Marg's French Horn Solo

Resolving the Conflict of Interest in Corporate Involvement with the Society of Critical Care Medicine and the Surviving Sepsis Campaign

A conflict of interest is a situation in which people have competing professional or personal interests. Thus, a conflict of interest exists only because the competing interests exist, whether or not there are improper actions derived from those interests.

The association of the Surviving Sepsis Campaign (the Campaign), the Society of Critical Care Medicine (SCCM, the Society) and corporate sponsorship by Eli Lilly (Lilly) was documented in a recent New England Journal of Medicine article (Eichacker PQ et al. Surviving sepsis — Practice guidelines, marketing campaigns, and Eli Lilly. N Engl J Med 2006 Oct 19; 355:1640-2). This article demonstrated a conflict of interest within the Campaign that may have biased the sepsis guidelines. The authors argued that there should be a "firewall" between industry and guideline development.

Opinions from executives and members of the SCCM were published in the Society's journal Critical Care Medicine and elsewhere. They reasoned that although the guidelines were partly funded by Lilly, there was no corporate influence on the outcome. They cite the standard objective procedures used to formulate the guidelines, the integrity or the people and the process, the laudable goals of the campaign, and that the guidelines are being newly redone without corporate sponsorship.

In my opinion, the Society's reasoning is flawed. First, conflicts of interest may bias outcomes despite using the best procedures. Second, in configuring a new committee to redo the guidelines, the Society had used many of the same people on the original committee, as though the conflict of interest no longer exists. In fact, the SCCM has never disclosed the personal financial arrangements between individual members of the Campaign committee and Lilly. Thus, in my view, the major interest of the Society and Campaign are to spin an illusion that the original opinion of the Campaign was objective without testing that opinion by the scrutiny of new and independent sepsis and guideline experts.

There is no question that members of the Campaign had conflicts of interest as pointed out in the uncontested facts in the New England Journal article cited above. There is also no question that the published rhetoric from the society has not resolved whether the conflicts of interest affected the Campaign's recommendations.

Dr. Martin’s opinion piece, “Digital Doctoring” published on March 29, in the Boston Globe intrested me. My bias is that the technology of electronic medical records, physican order entry, and many other computer technologies intended to assist physicians and other health professionals are promising. Having admitted that bias I have to say two things. First, it’s a bias, there is no reason to stongly suspect that the promise will hold. Second, the current systems don’t have it quite right and may actually be doing more harm than good.

I have been using physican order entry and electronic medical records for the last 7 years of my medical practice in a hospital associated with Dr. Martin’s medical school. These computer systems can facilitate sloppy thinking by physicians. It is wonderful to read a patients medical record from any computer in the hospital. However, upon reading, I find that many of the entries have perpetuated inaccuracies by allowing cut and paste of previous false statements into subsequent ones. This in itself is not a unique problem to computer records. Yet cut and paste (cntrl-C, cntrl-V) makes this an attractively easy operation. With pharmacy systems, the templates for orders enable those who know little about the drug to order it according to a standard protocol. These protocols may not be correct for their patient and cause harm. These are two examples briefly described, but I find that those who grew up in the digital age, the younger physicians are more comfortable with going with the computer suggestion rather than considering the context of their individual patients. Frankly, Dr. Martin’s comments reflect a lack of knowlege typical of a medical school administrator who has been years out of touch with the complexities of patient care.