Physicians Must Be Wary of Conflict of Interest

By now, most of America has heard of Dr. Mehmet Oz, a physician with a daytime television show that reaches between 1.8 million and 3 million daily viewers. A couple of weeks ago, 10 doctors sent a letter to Columbia University demanding that he lose his faculty position for "promoting quack treatments and cures in the interest of personal financial gain."

Although it may sound harsh, Dr. Oz does have many critics who believe he promotes unhealthy products to viewers, such as the weight-loss supplement that sparked an FTC lawsuit over false advertising. It's true; one can hardly be on Facebook or Twitter without an ad for a product Dr. Oz supports popping up. And there are quite a few other controversial positions and recommendations Dr. Oz has taken, which many physicians believe misinform the public.

Dr. Oz's response to the criticism is that he is free to express his opinions under the First Amendment protections, which states: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances."

Certainly Dr. Oz has the right to free speech, but that's not really what the issue is here. What about the Hippocratic Oath Dr. Oz took as a physician to protect his patients? Is his right to free speech superior to his oath?

Physicians have a very strong ethical responsibility to those who take their advice when they are acting in the capacity of a "physician." Although there is no AMA opinion on physicians who sell products on television, a parallel can be drawn to AMA Opinion 8.063, which addresses doctors who sell health-related products from their office or over the Internet. The AMA opinion warns that such sales present a financial conflict of interest, risks placing undue pressure on the patient, and threatens to erode patient trust and undermine the primary obligation of physicians to serve the interests of patients before their own. The rules go on to say, in part, that physicians should not sell any health-related products whose claims of benefit lack scientific validity and that physicians must disclose fully the nature of their financial arrangement with a manufacturer or supplier to sell health-related products.

Although Dr. Oz is not selling products directly to patients through his own practice, many viewers of his show take the advice he provides and may assume the products he endorses are supported by scientific research, and that Dr. Oz is not incentivized financially. I am not aware of the (direct or indirect) financial relationship he or his show may have with the products he promotes, but there is much speculation based on leaked Sony e-mails (according to Forbes Magazine) that Dr. Oz picks products to promote based on business considerations, not health reasons.

Many physicians sell or promote products in their office, speak on behalf of manufacturers, or are otherwise involved in promoting products where their medical license and reputation enhance the likelihood that an individual will be convinced to select or acquire the item or service. I warn my clients of the risk of exploiting their patients' trust and how essential it is to disclose any and all possible conflicts, preferably in writing. Although not many physicians have the power of Dr. Oz, every physician has the ability, through the advice they share and the orders they place, to impact every life with which they come into contact in their role as a physician. This is a responsibility not to be taken lightly.

As for Dr. Oz, even if he is hiding behind free speech to avoid responding to criticism from his own medical colleagues, one can hope he will be more careful going forward in balancing his business interests with his ethical obligations.