For the record, I forgot to mention…
Our society today is obsessed with transparency, and the need for full disclosure, and revealing all conflicts of interest consumes most of our time and energy in comparison to the time spent actually focusing on issues. We hear a speaker and we wonder who is paying for the talk and what the speaker might be hiding. We read a report and we have to consider the source. And as for patients, forget about it (not spelled correctly, sorry New York!)—they care more about side effects and how much we are reimbursed for writing high-priced drugs, rather than actually believing it is our responsibility to do what is best for them.
So my lovely bride, who went to a lot of hard work to make sure my 50th birthday was a memorable celebration, decided on the following Sunday afternoon she would pay me back for all the Packer games she had to watch by turning on a cheesy Bollywood movie with all of the singing, dancing, drama, and predictable plots that make Indians hide from their heritage. This one was interesting in that the main female character, who of course loved her childhood friend from afar, could not express her devotion directly. So she signed a friend’s name on the letters she wrote to him. As you would guess, he fell in love with the friend instead of her. The love triangle endured for three hours until the musical and poignant ending when, finally, the big truth was revealed to all and they ended up together in true Bollywood fashion. How it ended, with the shame of her not being truthful, or disclosing her conflict of interest in this case, almost cost her the true love she sought but could not claim. Of course, my disclosure was that I was bored senseless and lost out on a nap.
In the end it occurred to me that there is a large divide in the impact of when conflict of interest, intent, bias, or even a hidden agenda are not fully disclosed. The results can be damaging, personally and/or professionally, intentional or not. Think of all the scenarios we face head on or hear buzz about in dermatology: not disclosing references in a paper, quid pro quo in prescription writing and professional relationships with industry, using someone else’s work without acknowledgment, participating on a committee or advisory board with a conflicting bias, voting on a policy or influencing change without disclosure, or the cardinal sin of blurring the boundaries between patients when secondary gain is the intent.
These are just a few examples that we may not think about until it is too late for outcomes to be remedied or reversed, and often might not have any impact on anyone else but the offender. In the example of the movie, the girl wasn’t just cheating herself by not being honest, she hurt the parents, the other suitor who pursued her, and of course the eventual jilted friend, even though after the pain she won the heart of her true love…who also was the one who busted her in the first place.
An article written by Dr. Harvey V. Fineberg,1 got into the nuts and bolts of how losing trust is devastating to the image of physicians to patients, policy makers, and the public eye. It is a good assessment of the global issues surrounding full disclosure, because physicians and our ways of doing things are under a microscope with a blazing hot light. Trust, per this assessment, cannot be compromised, or we will find ourselves swimming upstream even harder. It was a nice change to read. Although the usual editorial2 about pharma and COI—which was nicely written by another former academician Dr. Allen S. Lichter—also reminds us to be transparent.
So I leave you with a few pearls: stand proudly by your disclosures and divestiture, find a way to see the outcomes when disclosure is not clear in any situation, and most of all, if your wife puts on a Bollywood movie…run.
— Neal Bhatia, MD
Chief Medical Editor