Myths in Medicine: The Epistemology behind so-called “Conflicts-of-Interest”

As tempting as it may be for one to believe that the medical products industry is free of corruption and that there are no people acting for heinous purposes, it’s difficult for anyone to take a position on issues in the health care industry without extensive knowledge. With the negativity of the discourse and multitude of issues surrounding making sure that we can provide for the health of everyone, it would be very refreshing and relieving for one to believe that all of those are simply results of misinformation and bad statistics.

In “Pharmaphobia” Dr. Thomas Stossel delineates his decades of research and work on studying the so-called “conflict-of-interest” issues in the medical industry. Stossel begins with general statements about how the health care that we receive today is, for better or for worse, much better than it has ever been in the history of forever. The modern medicine Dr. Stossel packs his book full of scientific studies, anecdotes, and policy analysis in his journey through the history of medicine up to the problems we face today. He makes the contrarian claim that there has been a “conflict-of-interest” movement founded on unjustified claims about responsibility of results, exploitation of research, flawed policies, and a number of other lofty subjects. As a result, we end up with unnecessary taxes on products, price controls, misconstrued research data and other causes that thwart medical innovation and progress.

Before we continue to explore these giants problems facing the medical industry, I’d like to take an aside and discuss certain epistemological approaches We tell ourselves to believe what is right and avoid what is wrong. What exactly does this mean though? As the moral value of knowledge lies on the foundation of what is true and what is false, it would be reasonable for us to ask ourselves what right we have to believe things that are true. Taking this a step further, we may posit that, by believing the truth, we are attempting to avoid believing things that are false and to have the most comprehensive set of beliefs as possible.

“The ‘flat earth’ vs. ’round earth’ is not a difference in opinion. It’s a matter of right & wrong.”

Consider two different approaches to solving a murder case. In the first approach, we choose to only use information given to us by evidence. In the second approach, we regard information by evidence as well as that information which we theorize. Which approach should we use? The former gives us a lesser chance of being wrong, as we take fewer risks with what could be true or false. The latter gives a greater chance of knowing more information. One might argue that you should believe something it  true to a certain degree of probability. Maybe there is a certain risk that we can take with the possibility of believing something that is false. But before we can confront knowledge as a microeconomics problem, things get more confusing when we confront paradoxes such as the preface and the lottery. Hopefully it should be more apparent why our right to have knowledge brings about issues upon close inspection. The epistemology in our approach must align with the appropriate rights to knowledge in research, industry, practice, or any other part.

These challenges to our knowledge seem devastating (and they’re only the tip of the iceberg of epistemology), but there are ways for us to try to make sense of things. One may suggest that beliefs about which we confidently believe to be true are different from those beliefs that we believe true during inquiry. This way, there is a certain context to the truth of beliefs that we determine to be true. In other words, when we take for granted that a certain thing is true, then it doesn’t matter whether or not we regard it as true in the context of inquiry. Does it truly make sense to regard a certain belief as true in one context yet false in another? Well, throughout the history of science and medicine we see theories that change time and time again through the self-amending scientific method. Our current models always match existing data and information, and our theories make sense to us at the moment of what is available of scientific research. But, since most theories and models eventually are replaced by bigger, better ones, then it is reasonable to assert that our beliefs are false in the context of inquiry (since there is a very high chance that, someday, they will be disproved), but, as we are confident with the knowledge of those beliefs, we can believe they are true for now.

“principle, that instances, of which we have had no experience, must resemble those, of which we have had experience, and that the course of nature continues always uniformly the same. (Hume “A Treatise of Human Nature” I.III.VI)

Evidence-based approaches to medicine have been criticism by scientists and philosophers, or both, such as Mario Bunge. Bunge would remark that evidence-based medicine “has only strengthened the empiricist tendency to accumulate undigested data and mistrust all theory.” Why should we throw away theory and hypothesis to only limit ourselves to the what may appear more “truthful” as empirical science? It may be appropriate to use the word “skepticism” here not in the sense that we are trying to believe as little information as possible to avoid the risk of believing something that is false, but applying skepticism to our theories of research and regulation in medicine to get a better understanding of the underlying assumptions that govern our lives. Any attempt to circumvent possible motives and purposes by mankind by putting our entire faith into the numbers and graphs given by scientific experiments does not allow the theoretical lead that should guide medical research. And, the more faith we put into developing models that we can use for developing medical products, the greater room we have for skepticism. We need to ask ourselves what are the true causes of the issues we face in medicine. If we don’t correctly identify the proper causes and effects of the issues, then, as Stossel explains, the conflict-of-interest myth will continue like a foggy, intimidating machine that envelopes various sectors of the American public.

Whether or not we call them “conflicts of interest” it is true that there have been dreadful instances in which the truth of science has been shrouded for other motives. When internist Barry Marshall and pathologist Robin Warren were working on a treatment for stomach ulcers, the cure, antibiotics, were cheap and easy to find. But the gastroenterologists had other ideas of the 1980’s had other ideas.

During that year Robin and I wrote the full paper. But everything was rejected. Whenever we presented our stuff to gastroenterologists, we got the same campaign of negativism. I had this discovery that could undermine a $3 billion industry, not just the drugs but the entire field of endoscopy. Every gastroenterologist was doing 20 or 30 patients a week who might have ulcers, and 25 percent of them would. Because it was a recurring disease that you could never cure, the patients kept coming back. And here I was handing it on a platter to the infectious-disease guys.  (source)

Ultimately, the two ended up experimenting on themselves to prove to the world that H. pylori, not stress, spicy foods, or anything else, caused stomach ulcers. More importantly, we see that, even as recent as the 1980’s, there were still causes for disease that we are unable to completely “rule out.” There are also issues between medical journals and doctors themselves in asserting what is actually true and false about diseases and treatments.

What are the best ways for us to dispel the Conflict-of-Interest myth? Maybe it is more appropriate for us to search for evidence of collusion or similar ethical issues in the actions among researchers and practitioners before taking for granted what we may imagine to be the case. But, before we can do that, we must ask ourselves, do we really know anything?

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