Of Money and Trust in Medical Care Redux

Should we be concerned about financial conflicts of interest (COI) between doctors and the pharmaceutical industry? Some people will say no as there are clearly doctors who celebrate the relationship. Others say that it does not matter to patients, but the evidence says otherwise. Financial COI is different from other types of conflicts because it is voluntary and can be refused. Finally, it is not just the large gifts that are a problem, the small ones also create a “gift relationship.” Drug companies know about this and spend billions on promotion with good effect from their point of view. Companies also woo doctors who honestly hold pro-industry points of view to speak on behalf of the companies. There are still multiple examples of financial COI, and although there are isolated examples of improvement, this is still an area of deep concern.