Disclosing conflicts of interest on social media

As the use of Twitter and other social media by physicians and patients rises, some physicians forget to do what many consider crucial for building doctor-patient trust: disclose potential conflicts of interest.

In a commentary published online in the Journal of General Internal Medicine, Dr. Matthew DeCamp, a postdoctoral fellow in the Johns Hopkins University School of Medicine’s Division of General Internal Medicine, argued that some physicians use social media to give advice to patients and the public without revealing drug industry ties or other information that may bias their opinions.

Without serious efforts to divulge such information – standard practice when publishing in medical journals and recommended in one-on-one contacts with patients – Dr. DeCamp said consumers are left in the dark.

“As physicians and patients increasingly interact online, the standards of appropriate behaviour become really unclear,” Dr. DeCamp said. “In light of norms of disclosure accepted throughout medicine, it’s surprising that major medical guidelines fail to adequately address this issue.”

Among the national organisations that have issued social media guidelines are the American Medical Association and the Federation of State Medical Boards.

Dr. DeCamp acknowledges that use of social media has the potential to improve patient care and trust by increasing patient access to information. However, vigorous online “boundaries” are needed to not only assure privacy and confidentiality, but also to protect patients from misinformation and biased advice, he said.

In an office setting, for example, when doctors prescribe a blood pressure medication, professional guidelines say they are ethically bound to tell patients if they have any financial relationship – such as receipt of consulting fees – with the manufacturer of the drug. Guidelines also call for disclosure when they publish studies about blood pressure medication, and medical journals require them to fill out a detailed disclosure form, but online, it’s “an unacceptably grey area”, Dr. DeCamp said.

The absence of stricter guidelines for online doctor-patient interactions is especially puzzling, Dr. DeCamp said, given the move to ever-stricter disclosure requirements offline. There has been a movement from simple disclosure to better efforts to manage and eliminate conflicts.

While some professional guidelines do recommend disclosure in social media, Dr. DeCamp said, they don’t lay out how it should be done, while many ignore the topic altogether.

“You need to be proactive so that your undisclosed conflict doesn’t end up on the front page of The New York Times. Conflicts need to be disclosed and it’s surprising that we have so far to go regarding disclosure and management on social media,” Dr. DeCamp said.

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