Showing posts with label conflict of interest. Show all posts
Showing posts with label conflict of interest. Show all posts

Friday, September 20, 2013

Conflicts of interest in caring for candidates for kidney transplants

Harvey Mysel has posted the following (reproduced in its entirety) here:

How Conflicts of Interest Negatively Impacts a Patients Chance to have a Kidney Transplant

Patients who need a kidney transplant expect their dialysis clinic and/or their transplant hospital to provide them with information on the best medical options available. CMS (Centers for Medicare and Medicaid Services) requires dialysis companies and transplant hospitals to provide this information. These companies may “technically” abide by these rules however, the information is often vague and not very useful.
The Conflict for Dialysis Companies
CMS requires dialysis companies to ask: “Has the patient been informed of kidney transplant options?” A Yes/No box needs to be checked. A dialysis company’s mission is to dialyze patients, not to educate them about kidney transplants. It’s a conflict of interest for the dialysis company. Once a patient receives a kidney transplant, they don’t need the services of the dialysis company. What company will educate their customer to an option that will result in losing their customer?
From the statistics you can see there is a problem in the dialysis community. There are over 400,000 people on dialysis but only 98,000 are on the kidney transplant waiting list. By some estimates, 10% of all dialysis patients die every year. Many dialysis patients were good candidates for a kidney transplant when they first started dialysis, but after years of treatments their health deteriorates and the majority is no longer healthy enough to recover from a kidney transplant.
The Conflict for Transplant Hospitals
CMS requires transplant hospitals to tell their patients they can register at more than one transplant hospital. The primary reason to register at another transplant hospital is to be on a shorter waiting list. Providing this information to their patients is a conflict of interest for the hospital. A hospital might tell their patients they could register somewhere else, without letting them know the benefit of doing so. There are regions in the U.S. where the wait for a deceased donor kidney is 5-­-10 years, while in another area, which might only be a 1.5 hour drive, the wait time is only 12 months.
There’s another conflict that can develop for the transplant hospital. Patients are given excellent advice and encouraged to find a living kidney donor. There are many benefits of a living donor kidney versus one from a deceased donor.
The biggest benefit is a kidney from a living donor lasts on average twice as long as one from a deceased donor. Statistics show about one-­-third of all potential donors who are evaluated are not compatible with their intended recipient. Potential donors could have an incompatible blood type or the recipient has certain antibodies, also referred to as being sensitized that will result in rejecting this person’s kidney. High levels of antibodies can develop as a result of a previous transplant, a blood transfusion or for some women giving birth.
Better anti-­-rejection drugs and Kidney Paired Donations (KPD) also called paired exchanges, chains or swaps allow these incompatible donors to help their intended recipient by donating to another recipient who also has an incompatible donor. KPDs have the potential of adding thousands of kidney transplants a year if a centralized national program is developed and all incompatible pairs are registered in the same pool. Unfortunately there isn’t one centralized program, but many different KPD options. To read more about KPDs go to: www.lkdn.org/LKDN_Paired_Exchanges.pdf
Since there are many KPD programs, the likelihood of being matched with another incompatible pair is increased when you join other KPD programs. It’s a numbers game. There are exceptions to this, if there are many pairs with rare blood types or when a pool contains many difficult pairs to match due to the recipient being sensitized. To read more about the paired exchange conundrum go to:http://www.lkdn.org/LKDN_The_Paired_Exchange_Conundrum.pdf
Here’s the conflict. Hospitals are under no obligation to tell their incompatible pairs about the benefits of registering with other KPD programs. This could result in a patient going to another hospital to receive a transplant. What company will educate their customer to an option that will result in losing their customer?
Kidney dialysis and kidney transplants are very profitable for these institutions. It costs approximately $83,000 a year to provide dialysis services for one patient and a kidney transplant can generate approximately $125,000 for a hospital.
What could be done to help patients understand their options and remove these conflicts of interest?
For the dialysis companies, CMS could authorize an independent company to educate the dialysis patients about kidney transplants. There’s no shortage of organizations that are qualified to provide these services.
For the transplant hospitals, CMS and/or UNOS could also authorize an independent company to educate patients about registering at other transplant hospitals and include the options patients have when a potential donor is incompatible.
A kidney transplant, whether from a deceased or living donor is a life changing and complicated process. Patients who are in need of a kidney transplant need much more help in understanding the options available to them.
Harvey Mysel is a two-­-time kidney transplant recipient and Founder of LKDN (Living Kidney Donors Network) a nonprofit organization that offers workshops and webinars to educate people in need of a kidney transplant about living kidney donation. LKDN also helps prepare those in need to effectively communicate their situation to family members and friends. LKDN’s website is www.lkdn.org and Harvey can be reached atharvey@lkdn.org
For a printable copy, click here.

