Bias

Artigo indicado pela AMICOR Maria Inês Reinert Azambuja

Understanding Bias — The Case for Careful Study

Lisa Rosenbaum, M.D.

N Engl J Med 2015; 372:1959-1963May 14, 2015DOI: 10.1056/NEJMms1502497

 Comments open through June 17, 2015

This article has multiple parts: First of Three Parts

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In 1980, the Journal’s editor Arnold Relman wrote an editorial entitled, “The New Medical-Industrial Complex.”1 Although it’s hard to pinpoint the moment when a culture forever changed, the editorial represented a seminal event. Concerned about profiteering by private health care corporations, Relman wondered whether physicians could continue to honor their duty to serve as patients’ trustees. He argued that in order to represent patients’ interests fairly, physicians “should have no economic conflict of interest and therefore no pecuniary association with the medical-industrial complex.” Four years later, the Journal established an unprecedented rule that authors disclose their financial ties.2

Relman wanted to mitigate undue influence by curtailing physicians’ financial associations with companies, but his concern seemed as much about appearance as about reality. Noting the uncertainty about the magnitude of physicians’ financial stake in the medical marketplace, he wrote, “The actual degree of involvement is less important than the fact that it exists at all. As the visibility and importance of the private health care industry grows, public confidence in the medical profession will depend on the public’s perception of the doctor as an honest, disinterested trustee.” To ensure the primacy of public interests over those of industry stockholders, Relman called for two things: closer attention from the public and careful study./.../