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Concerns about conflict of interests apply to Grassley, too

By JESS FIEDOROWICZ
Des Moines Register
June 7, 2009

Over the last several years, Iowa Sen. Charles Grassley has aggressively campaigned against conflict of interests in academic medicine. He has criticized academics at dozens of institutions across the country, including but not limited to Harvard and Stanford universities. His primary targets are government-funded researchers who had undisclosed or inadequately disclosed ties to the pharmaceutical industry. The concern as detailed by Grassley in a letter to the chancellor of the University of Texas system is that “funding from pharmaceutical companies can influence scientific studies, continuing medical education, and the prescribing patterns of doctors.” Beyond disclosure of this conflict, Grassley demands an explanation of how “the interest has been managed, reduced, or eliminated.”

The disclosure and management of conflict of interests is indeed an important concern for those with an ethical and fiduciary responsibility to act in the best interests of others. Physicians have a responsibility to act in the best interests of their patients. Elected officials have a responsibility to act in the best interests of those they represent. We should be pleased Grassley has brought up this very timely, relevant issue.

The Senate Finance Committee, on which Grassley serves as the ranking member, has recently taken up the issue of health-care reform. While potential conflicts of interest for committee members have not been formally disclosed as part of the process, the data is publicly available. According to MAPLight.org, Grassley received $376,893 and $243,722 in campaign contributions from the insurance and pharmaceutical industries, respectively, from 2003-2008. During this time, Committee Chairman Sen. Max Baucus (D-Mont.) received $592,185 and $524,813, from the same respective industries. There does not appear to be any plan to reduce or eliminate these apparent conflicts of interests. Yet, any conflict may interfere with the ethical and fiduciary responsibility of our representatives, and the behavior of committee members suggests conflicting interests.

In several polls, the majority of Americans and physicians support national health insurance. A single-payer, national health-insurance system could save over $350 billion annually by reducing unnecessary overhead and bureaucracy and is the most affordable option to provide universal coverage. Advocates for single-payer, national health insurance, however, were denied a seat at the table in Senate Finance Committee hearings led by Baucus, who instead included industry “stakeholders.” Grassley has gone even further, opposing any public plan, arguing “that the government is an unfair competitor” to private insurers. The position of the private insurance industry appears to be well represented. Populist proposals such as single payer have been ignored in the setting of strong industry opposition.

Money and power have tremendous influence in Washington. Grassley’s crusade against conflict of interests in academic medicine may provide insight into how we can combat similar undue influence in Washington to protect our democracy. Our representatives need to not only disclose conflicts, but also take measures to reduce risk. This minimally requires open inclusion and serious consideration of proposals with proven effectiveness or popular support, such as single-payer, national health insurance. It further requires re-identification of the American public as the real “stakeholders.”


JESS FIEDOROWICZ is an academic psychiatrist. Contact: mkejess@yahoo.com