Monday, January 16, 2012

Paywalls create conflict of interest between newspapers and journalists

Journalists, like academics, want their writing to be read. Newspapers, like academic publishers, like to be paid for what they sell. Journalists, like academics like to make their papers available on the web. A recent email from the editor of the Boston Globe Ideas Section makes this clear:

"As you may know, this fall the Globe launched a spiffy new web site devoted exclusively to the newspaper. You may also have noticed it means Ideas is now behind a paywall. However, we have a "one click free" policy from any outside links -- and to provide you those links, and an easy way to keep up with Ideas, we've started a Boston Globe Ideas Facebook page. We also have a Twitter feed, @globeideas. Of course we'd love it if you subscribed to Bostonglobe.com -- but we're also making it easy for you to read and share Ideas stories for free by following one of our accounts."

Friday, October 15, 2010

Commerce and self interest in medicine

A Guided Tour of Modern Medicine’s Underbelly is a NY Times  book review by Dr. Abigail Zuger of  the book WHITE COAT, BLACK HAT: Adventures on the Dark Side of Medicine. By Dr. Carl Elliott.

"A physician who specializes in philosophy and ethics, Dr. Elliott hails from that quiet zone of medicine where much of the job involves thinking about, talking about and doling out medications. Hence his primary focus is on the ever-evolving relationship between the high art of medicine and the big business of drugs.

...
"Doctors get pens and trinkets, football tickets, junkets to beach resorts. Less visible are the large sums handed over in “I’m going to make you a star” projects to groom them as trusted faces and voices in the service of some drug. Education and advertisement merge in these elaborate ventures, as the paid professor travels the country, lecturing about disease and, incidentally, the treatment thereof.


"These “key opinion leaders” are bad enough, but who would ever imagine that the curricula vitae of many academic physicians (those on a medical school faculty) are packed with journal articles actually written by ghostwriters sponsored by pharmaceutical companies?

"“Nobody expects American politicians to write their own speeches anymore,” Dr. Elliott reminds us, “and nobody expects celebrities to write their own memoirs.” Apparently doctors have now joined the ranks of the charismatic talking heads, mouthing the words of others.

"And just as “professor” generally describes someone who writes his or her own sentences, “ethicist” generally describes someone who dwells (or at least works) on an unusually high moral plane. But Dr. Elliott also takes a brief and very informative excursion into the world of the medical ethicists. Once they were highly principled, underpaid gadflies, trying to sort out medical decision making. Now they are part of a booming industry, and, speaking of industry, their ties to the pharmaceutical industry are many and complex. Many companies now hire their own ethicists. But who guards those guards?
...
"What a world, what a world, as the melting witch said in “The Wizard of Oz.” But there is one small consolation: at least Dr. Elliott didn’t have to call his book “White Coat, Black Heart.” Now that would have been depressing. The bottom line is that much of what he describes is simply the big business of medicine as we have allowed it to take shape. His bad actors are mostly just that: actors caught up in a script not of their own devising. They all come home in the evening, take off their black hats and hang up their white coats, just regular working stiffs out to make a buck. "

Wednesday, October 28, 2009

College admissions in Illinois, conclusion?

U. of Illinois at Urbana-Champaign Chancellor Resigns in Wake of Admissions Scandal
Richard Herman, chancellor of the University of Illinois at Urbana-Champaign, has resigned in the wake of an admissions scandal in which well-connected applicants were put on a "clout list" and given preferential treatment, the Chicago Tribune reported on Tuesday. Mr. Herman, who made a remorseful apology to the faculty after a state panel found he was the "ultimate decision maker" for clout-listed applicants, will join the university's faculty. His resignation follows those of the university president last month and several trustees.

Friday, October 3, 2008

Auctioneers and sellers: Sotheby's mixed role

The WSJ reports Sotheby's Faces Suit Over Disclosure
"Mr. Minor's attorneys say he purchased the work on advice from a Sotheby's specialist and didn't realize the auction house was selling the work to recoup money owed it by another collector. ...
Mr. Minor's suit highlights the increasingly blurred lines that can develop at auction houses between their traditional role as disinterested auctioneers and their emerging business as direct stakeholders or financiers of the work they auction. In their competition for market share and their battle to secure top art work, Sotheby's and Christie's are increasingly acquiring, trading and preselling stakes in works they auction."
...
"For buyers, deciphering the financial dealings behind a work of art has become increasingly difficult. In some cases, like Mr. Minor's, auction houses sell the work as collateral for loans. More commonly, they issue so-called "guarantees" -- promises to pay the seller a minimum price for the work sold through the auction house. The auction house has to pay the guarantee even if the work doesn't sell, so it becomes an effective stakeholder.
Guarantees have surged in recent years. Last year, Sotheby's issued $902 million in guarantees, double the amount in 2006, according to securities filings."