Be careful of conflicts of interest in healthcare

Living in an Asian society, we are almost always inundated with well-meaning advice offered for almost everything under the sun. For example, when you are diagnosed with dengue fever, at least five different people will prescribe a host of different remedies – ranging from frog porridge from a particular stall in Port Klang to the juice of a particular fruit which is only found in the hills of Pahang.

Unfortunately, today, this has turned into something more sinister: the monetisation of well-meaning advice. When someone offers health advice these days, there is often an underlying motive. What do I mean by this? In previous years, an acquaintance would ask you to get some honey and ginger tea to drink to help you with that long cough you have been having. Today, the same advice comes with an addendum: “You need Brand X herbal medicine ginger tea and honey extract, which luckily I am selling and will give to you for RM Y”.

As someone working in the field of cancer, this is something I face every day. Patients are inundated with “well-meaning” friends, acquaintances, neighbours and even family members trying to give them “treatment advice”, which unfortunately comes with a price tag attached.

In fact, nine times out of 10, when my patients are offered “well-meaning” advice someone is trying to sell them some kind of “miracle” drug or medication which, oh, by the way, also gives the seller some kind of “small” profit (or as is often said, “a bit of cari makanlah”). Is this a conflict of interest?

Traditionally, a conflict of interest usually happens when someone in an official capacity makes a decision which has a personal benefit for them. An easy example of this would be when the office boss decides to award the office annual dinner catering contract to his wife’s company. In this case, the boss in his official capacity is the decision-maker who decides who gets the catering contract; and by awarding it to his wife’s company, he indirectly profits from that decision. This is a conflict of interest.

However, conflicts of interest are not limited to those acting in their official capacity. As in the anecdote shared earlier, when someone gives health advice, I make the case that they are in a “position of power” – simply because you or they feel that they “know better”. But when you take that advice and buy the medication or take up the treatment, they earn a profit. Thus there is actually a conflict of interest when they give you the so-called “well-meaning” advice. Not many people realise this.

Doctors and other healthcare professionals are often accused of having conflicts of interest. An oft-cited myth is how “doctors ask us to take so many medicines because they are making a profit from selling these medicines”. Many people try to stay away from taking conventionally-prescribed treatments from doctors as they think that the doctors have a conflict of interest.

Ironically the same group of people who reject conventional treatment or medications because they think doctors are making money from it are often the ones who buy a whole lot of alternative, non-proven medication from other sources – including on the recommendation of friends and colleagues who often are peddling these alternative medications as “authorised agents”.

Few people realise how severe this conflict of interest is in the healthcare sector. One of the classic examples is that of the anti-vaccination movement even here in Malaysia. Research conducted within the “anti-vaxxer” community reveals many of them firmly believe that these vaccines are doing harm to their children, which is why they refuse the administration of these vaccines. These beliefs, interestingly or unfortunately, have been inculcated into them by peddlers of “alternative” medications who market inefficacious but well-branded products which are claimed to be safer than vaccines in protection against infectious diseases. This includes the sale of different types of “mega vitamins” and other supplements, many of which are either not-registered or touted to be efficacious for uses that they were never conceived for.

Another health example where conflict of interest crops up is within the sphere of “smoking” – an important area of public health concern. E-cigarettes are being touted as an effective alternative to conventional cigarettes with many parties fighting to legalise e-cigarettes and make them as widely available as possible despite more and more evidence emerging of the health and social risks of e-cigarettes.

Looking closely, however, one can discover that many of the parties pushing for the legalisation and expansion of the sale of e-cigarettes are parties who will benefit from this, including manufacturers and retailers. When e-cigarette retailers who will gain a huge profit from the sale of these devices push for people to switch to e-cigarettes because these are “healthy”, isn’t it a conflict of interest?

I am a doctor. Thus my conflict of interest is clear when I am seen to defend the healthcare profession although I am clear about calling a spade a spade. Healthcare professionals often have an inverse conflict of interest in healthcare. How? Healthcare professionals work in treatment and health prevention. In fact, the more successful we are at doing our jobs, the more we risk running out of a job in that sense. So generally for healthcare professionals, a conflict of interest is the last thing on our minds since in our daily lives, we are actually working against our personal interests!

As we start 2020, there are two immediate things that any layperson should be careful about when talking about conflict of interest, especially in healthcare. First, always consider carefully when you receive “health” advice by non-health personnel, even when given in a well-meaning vein. Look deeper to see whether the person giving the advice is benefitting financially from the advice. If they do, they definitely have a conflict of interest. Take such advice or recommendations with a huge tablespoon of salt.

On the other side of the coin, please don’t be so suspicious of the advice or recommendations of healthcare professionals. In terms of health, your health is the only interest they have at heart.

The views expressed are those of the author and do not necessarily reflect those of FMT.