Disclosures in Medicine Have the Opposite Effect?
You can’t attend a lecture or give one at a medical conference without seeing disclosure statements. The idea behind them is a good and well-meaning one—the audience needs to know if the doctor who’s lecturing takes money from a drug company or manufacturer so it can filter the advice accordingly. However, some new behavioral research shows that these disclosures actually have the opposite of the intended effect; they make the audience more likely to follow the biased advice.
Conflicts of Interest in Medicine
With the decline in physician reimbursement due to managed care, some physicians have turned toward industry to supplement their income. This type of arrangement can take many forms. For example, the doctor may lecture on behalf of a drug or device company to educate other physicians about the products that are being sold. Another common arrangement is when the doctor is paid to perform research on behalf of the company. This last one is very lucrative as once the infrastructure is developed, the physician can earn big money churning out studies.
While the universities should be the cleanest in this regard, often it’s just the opposite. Many university physicians earn less than their private-practice counterparts, so in my experience they are more likely to turn to industry to supplement their incomes. This often takes the form of research or consulting fees.
Propublica has developed a great tool to see if your doctor takes money from industry. It lets you see from whom and how much. It’s not always 100% accurate. As of this morning, I’m proud to say that my grand total is $13. In fact, since I have a policy not to let drug company reps into my office and haven’t attended a drug function in many years, it’s a mystery how I even got that much. I would suspect that it got assigned to me because some drug company rep tagged me on their report when my old physician’s assistant attended a lunch.
The Psychology of Disclosures
The whole purpose of letting an audience know that you took money from company X to do Y is that the audience will then filter your advice accordingly. However, does that really work? Based on some recent research, not really. For example, in one study, disclosure by a trusted authority actually increased the audience’s burden to comply with that advice—having the direct opposite effect.
This problem for disclosure also extends to things like specialty bias. For example, it’s well known that surgeons often suggest surgery more commonly than nonsurgeons. However, in another recent study, when surgeons disclose this bias, it doesn’t make the patient less likely to end up in surgery or the surgeon less likely to recommend surgery—it has the opposite effect. The patient is more likely to choose surgery, and the physician is more likely to perform surgery!
Are There Solutions?
The author of the two papers cited above has some recommendations based on his research:
- The disclosure is provided by an external source rather than from the advisor.
- The advisee has an opportunity to change his/her mind later.
- The advisee is able to make the decision in private.
The upshot? These days in medicine, a good number of doctors take money from industry. It looks like the disclosure systems designed to help physicians and patients make informed healthcare decisions are having the opposite of the intended effect. Does this mean we should scrap the whole system? Not sure. However, the next time someone discloses something, you may want to walk away and think about it before you make a reflex decision to go with the advice anyway!