It's not about the money

H.L. Mencken wrote that ‘‘When somebody says it’s not about money. It’s about the money.’’ Once again, the issue is about the money. Five years ago, I founded the Association for Medical Ethics (AME), calling for full disclosure of all money paid to researchers by manufacturers. Over those past 5 years, I have often heard ‘‘It’s the principle, not the money,’’ from defensive clinical researchers and industry folks. Would any reasonable person believe what I write when my article is about a product whose manufacturer is paying me? Well, if it is a little money say for implant expenses for testing you will probably have more confidence than if it is millions of dollarsdwith large sum comes large doubts. In those cases, you will probably reserve judgment on using the product and first perform the necessary due diligence to confirm the findings independently. This scenario may be a big problem for industries with marginal products who have a low expectation that initial company data will stand up to independent surveillance and analysis. Conversely, companies with substantial confidence in product performance have little to fear if surgeons choose conservative ‘‘wait and see’’ attitudes and do not jump right in there using the new product. Most prudent doctors will ‘‘wait and see’’ when they detect the influence of something other than independent unbiased literature from a historically trusted source in medicine. ‘‘Wait and see’’ can be very bad for launching new products because as industry folks say, ‘‘what ruins all those good papers is follow-up.’’ Unless practice patterns have already been changed to adopt the product in the absence of independent data, if complications and bad results surface in articles with generalized use, the battle to launch a new product with efficacy or safety problems is lost. It should not be surprising then that the solution for some company executives to prevent hindering profit making is to sweep these problems (complications) under the rug