In the 5th Century B.C., an important document was created entitled the “Hippocratic Oath.” It is a pledge taken by medical students to defend the ethical standards of the profession. “I will observe and keep this underwritten oath, to the utmost of my power and judgment...” Even though there have been more revisions to this document, and scholarly discussions regarding whether Hippocrates was in fact the author, the original document is not a law. So, there are no direct consequences for violating the oath.
Inherent in this document is the fundamental concept of fiduciary responsibility and avoiding conflicts of interest. Unfortunately, patients today continue to sustain serious harm as a result of physicians and their organizations compromising their responsibilities by pursuing private financial gain.
In a recent editorial in the “Journal of Patient Safety,” their former editor and expert in patient safety Dr. Charles Denham was accused of having undeclared conflicts of interest in several articles he published in the periodical. In fact, earlier this year, he was accused of taking kickbacks from a medical supply company to endorse their product by influencing the National Quality Forum, where he was a co-chair of safe practices. If true, these allegations are particularly disturbing.
One method used by physicians to stay current is the reading of peer-reviewed journals. When articles are written based on valid research properly vetted by peers, both physicians and their patients benefit. It is critical that the information that is published is not biased or financially conflicted. When this happens, patient care becomes compromised, and the trust inherent in and necessary to our system is lost.
Publishers of medical journals must set conflict of interest policies and define the relationships that are acceptable and those that are not. Collaborations must be prudently regulated and, when necessary, prohibited to protect the well being of patients and encourage scientific integrity. Only then will we ensure the public trust, and truly do no harm.