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The doctor as a scholar: Restoring truth and integrity

Eunice Minford

Part two

In part one, Has medicine taken a turn towards darkness?,  I raised the concerns echoed by eminent editors of leading medical journals (The Lancet and NEJM) that science had taken a turn toward darkness, with evidence of financial impropriety, conflicts of interest, poorly conducted and biased research and much more.

It is up to us as a profession to call out such practices and take the necessary steps to effect change, such that trust can be maintained in the profession and the quality of research that is produced.

What are those steps?

What will it take to resolve what seems to be an ever-increasing tide of ‘sponsored science’ with dubious and biased results, which are not only wrong but which in the worst cases put patient lives at risk?

What measures are needed to curb the lure of financial rewards in return for supportive and favourable research outputs?

A multitude of sins can still be hidden under the veil of illusion of supposed transparency in a conflict of interest statement.

Is a declaration of conflict of interests enough? Does it go far enough to give the level of transparency that is needed?

In my view, whilst it is a necessary step, a statement of conflict of interests is not enough – it may give a clue towards bias but it does not remove it. A multitude of sins can still be hidden under the veil of illusion of supposed transparency in a conflict of interest statement.

What needs to happen regarding financing of research?

Should there be separation of the medical profession and the pharmaceutical industry – such that personal financial or other rewards for doctors are no longer part of the package?

Should drug company support for research come with no strings attached?

What is driving the attachment and need of the medical profession to be lucratively rewarded by drug companies on top of any salary they may be earning?

Is greed the underlying problem?

Fear of not having enough? Fear of not being enough?

What if we knew that we were already enough – so that we did not need to fill ourselves up with these excessive outer accoutrements?

Why do we need to fill ourselves up with more pennies and pounds at the expense of our conscience, our integrity, ethical practice and doing what is true?

Are we so empty of true value and care for ourselves that we are dependent on outer labels, identifiers, achievements, accolades, money and rewards to feel better about ourselves?

What if we knew that we were already enough – so that we did not need to fill ourselves up with these excessive outer accoutrements? It does not mean we do not work and achieve – but the intention and motivation for doing so significantly changes.

How much stronger would the research field be and the productivity and creativity if we worked together, truly together, instead of in competition?

Does there need to be a radical re-think around the whole paradigm of competition and research assessment exercises that drive the competitive mindset – to replace it with one that is focused on collaboration and working together for the greater good of the whole?

For ultimately, is that not the purpose of true service?

Let’s face it, if we are solely concerned with our needs, our profile, our research, our university, our financial rewards – we are just working for self and not to advance the field of medicine and humanity as a whole.

How much stronger would the research field be and the productivity and creativity if we worked together, truly together, instead of in competition?

Surely the sensible thing is to work together, to pool resources, to collaborate, to share, to know that it’s not about us, but everyone equally so?

What if competition is the poison, or one of the main poisons, that underpins this drive to produce research of any kind irrespective of the quality or ethical conduct, as well as the drive to have the most, to be the richest, to know the most, to be the highest achieving, irrespective of what we have to do or say to get there?

If we were truly working for the good of all humanity then surely the sensible thing is to work together, to pool resources, to collaborate, to share, to know that it’s not about us, but everyone equally so?

Do we need radical change?

I know this is far from the current mind-set and from how Universities are presently funded – but again perhaps radical change is needed, for we cannot solve the problem with the same level of consciousness that created it.

We have to think outside the box, to get outside the box and approach it from a different angle – one that has the concerns of all of humanity at heart – not just the medical profession, not just patients, not just Universities, not just businesses – but everyone, everywhere.

If we had as our intention, motivation and focus the greater good of the whole then our whole outlook changes.

If we were to work accordingly – there is no way we could work in a business or University that buried or subjugated negative trial results that could detrimentally impact patient care.

There is no way we would be influenced by pure financial reward to say or do something that was not ethically correct.

There is no way we would publish work that we knew was detrimental to patients in any way.

If we had as our intention, motivation and focus the greater good of the whole then our whole outlook changes. It is no longer about me and mine but us, all of us, together, knowing that how we live and work influences the whole, not just our own lives.

As long as we continue in the illusion that we are somehow separate islands, doing separate pieces of work, doing our own thing and thinking that what we do does not affect the whole, then we are doomed to be driven by false intentions and motivations that can culminate in some of the unethical practices that have been highlighted, leading us towards darkness.

Working for the greater good of the whole, where we know that what we do and how we do it, impacts not just us but everyone.

When we truly realise that everything we do, say and think has an impact on the whole sphere of life, do we begin perhaps to get a glimpse and taste of the responsibility we have to live and work in a way that is not driven by our own self-driven agendas, but which is caring for the whole and where the true poison of acting unethically is all too readily felt.

Working for the greater good of the whole, where we know that what we do and how we do it, impacts not just us but everyone, is the key to restoring truth and integrity to medicine and science, to turning away from the darkness and back to the light.

Eunice Minford is currently working as a Consultant General Surgeon in N.Ireland. She has a strong interest in self-care for medical students and doctors based on a holistic understanding of the human being. She blogs at www.thesoulfuldoctor.co.uk and tweets @thesoulfuldoc

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Discussion

  1. Jennifer Smith says:

    There is much that has been said here, there is a lot to consider. So much does need to change from our approach and reasons for wanting to do research, to how projects are funded. Imagine the research that could be done if it is done in a spirit of cooperation and a shared concern for the wellbeing of people, everywhere and knowing that everything about a project from its outset will benefit all of humanity or not. This is very powerful.

    • Russell Cartwright says:

      Thanks for your comments Jennifer. All comments and blog posts left on this site will feed in to the medical professionalism matters report that we are working on.

  2. Sandra Williamson says:

    To truly care for peoples well-being, you’d presume that care comes before personal monetary gain and integrity would be high.

    • Susan Wilson says:

      Yes, Sandra, I agree and as Eunice has proposed maybe it is time to get outside of the box and take a wider view of what medicine should really be about – anything that is good for us. To me that means taking a more spherical look at the way medicine is practised and bringing in those that truly understand how our bodies work and that there is more to them than the physical that we see.

  3. Dr Gareth Vincenti says:

    This is all well and good, and I do not decry the good intentions but it is perhaps all a bit naïve as it bears little relationship to the reality of human nature let alone human history, which like it or not has its dark side. When people face a joint crisis then a spirit of cooperation (and the best of human nature) comes to the fore, but otherwise generally not. Hence some of the most innovative developments in human history have come from competition and conflict (for example radar, nuclear fission, computers, trauma surgery) which is why we have the proverb that says necessity is the mother of invention. When people face a joint crisis then a spirit of cooperation comes to the fore, but generally otherwise not. We cannot move forward by simple appeals to cooperation and one’s better nature, that is simply not how most of our species operates and medicine and science are not somehow separate from such forces.

  4. sonia Gehlcken says:

    Whilst I agree that this would be the ideal, where would it begin?

    I believe that what actually needs to occur is the transparency. Studies should not be allowed to manipulate results to show what they want to portray. If true results show an undesired outcome, then this should be available to the public. I believe it’s a common problem that doctors no longer know what all the negative side effects are of the medication they prescribe because it is concealed.

    I perceive this problem too be much bigger than competition and conflict of interest. If this information was freely published then the potential of skewed results to enable positive bias towards the funder would be eliminated.

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