This British Medical Journal editorial presents a chilling, not-often-discussed view of how conflict of interest in medicine endangers even those of us with good doctors. The author recounts the story of how a group of doctors, all of whom had been bought off by the manufacturer of the drug alteplase, wrote a best-practices guideline for treating acute stroke with the drug alteplase. However, the body of scientific evidence, and most emergency room physicians, found the drug of little benefit and with very high risks. Nevertheless, doctors risk being sued for not following these now-established guidelines.
Meanwhile, emergency physicians find themselves in a difficult position. The guidelines represent the standard of care against which they will be judged in any claims of malpractice. And although the rules on conflict of interest may be tightening, the current standards of care across much of medicine originate with similarly biased guideline panels.