“You’re out,” shouted Matt. Matt was the second baseman and bonafide schoolyard bully whose underlying goal was to win every game. “Fielder’s choice and I get to decide,” he declared as if he was a major league umpire. With sweat dripping from my brow, I dutifully left 2nd base in the sweltering summer of the mid ’60’s in Queens. After the game, I consulted a higher authority (my dad) who informed me that fielder’s choice did not give infielders the right to choose who is or is not out. It would be a conflict of interest, he told me. I brought this enlightened info back to my stickball overlord and was greeted by scorn and a subtle threat of possible physical harm in the future.
While learning about truth, honesty, civility and camaraderie in school, the real world of hidden agendas creeped in. New and improved Fruit Loops tasted exactly the same as the old Fruit Loops. Two box tops and $2.00 did not get you “life sized action figures” but ant sized plastic toy soldiers. Reality only accelerated with age. “This VCR is state of the art and will remain a standard for years,” the Circuit City salesman told me with a straight face in 1982 as I drained my bank account of $1,200. Obviously, the advertising on cereal boxes and a stereo salesman suffered from hidden agendas or conflicts of interest.
The world of medicine brought its own litany of hidden agendas. Pharmaceutical representatives extolling the virtue of their brand name products when a generic and a lower cost substitute achieved the same goals. I entered the profession during the era of drug sponsored free Caribbean vacations, five star restaurant outings, and “free” basketball playoff tickets. Was there a potential for bias in prescribing habits when you’re cutting into a filet mignon paid for by an acid reducer you haven’t used before? One would have to think so.
Transparency in medicine became clearer when government edicts regulated Pharma’s gifts to the medical profession. The trips, five star restaurants, and sporting event tickets disappeared. Finally, even complementary pens and trackpads were forbidden. Quite rightly, transparency in prescribing was demanded by consumers. Today, the consumer can check on their provider’s lunch reimbursements, Medicare payments, and Big Pharma consultant fees. A simple internet search will quickly reveal the truth regarding your doctors financial ties—if any— to pharmaceutical companies and the like.
Regretfully, most of the world operates with hidden agendas and conflicts of interest unbeknownst to the consumer or general public. However, to the world of medicine’s credit, regulatory agents have collectively required physicians to publicly reveal conflicts of interest. For example, if you are a physician presenting a paper at a meeting regarding your research on a drug, you must disclose any conflict you have with the company making or marketing said drug. Furthermore, your research paper must cite any conflict you have as well.
Certain areas of the field of medicine have escaped transparency and issues of reporting conflicts of interest. Lobbying has produced the DSHEA Act of 1994 which stripped regulation and FDA oversight from over-the-counter pharmaceuticals. Many over-the-counter medicines have not been subjected to vigorous oversight or proof of efficacy. Billions of dollars of products are bought that may have little or no assurance that they help or improve what it professes to do on the package information. Fortunes have been made from this lack of transparency to the patient slash consumer. It would seem, in the public’s interest, that a warning indicating that a product that has not been rigorously tested and proven in its stated efficacy, should be placed on the product packaging.
It seems that physicians and some areas of medicine are leaders in self-reporting conflicts of interest and public available transparency of these conflicts should be the standard applied to all businesses that interface with the public at large. For example, politics operates in the world of dark money facilitated by Citizen’s United and the death of campaign reform. So when a politician publicly espouses a certain political opinion, why do they not have to disclose any influence or conflicts of interest they might have that would benefit from their political stance on an issue? Doesn’t the American citizen need this transparency to be an educated voter?
Furthering this argument, Journalists in a variety of communication forums report information in the public’s best interest. Under their by-line in a newspaper or in a chyron on the bottom your television screen there should be a clear statement of any conflict of interest the journalist might have. If you own stock in a company that spilled oil into the ocean, I’d like to know that when you present information on the oil-spill.
A rational world should apply the rules that govern conflicts of interest or hidden agendas in a schoolyard playground the same as they should in the world of medicine, politics and journalism to name a few. Self-reporting, fairness, and truthfulness should be a minimal requirement for all who interface with the public who are purportedly looking out for your best interest.
Let’s level the playing field.
