Another "Surprising" Headline about Conflicts of Interest

Today's New York Times has a brief article by Robert Pear with one of the most un-surprising headlines I can remember: "Doctors Who Profit From Radiation Prescribe It More Often, Study Finds".

Well, sure.

That doesn't mean I"m happy about it, of course.

I've written before about how easily humans are swayed, even by a pharmaceutical sales rep's "gimme" pens (full post, here), and about how hard it can be to see a conflict of interest, especially from the inside (full post, here), so I do sympathize... up to a point.

Today's article draws from a July 2013 report from the Government Accounting Office (full report, in .pdf format, here) on the recommendation of doctors for IMRT (Intensity-Modulated Radiation Therapy), a relatively common and costly prostate-cancer treatment.

The bottom line: "Doctors who have a financial interest in radiation treatment centers are much more likely to prescribe such treatments for patients with prostate cancer."

The report stated that,

The number of Medicare prostate cancer... IMRT services performed by self-referring groups increased rapidly, while declining for non-self referring groups from 2006 to 2010.... The growth in services performed by self-referring groups was due entirely to limited specialty groups -- groups comprised of urologists and a small number of other specialties -- rather than multispecialty groups.

The report explains that "self-referral" means that "a provider refers patients to entities in which the provider or the provider's family members have a financial interest", and goes on to explain that the Medicare beneficiaries are generally unaware of the financial connection.

For those of us on the outside, it isn't hard to see the conflict of interest.

But I can understand how easy it might be to overlook from the inside. A group of urologists may purchase the radiation therapy equipment, and honestly believe that their brand-new machine is better than anyone else's in town.

And it's possible that it is.

But wouldn't you want to know that the bills for the machine's use will eventually work their way back to the doctor who recommended that treatment center? (The GAO report recommends that "Congress should consider directing the Secretary of Health and Human Services ...to require providers to disclose their financial interests in IMRT to their patients.")

Disclosure is always a good first step. But it shouldn't be the only step. It's valuable to try to step outside of one's own perspective whenever possible: How will this action look to someone who doesn't know me?