15 Jul It’s All a Question of Integrity

It’s a Saturday morning. I just finished my second cup of strong coffee and my reading of an “Opinion” article in the Wall Street Journal describing “…Dr. Stossel, a hematologist and medical researcher…who is reawakening the conflict of interest argument.” During my surgical residency, my own research was supported by private companies as well as the United States Army. I never considered such financial assistance as a “conflict of interest.” It was merely an interest group supporting research that could be beneficial to their goals. I certainly never looked at the work done as needing predetermined results. Why? It was about the integrity of the individual doing the work. As a young researcher whose fervor for knowledge continues to this day, it never occurred to me to design an experiment so that the outcome would be assured. The hypothesis was either proven or supported by the experimental results or it wasn’t. More commonly, the data led to inconclusive results, experimental redesign, more data and finally a decision regarding the original hypothesis. Abandonment of the original concept was always an option.

Of more immediate concern to me are articles that I have had published and seminars I have given which have needed to include a “possible conflict of interest” statement. Do I really think I am conflicted in what I write or what I say? No, I do not but such a requirement has now become common because company sponsorship or grants of aid, etc., have become a stigmatized form of financial support that all research requires even when it is done at third party facilities. If I did or financially supported my own research, no matter how disciplined and methodical the process, the data obtained would immediately by suspect for no other reason than the suspicion that I lacked integrity. It would be assumed that I would not be obliged to tell the truth.

But the problem of believability is much worse since the third party data is also suspect if it was supported by an interested party suggesting that favorable results were obtained to promote additional financial support. Is there no one left with the integrity to seek the truth? Should we discard the results of research if it supports the value of a company’s products or services? Of course not but to do so we must accept an author’s methods and conclusions as based on his or her integrity. Is there a back-up to such criticism? Absolutely! It is called repeating the experiments at another laboratory but that takes time and money and authorship. Why bother when disparagement and ridicule of published research data contrary to a competitor’s marketing hype can get media coverage?

More to the point, surgical facilities cry out for documentation to support purchases for their operating rooms, preferably from independent laboratories. When available, such data should be used by hospital committees for their cost-effective analyses. If these studies are to be useful, however, those charged with decision-making must accept that such studies were performed by people with integrity and that their work was supported by companies that simply wanted to know the truth about the value of their products or services.

Contracts and cost containment are important but so too is a commitment to improve patient care based on claims with evidence-based documentation.