Lack of Context Leads to Conflict of Interest Charges at Patients Expense

The AdvaMed and PhRMA codes are widely acknowledged, if soto voce, as penance by many of the largest members of these trade organizations for being habitual offenders. Look up fines paid by Lilly, Pfizer, Merck, Medtronic, and on down the list. The codes were "retrospectively pre-emptive" and designed to mitigate huge OIG and DoJ judgments. This has now been spun by journalists as higher industry self-awareness. Little wonder the New York Times is failing.

Enthusiasm by physicians for relationships with industry tend to follow along lines of co-dependence and mutual benefit. Interventionalists and surgeons are inclined to work quite closely with device companies and orthopedic surgeons and cardiologists are probably the prototype. Psychiatrists and internists often have close ties to pharma. They write a lot of prescriptions, not because they got a free slice of pizza as a resident but because it's the best care they can offer to many of their patients. Imagine being a psychiatrist today without an SSRI or sedative option (psychoanalysis is on the decline for those who have been out of town lately), or an internist without antibiotics, beta blockers, statins or pain medications. Pretty much leaves bedside manner as the therapy of choice.

Pediatricians, dermatologists, pathologists, physicians in social medicine (Angell, Brody) and herbalists (of Albuquerque fame) tend to rely less heavily on and derive less value from technology, so are generally more critical of these translational relationships. If you look at the "inclusive" COI policy committees at many schools, you will see a population disproportionate to specialty percentages (check Pizzo's committee at Stanford on their website, for example). I believe this qualifies as bias, but not in the patient-sparing, pain-relieving sense.

The US government, through the department of agriculture, subsidizes many American farmers. Some farmers use their subsidies to buy a new tractor.
I'm not a farmer so I don't qualify for a new tractor. For this, I may be resentful and inclined to disparage both the farmer and USDA. This is kind of how it works for Marcia Angell and David Rothmann, only in this case, the subsidy is often a piece of pizza or a donut.