A Deadly Conflict of Interest
Last week, Farid Fata, a Michigan doctor, was sentenced to 45 years in jail for subjecting more than 500 patients to cancer treatments they did not need so he could collect millions in insurance payments. According to CBS News, he told healthy patients they were sick, he told sick patients they were dying, and he told dying patients he was their only hope. All in order to file insurance claims.
He valued money more than the lives of his patients.
Conflicts of interest in health care are not new. This is one of the reasons the Physician Payments Sunshine Act was passed in conjunction with the Affordable Care Act. This law requires that payments made to physicians be reported in a database maintained by the Centers for Medicare and Medicaid Services. It is hoped that transparency will help prevent bias from negatively impacting health care.
Safety and health professionals also face potential conflicts of interest in situations that impact the health of others. These situations are usually more subtle and difficult to recognize than those that occur in medical practice. They are more to likely involve conflict between the disclosure of potential harm to others vs. the loyalty owed to employers or clients. In other words, being a whistleblower or being a team player.
One area with a significant potential for bias is risk assessment. The potential for bias arises throughout the risk assessment process – from the selection of what information is included or excluded to the exposure assumptions made, the level of uncertainties selected and the reporting of the results. According to Ruthann Rudel, director of research at the Silent Spring Institute, it’s “about what questions you ask, what uncertainties you leave alone and which ones you decide of focus on.”
We are all biased. More importantly, we are often poor judges of our own bias.
This is why it is important for organizations to establish systems to double-check decision-making processes – particularly when the results impact the health and safety of others.
Related Resources:
The Institute of Medicine defined conflict of interest as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.
According to the ABIH Code of Ethics – CIHs need to “assure that a conflict of interest does not compromise legitimate interests of a client, employer, employee or the public and does not influence or interfere with professional judgments.”
As stated above, we are often poor judges of how we would act in conflict of interest situations. In a study of radiation oncologists, whereas each physician consider himself or herself immune from being influenced by gift giving, a third of those responding thought their peers would be influenced. Surveys of other professionals have found similar results.
For an interesting discussion of potential bias in the setting of Texas air pollution guidelines, check out the article Texas weakens chemical exposure guidelines, opens door for polluters.
