Right now, there's a lot of talk, especially in North America, about the subversion of medical authorities, which presents a bioethical violation of potentially colossal proportions. Two doctors in Southern California were recently arrested for a purported $250 million weight-loss scam, and as isolated as this seems on the surface, it speaks to a broader epidemic, so to speak, of doctors taking money for unethical actions and influence in general. A textbook considered in the US to be, for all intents and purposes, the Bible of internal medicine, has reportedly just been found to contain certain content as a result of uncovered conflicts of interest. Moreover, at least ten major Big Pharma companies in Canada are now publicly listing how much money they give to hospitals, doctors and healthcare groups, which may very well cause innumerable conflicts of interests throughout North America and beyond.

Harrison's Principles of Internal Medicine is referred to as "the most recognized book in all of medicine," and in its 20th edition now, it represents a long-established influence on med students for generations. Researchers now claim to have proven in a study that Harrison's is only one of several major medical texts compromised by financial interests that the authors have consistently neglected to disclose to students despite those interests pertaining directly to the subject matter being taught therein. The study found that over $11 million went from the developers of leading drugs and medical devices to the authors of Harrison's Principles of Internal Medicine in particular from 2009 to 2013.

It's significant that the authors of texts like Harrison's should be found to have been taking so much money from these industry interest groups in exchange for bending content to favor certain outcomes. It suggests that some practices previously considered to be well-founded might actually have alternative methods that work just as well but aren't being explored due to what med students have been allegedly brainwashed to think all this time. One physician who has served as a long-time Harrison's author thus far took almost $870,000 — some but not all of which was funding for research — according to ProPublica's Dollars For Docs database, which catalogs and lists payments given to doctors from drug companies.

The authors of Harrison's, in particular, are in the spotlight now because they also happen to consist of major patent holders across several respective fields, and this represents an unrelated yet equally egregious conflict of interest that also has not been disclosed lo these 20 published editions. The study in which these findings were revealed was published in AJOB Empirical Bioethics. It reads, "These findings indicate that full transparency of [authorial conflicts of interests] should become a standard practice among the authors of biomedical educational materials."

The research team was led by Brian Piper, a Geisinger Commonwealth School of Medicine neuroscientist based in Scranton, Pennsylvania. The authors were careful to note in the study that the cross-referencing of fees from biomedical companies and the awarding of patents doesn't inherently prove bias, but they also explain the broad influence of the perceived authority and wide readership of the texts in question like Harrison's. They didn't find any of this surprising either. Piper himself analyzed this topic with his colleagues back in 2015 and published a paper on it then, too.

"Sadly, after six years doing these types of studies, we were not surprised by these findings," Piper says. "However, we continue to be surprised that the publishers and authors of medical textbooks do not have the same transparency standards about conflicts of interest that have become widely accepted for clinical trials and other primary sources."

Ten of the large drug companies in Canada releasing financial disclosures on their respective websites now have been reportedly doing so since June 2017. These include GlaxoSmithKline, Amgen, AbbVie Corp., Roche, Bristol-Myers Squibb, Purdue, Gilead, Novartis, Eli Lilly and Merck. The first, GSK Canada, has been leading the voluntary disclosure, and they disclosed some $2 million to healthcare providers and related institutions back in 2016. Merck Canada similarly disclosed upwards of $7 million for healthcare professional services with an additional $2 million for health organizations and patient groups. Roche Canada disclosed $8 million to the same organizations and physicians.

This is what bolstered a lot of the information in ProPublica's Dollars for Docs database, which Piper and his team were able to use to corroborate findings of conflicts of interests. ProPublica cataloged all the information released by these corporations when the companies jointly announced almost exactly a year ago now (March 2017) that these disclosures were forthcoming. They made the announcement through the industry group, Innovative Medicines Canada, which stated that the release of these figures was intended as a manifestation of their commitment to "enhancing trust by disclosing the payment voluntarily."

The bioethics that pertains to what drugs and medical devices are best suited for what purposes and why make no allowances for this kind of behavior, and some fear that the voluntary disclosures only serve as a means to feign transparency to enough of an extent that the status quo can be effectually maintained.

[researchpaper 리서치페이퍼= Cedric Dent 기자]