Sunday, February 16, 2014

Patient Safety and Medical Professionalism: How Far Do the Conflicts Go?

Recently, the US Department of Justice levied a 40 million dollar fine against CareFusion, makers of ChloraPrep® surgical skin antiseptic agent, because of kickback money paid to one member of the National Quality Forum's board, Dr. Charles Denham, MD.  As a result, it's become clear that much of the physician demonizing and marketing hoopla surrounding the patient safety movement might not be just about patient safety, but rather more about a money grab.  And it hasn't stopped there.

We have now learned that Christine Cassells, MD, former President of the American Board of Internal Medicine (ABIM) and the current President and CEO of the National Quality Forum has her own conflicts of interest since she was also serving as a paid consultant to several organizations who stand to benefit from the patient safety and quality initiatives created by the National Quality Forum.

Fool me once, shame on you.  Fool me twice, shame on me.

Given these ongoing revelations, it seems only logical to investigate if other conflicts might exist with these same doctors who make their living in these professional society circuits, especially when they serve as authors of papers outlining how doctors should behave professionally.  After all, the seemingly well-intentioned paper entitled "Medical Professionalism in the New Millenium: A Physician Charter" was published by Ms. Cassell's former organization that she lead at the time, the American Board of Internal Medicine (in conjunction with the American College of Physician-American Society of  Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine).

Not surprisingly, the current analysis is stunning.

For instance, remember the recent announcement from CVS Caremark about no more sales of tobacco products in CVS Stores splashed far and wide in the media - even by the President of the United States and the head of the Department of Health and Human Services?  Well guess who now serves as the Executive Vice President and Chief Medical Officer for CVS Caremark?  Troy Brennan, MD, JD, the lead author of the medical professionalism paper published in 2002.  While employment in the private sector after a lifetime in medicine does not violate current ethical standards, we have to wonder if it's medically professional to leave the medical profession itself to a greener, more lucrative pasture sculpted by one's papers that now are seen to serve corporate (and perhaps self-) interests more than patients, especially when they invoke the relatively new ethical requirement for social justice: that is, the needs of the collective should supersede the needs of the individual patient in the name of cost savings.

Another author of the medical professionalism paper, Walter McDonald, MD, also seems to feel it's medically professional to serve as executive vice president and CEO of the ACP-ASIM while also  serving as the senior vice president for QHc Advisory Group, LLC.

Double-standard, anyone?

Finally, let's not forget about Lisa J Lavisso-Mourey, MD, another of the paper's authors, who is President and CEO of the Robert Woods Johnson Foundation itself created from the riches of one of the sons of the Johnson and Johnson, Inc. fortune.  According to the organization's 2012 Form 990, Dr. Lavisso-Mourey pulls in a cool $918,519 in salary and benefits as its President and CEO.  Not a bad day job.  But why was she authoring an article on medical professionalism?  Shouldn't she have recused herself when not actually practicing medicine?  We should note that before joining RWJF, Dr. Lavisso-Maurey was senior vice president of the Health Care Group and member of the Clinton Task Force for Health Care Reform, so a political motive might have superseded a truly medical motive.  And since she was a co-author with Dr. Troy Brennan on the medical professionalism paper cited above, we should not be surprised that Dr. Lavisso-Mourey's had nothing but a glowing endorsement of the CVS Caremark decision to abandon tobacco sales.   After all, the back-slapping by these old pals goes way back.

For patients and hard-working doctors in the trenches, what does all of this really mean?  Can anything our professional organizations say to us and the public be trusted any longer?  Are edicts on medical professionalism, patient safety, prevention, EMR order sets with their "meaningful use" requirements,  more about a power and money grab than real ideals for patient care?

We have to wonder.

When any organization tolerates board members receiving kickbacks and ignoring cushy consultant positions that have clear conflicts of interest, a good, thorough, house-cleaning is needed.  And that house-cleaning should start at the top.  Anything else is window-dressing.

Without such a dramatic move, our professional organizations' credibility with those they pretend to serve will never recover.



Paul Kempen said...

The reply to this charter paper from Charles Haskil was quite pertinent:
It is understandable that the authors of the physician charter
omitted business integrity as an issue of medical professionalism,
given their premise that market forces are serving to erode the professional
values of our profession. Nevertheless, I submit that this
omission is shortsighted. I think it is time that we accept business
integrity as a component of medical professionalism and that we start
teaching this material to medical students as part of the core curriculum.

Maybe we need the ABMS and other executive docs to go back to "ethics School"

james gaulte said...

Great blog posting.If you consider the authors of the New Professionalism and go with the Mafia rule of follow the money, you see some interesting associations.The self righteous pronouncements of some of these thought leaders seems to clash a bit with what seems to be conflicts of interests and cashing large checks.

Anonymous said...

I'm just a patient, but a frequent one at some of the finest hospitals and practices in the East. I generally see above-avg. doctors. That said, they bridle at the notion that medicine is a business. They recoil when asked how much a procedure or other treatment might cost (just ballpark it please, doc). As if money were dirty. Some of them have relationships with suppliers that one only sees if one burrows into their public participation at conferences or in blogs where that might be disclosed. One wonders if shunning or blinding oneself from the business side of things because it is somehow odious, or too embarrassing in the sunlight, also makes them unconscious or uncaring about costs. I did walk out of a consultation with one of the top doctors at a top center when he said in response to a question about a procedure: What do you care, you have good endurance--as if it were free medical care. That's the kind of thinking that will ensure much deserved scrutiny and truly intrusive regulation.