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:
Usha Sinha, 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 rad onc 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
Rad Onc center since the surgeon’s arrival. Based on this increased patient throughput, the Rad
Onc 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
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Teaching Responsible Conduct of Research (RCR): A Resource Guide for Professional Science Master’s Degree Programs
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 Rad Onc 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 Rad Onc’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 Rad Onc 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
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Teaching Responsible Conduct of Research (RCR): A Resource Guide for Professional Science Master’s Degree Programs
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:
1. How should Ms. Y proceed now? Does she have recourse within the hospital
administration?
2. 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?
3. Should she have consulted with a national board such as the AAPM or national conference
board members such as ASTRO before drawing conclusions?
4. 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?
5. 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?
6. Does she have recourse within the hospital system regarding “retaliation?”
7.
Should she update her academic mentor/director of the program?
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