The Clinical Divide: When Special Interests Influence Data

What happens when big money enters medicine and can influence academic publications? Should healthcare become more of a business than a science? Should physicians and other healthcare leaders be investing in practices and healthcare businesses that pose a perceived significant conflict of interest? Is medicine the next boom for venture capitalists?

Welcome to the Clinical Divide. I’m Dr. Kevin Campbell, a Duke-trained cardiologist and CEO of the health data startup PaceMate. Every week, this Healthcare Analytics News™ video series examines medicine’s top news. I bring the views that help physicians and healthcare executives bridge the clinical divide.

Today’s story brings us to the New York Times and a report concerning the field of dermatology. Historically, the practice of dermatology is a highly profitable specialty, and the overhead involved in a dermatology practice is quite small. The specialty is seeing a wave of private equity firms swooping in and buying and running practices across the nation. The trend is fueling consolidation. It’s also causing some dermatologists to wonder whether profits are now beginning to overshadow patient care. Let’s face it: Most doctors focus on providing high-quality care, and the economics of running a practice have always been a secondary consideration for most. However, VCs and private equity firms are singularly focused on making money — at all costs.

Several researchers set out to examine how the influx of private equity is playing out in the dermatology space. They published an article in the Journal of the American Academy of Dermatology this month, finding that investors are mostly buying up practices that perform a large number of procedures that earn big reimbursements from Medicare. They also found that these organizations are opening high-profit labs and recruiting influential dermatologists to support their practices. All designed to maximize profits and their own ROI.

The peer-reviewed article ignited a firestorm, and in little more than a week after publication, the journal’s editor scrubbed it from the website — and suggested that the article would be retracted and or revised. After getting lots of pushback from academics and those on his own editorial board, the editor of JAAD eventually said people associated with private equity lodged factual complaints. These private equity groups demanded that the article be removed. Interestingly, some of those that were involved with the private equity firm’s complaint included leaders of the American Academy of Dermatology, which publishes the journal, suggesting lots of conflict of interest. The paper’s authors are vehemently denying any inaccuracies or biases, yet the paper is no longer available online.

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There’s a lot to unpack here, so let’s get to it.

First, do we really want private equity firms running medical practices? These organizations are all about cutting costs and maximizing profits. As clinicians, we are sworn to advocate for patients and just can’t allow that to happen at the expense of patient care. Perhaps our friends in the C-suite can talk to private equity folks and share best practices to support both top-notch medical care and the economic stability of a healthcare system. No matter the case, administrators and doctors must talk openly about partnerships and expectations. In the end, it’s all about patients. However, the bottom line is now more than ever dictating how doctors and patients interact — and we cannot sacrifice care just for more cash. We must limit conflicts of interest in medicine and we must make sure that we keep a close eye on the commercialization of medicine.

Second, it’s very concerning to me that a respected journal could pull a peer-reviewed article — that took more than a year to research and write — without a detailed and immediate explanation. When journals are responsive to outside pressures from private equity firm, it smells a lot like the pharma lobby in D.C. This is completely unacceptable. Science and well-conducted research should be above the influence of big money interest groups. Unfortunately, this in no longer the case. At some point, we must take medicine back and refocus on the patient.

Data and science are critical to healthcare’s growth. Yes, we need to vet the information and conclusions — that is why we have peer-reviewed journals. But no, we cannot pull findings just because influential people don’t like them — if we do, then how will we ever decide which study is reliable and worth changing practice for? Now, maybe that’s not what happened here, but it sure looks like there is “something rotten in the state of Denmark,” to quote a little Shakespeare. At the very least, this is a reminder for physicians and C-suites alike: Even if you don’t like what the data say, you must analyze the quality of the research and ultimately respect the conclusions of a well-designed study. That’s the only way we can continue to advance science and improve our patients’ lives.

Thank you for joining me for this episode of the Clinical Divide. Until next week, I’m Dr. Kevin Campbell, for Healthcare Analytics News™.

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