TV's Dr. Mehmet Oz is one of 17 heart doctors who made more than a million dollars from a drug or medical device company between 2013 and 2014.

That's according to MedPage Today, which parsed an open data set of payments to doctors from industry. According to the analysis, Oz earned $1.17 million from Covidien/Medtronic, which owns HET Systems, the maker of a hemorrhoid therapy he helped develop.





Oz also used his media platform to promote the treatment just ahead of it hitting the market. In one of his syndicated columns with co-author Dr. Mike Roizen, he doled out some advice for how people can deal with their "rhoid rage," including this:

If you need treatment, a device is coming to the market that makes getting rid of these much less painful: Ask your doc about HET bipolar ligator. (We helped develop this, and it’s a major reducer of pain in the, well, you know what.)

Many doctors have financial relationships with drug and device companies, and ethics guidelines mandate that they disclose them. Oz and Roizen did just that in their parenthetical reference.

However, situations like this one bring up some questions that the medical profession has been struggling with on the whole: how to approach disclosure, transparency, and conflicts of interest in order to best serve public health.

Oz isn't alone in his ties with industry



Research has shown that relationships between the medical profession and industry are common, according to the New England Journal of Medicine: A 2007 study found that 94 percent of American physicians had some kind of tie with industry. In the last five months of 2013 alone, medical device and drug companies paid American doctors $3.5 billion.

The trouble is, sometimes these relationships twist medical practice. Lawsuits in recent years have revealed that doctors' relationships with industry can alter their prescribing practices and decision-making for the worse, and pharmaceutical companies have paid out billions of dollars in fines for fraudulent marketing practices.

In response, lawmakers have been pushing to make payments to doctors more transparent through federal legislation. The Sunshine Law, part of the Affordable Care Act passed by Congress in 2010, put the burden on the industry: It mandates that every pharmaceutical and medical device company in the country annually disclose payments made to doctors and teaching hospitals for a range of activities — including promotional speaking, research grants, meals, and trips of at least $10 value.

Last year, this information was made public in a searchable online database. (It's the same database MedPage used to uncover the top paid heart doctors in the country.) The move followed the proliferation of rules at medical schools, journals, and research institutes to guide industry relations.

The idea is that sunshine is the best disinfectant: More disclosure should, in theory, lead doctors to more carefully consider, and potentially avoid, conflicts of interest.

Some argue that disclosing conflicts of interest is not enough

But there's some evidence that shedding light on conflicts doesn't always make that much of a difference. For example, one study examined what effect state sunshine laws in Maine and West Virginia had on doctors' prescribing of cholesterol-lowering statins and SSRI drugs for some mood disorders — drug classes with good generic alternatives but also with pharmaceutical companies heavily marketing the branded versions to doctors. They found physicians continued to prescribe branded medications and that the state laws had little impact on prescribing. In other words, disclosure didn't change their behavior.



Doctors and former journal editors writing in the British Medical Journal recently argued that disclosure and conflict of interest policies for doctors aren't very effective:

Judges are expected to recuse themselves from hearing a case in which there are concerns that they could benefit financially from the outcome. Journalists are expected not to write stories on topics in which they have a financial conflict of interest. The problem, obviously, is that their objectivity might be compromised, either consciously or unconsciously, and there would be no easy way to know whether it had been... Doctors might wish it were otherwise, but none of us is immune to human nature.

So is disclosure enough? In the context of Oz's disclosure, the fact that he mentioned his conflict theoretically made it okay.

But would his audience understand that "helping to develop" the therapy also meant that he'd profit if they took his advice and sought it out? That's less clear, and it's a question for not only Oz but for all doctors.



Correction: An earlier version of this post included a graphic and reference to MedPage Today which mischaracterized Oz as a cardiologist. He is a cardiothoracic surgeon.