Teaching Responsible Conduct of Research (RCR): A Resource Guide for Professional Science Master’s Degree Programs
Case Studies from Medical Physics
Case: Conflict of Interest
Discipline:Medical Physics
Title: A Case of Conflict of Interest
Author: UshaSinha, Ph.D.
Contributor: Adam Torres
Edited by:Steven Goetsch, Ph.D.
Ms. Y is a physics intern in the Radiation Oncology Division in a large hospital. She works directly under the chief medical physicist of the Division. However, she also interacts professionally with other members of the Radiation Oncology team: a junior medical physicist, three dosimetrists, two radiation oncologists, and three radonc technologists. The team is a close-knit group, which is essential, as proper patient care requires coordination between all the different personnel. Ms. Y is a diligent worker and quickly learns key quality assurance procedures and to perform treatment planning.
The radiation oncology division is considering expanding their operations based on patient referrals from a recent recruit in the surgery department. The hospital is extremely lucky to have attracted a famous surgeon from a competing academic hospital. The number of patients nearly doubles to the RadOnc center since the surgeon’s arrival. Based on this increased patient throughput, the RadOnc division is considering buying a state of the art system. The chief medical physicist draws up the system specifications consulting the radiation oncologists and the surgeon to confirm that the specifications meet their requirements. Ms. Y is closely involved in the drafting of this specification document: she is thrilled at the ability to learn so much about system performance and technical specifications as well translating clinical requirements. The hospital follows routine procedures in requesting open bids from vendors. Only two vendors, both well established, respond to the bid. Most of the other vendors do not have a product that meets the required specifications.
Ms. Y, under the guidance of the chief medical physicist, performs a thorough evaluation of both bids and selects Vendor A. Vendor A has a reliable product that has been installed in several sites worldwide with excellent patient outcomes. Vendor B’s system is newer, incorporates some elements that are not available in Vendor A’s system (but were not part of the specifications either). Vendor B’s system incorporates some very recent developments that have been only tested in a research setting. The few sites with the particular product from Vendor B have mixed reports on patient outcomes. Further, limited feedback is available on the new features of the Vendor B system. From the little feedback, it can be gleaned that there is a slight negative attitude about these features. Further, Vendor B’s system is pricier by a significant amount than Vendor A. The RadOnc team headed by the chief medical physicist makes the recommendation for the Vendor A product. They note however that some new features in Vendor B’s product are not available on the Vendor A system. Vendor A claims that they are in the process of developing/evaluating these additional features.Vendor A promises to provide a free upgrade once these features are available for distribution. Ms. Y is very excited to have contributed to this important decision process.
In the next two weeks, the hospital makes the decision to buy Vendor B’s product. The final decision was made by the surgeon who had essentially vetoed the RadOnc’s recommendations. This news devastates the enthusiastic Ms. Y. She had noticed during the Vendor demonstrations that Vendor B hosted their presentation and included a fancy lunch and dinner and distributed tickets to an exclusive entertainment show hosted by them in an upcoming conference. Vendor A was more low key. She voices her opinions to several members of the RadOnc team and also to the chief medical physicist. The chief physicist has a long conversation with Ms. Y and tries to convince her that both systems match specifications almost equally. And that the surgeon wanted the new features of Vendor B and the hospital is going to test these features. The chief physicist assures her that these will lead to ground breaking procedures and bring fame and name to their hospital. Further, Vendor B is going to invest research money in the hospital to perform clinical trials with the new features.
Ms. Y, having spent a lot of effort researching the two systems is not quite convinced. She pulls up the few papers that report on the new features. She finds that all of them are authored by the surgeon and none report any finding that would lead one to believe that they are breakthrough treatments. Further, she reads that the surgeon has been involved in many of Vendor B’s educational workshops. She feels that the surgeon would have been compensated handsomely for his participation. She also checks that some procedures using the new features are labeled Research Investigational and are still pending FDA approval. However, she also notes that none of the new features have caused any harm to any of the subjects. It is more a case that they could have been treated just as effectively and at much lower cost with the established procedures.
Ms. Y compiles all the facts and presents them to the Chief Medical Physicist. He presents his own arguments but, when Ms Y does not see his viewpoint, gets annoyed with her. She notices a slight cooling off in her relationship with the rest of the team as well. Ms. Y is in a dilemma now: the chief medical physicist is her mentor and she was hoping to obtain a recommendation from him.
Teaching Questions:
- How should Ms. Y proceed now? Does she have recourse within the hospital administration?
- Did she do the right thing by presenting the facts to the chief medical physicist? Should she have consulted a neutral third party: her academic mentor, other senior radiation therapy physicists?
- Should she have consulted with a national board such as the AAPM or national conference board members such as ASTRO before drawing conclusions?
- Is this a serious violation or something in the gray zone where there is no strong evidence of wrong-doing? How does one proceed in these gray zone areas?
- If the chief physicist now turns against Ms Y and he and the team participate very little in the mentoring process, what should Ms. Y do now?
- Does she have recourse within the hospital system regarding “retaliation?”
- Should she update her academic mentor/director of the program?
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