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October 15, 2007

On Conflicts of Interest

Conflicts of interest is one of my personal areas of interest (I write and speak on it), and has, IMO, an overwhelming effect on structuring health care delivery, financing, and policy.  In other words, virtually all of one's experiences with the U.S. health care nonsystem are profoundly affected by the myriad conflicts of interest that pervade both clinical care and biomedical research.  Because of the byzantine nature of our nonsytem, it can sometimes be difficult to apprehend the nature of these conflicts, though interested parties could begin by reading the Health Care Renewal or the HOOKED blogs.

The conflicts of interest are so extensive it is sometimes difficult to see the largest ones, standing right in front of our collective noses.  Here, I am referring to the fact that a large proportion of the FDA's resources are generated by the user fees paid by the industry seeking to win approval of their products.  In other words, industry sponsors much of the work done by the FDA.  I have had the bemusing experience, on several different occasions, of discussing this with providers or other health care practitioners, who are flabbergasted when I inform them of this arrangement.  They insist that it cannot be the case.  But it is, as this story notes.  The first paragraph captures the rub:

The Food and Drug Administration is moving with unprecedented speed to launch a drug research center to be paid for by companies it regulates.

Yes, well.  Note this is hardly a new development; user fees have long been paid for by industry.  This article refers to the sponsorship of the latest drug research center.

Of course, there are more than a few parties who argue that not only are these conflicts of interest of little concern, but also the FDA itself stymies innovation to such an extent that its regulatory powers ought to be either severely curtailed or abolished.  I will note here that I heartily disagree with these views and leave it at that.


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