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To the Editor

      I read with serious interest your editorial
      • Alpert J.S.
      Doctors and the drug industry how can we handle potential conflicts of interest?.
      in The American Journal of Medicine, February 2005 (issue), entitled “Doctors in the Drug Industry: How Can We Handle Potential Conflicts of Interest?” As you pointed out, the potential for conflict of interest has existed in the profession of medicine long before the 21st century. I am a proponent of disclosure, but I am skeptical of databases. I personally would have no problem telling my patients (as I have in the past) that I have provided education conferences for drug company A, drug company B, or drug company C. I frequently point out that I often speak for competing companies who have products they market to essentially the same doctors for essentially the same medical condition. I do not have any qualms about doing this because I am not ashamed of it. I would not be ashamed to have my name listed in yet another database. I would be scared to death, however, that the information in that database might be misused. Knowledge is power as they say, but it can be power for good or power for evil.
      Here are my questions for you, assuming we should all band together and create such a database:
      • 1
        Who organizes the database and how is it funded? Web sites and databases do not exist in a vacuum. Do all drug companies pay some sort of “tax” to support this? Is it a university-driven phenomenon? Do we invest a single individual with the title of “ethics czar”? It seems there exists a conflict of interest even from the inception of setting up this particular database.
      • 2
        How do we instruct people in its proper use? For that matter, who decides what use of this information is “proper”? I am not sure I would have any clue as to what to do with this information. This is especially true when doctors might obtain honoraria or other remuneration from pharmaceutical companies that have a medication without competition. Because I take money from company X to promote product Y, which has no competitor, does that mean that patients should skeptically look at me when I write prescriptions for this drug?
      • 3
        So what if my colleagues take honoraria and stipends from pharmaceutical companies? I trained with a prominent rheumatologist who is the editor of a major textbook. On the basis of the disclosures that are made at the ends of published articles that carry his name in medical journals, I am certain he has received remuneration from several different pharmaceutical companies. When I call him on the telephone and ask his opinion about such and such treatment for so and so patient, am I supposed to access this database to be sure that my information is not tainted?
      • 4
        I think your goals are laudable, but as the cliché goes, “the devil is in the details.” Already there are more databases than you could ever possibly imagine that have your name in them. As a matter of fact, hardly a month goes by that there is not a report concerning “theft” of “confidential” data regarding personal information such as Social Security numbers and telephone numbers or even bank account numbers from big companies who maintain large files on computers. Exactly how much additional personal information am I going to be asked to provide to this database, and what reassurances will I have that the information will not “fall into the wrong hands” as has happened so many times before? To summarize, this is a great idea, but I question the details of its implementation. I would be very interested to hear what answers you might provide.

      Reference

        • Alpert J.S.
        Doctors and the drug industry.
        Am J Med. 2005; 118: 99-100

      Linked Article

      • The Reply
        The American Journal of MedicineVol. 118Issue 10
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          Thank you for your thoughtful letter responding to my recent editorial. You are absolutely right that “the devil is in the details” with respect to the suggested Web site for listing the names of physicians, companies involved, and amount of money received. The entire process would, of course, have to be negotiated before it could start. Let me give you a “rough draft” of one possible way to create and pay for such a Web site.
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