of view to reach a conclusion; they have started from a conclusion and are arguing a point.  Having a conflict of interest does not invalidate an author’s views in any way, it serves to inform the reader.

A revision to the Medical Act in 2006 removed the statutory obligation for doctors in the UK to live at hospital for one year after graduation, until full registration with the General Medical Council has been obtained. The government decided that although hospitals have accommodation built around them specifically for this purpose, first year doctors should lose this right. This was equivalent to a 20% pay cut. The British Medical Association co-ordinated a series of protests culminating in one large one in central London. This was largely ignored by the mainstream media. True, few other professions will give you a home free of charge but with the infrastructure there it makes sense. It’s beneficial to patients to have lots more doctors, albeit very junior ones, milling around in case they are needed. You’re also going to get better quality doctors if they are able to get into hospital at a moment’s notice in the middle of the night to see rare conditions or interesting disease presentations they might not otherwise encounter. These blocks of accommodation are now increasingly unused outside hospitals as the rent being charged isn’t highly competitive. 

It is therefore not highly surprising that the predominant response of doctors to the MP’s expenses scandal hasn’t been that sympathetic. If doctors have lost one-year’s use of concrete monoliths built in the 1960s, the sentiment goes, the MPs should lose their second homes including their moats, duck houses, love chairs and everything else. It certainly isn’t fair to have the taxpayer subsidise accommodation that is neither in Westminster nor the MP’s constituency.

RemedyUK have pointed out that doctors also fiddle the books to contravene the rules. However, this isn’t in order to make more money, or steal, it’s to do more work in contravention of the European Working Time Directive. Even with all this skulduggery, there is no way the NHS will be EWTD compliant in August. Ireland seem to have virtually given up, and decided that it’s cheaper to accept fines than pay doctors for what they actually do.

Tempting though it is to enjoy the schadenfreude at the backlash against MPs’ expenses, I believe MPs are perfectly entitled to second homes. Many work very hard representing Westminster in their constituencies as well as their constituencies in Westminster. Governing the country is important business, especially in these difficult times. MPs can be called down to London with not much notice to important meetings, and I wouldn’t want them to be distracted by worrying about carching the tube or finding a hotel. 

There is a solution simpler and cheaper than both the current inadequacy and the proposed extra bureaucracy. Acquire or build blocks of accommodation near Westminster. Make them comfortable and spacious, and provide the essentials of running water, electricity, heating and broadband. Allow MPs to live there free of charge. This would save a lot of paperwork, and free up the time MPs spend juggling their second home allowance around. They may not be happy with this proposal, but at least they’d still be better off than junior doctors.  There’s unlikely to be anything other waking them up in the middle of the night. Well, maybe guilt.

While some people would come up with other ways of dealing with it, Egyptian pop star Shaaban Abdel Rahim has written a song about swine flu.

Stephan Zielinski has taken a different approach my making music out of coding genes themselves.

The BNF is thing of wonder, listing all the drugs that doctors can prescribe.  For smoking cessation there are QOFs and different strategies available. A new one just came on the market: blogging addiction away. Quitters Blog has been set up towards this end.

Despite increasing numbers of consultations being held it is difficult to find them and know what’s going on. This website has send up an RSS feed so a reader can be used to keep up. However, even relative ‘experts’ in the medical field can become completely confused by all the management-speak used. Simply Understand exists to make it comprehensible, providing unofficial translations.

How exciting Macleod’s has made it into the: MEDICAL CLASSICS Section of The BRITISH MEDICAL JOURNAL : May 2009. Here are some extracts Clinical Examination by John Macleod

“Despite the book’s title its first mandate is the spoken art of history taking: the importance of an accurate one, the perils of a poor one, and the inexcusable “poor historian”. The most inspiring doctors have breathtaking vision, one moment passively surveying the patient’s entire human condition, the next seamlessly zooming in to the minutiae of their pathology. That is what places this book among the greats, as it trains the reader’s eye to share the same vision. If you wish to pass clinical exams, excel in the teaching of examination skills, and know your Schirmer’s test from your Schober’s, I would strongly recommend this book.”

BRITISH MEDICAL JOURNAL : May 2009

Take a look at at sample chapter of the new edition here

University of Guelph in Canada researchers investigated whether MRSA and C.difficile could be passed between pet therapy dogs and patients. The findings suggested that MRSA and C. difficile may have been transferred to the fur and paws of these canine visitors through patients handling or kissing the dogs, or through exposure to a contaminated healthcare environment. Read more here

Dog shaking paws. The dog that acquired C.difficile had politely shaken paws with many of the patients. (Credit: iStockphoto)

This is quite funny, or at least I think… have a look if you fancy: http://drawyourdad.com/