Conflicts of Interest in the Health & Wellness Industry
Conflicts of Interest is such a boring and dry topic and the vast majority of us probably don’t feel like conflicts of interest apply to our day-to-day lives. You probably feel like you’re immune to conflicts of interest and that they only affect someone else such as corporate CEO’s and super villains. Unfortunately, we couldn’t be further from the truth. Each of us has more conflicts of interest than we care to admit or willingly acknowledge.
When we think of conflicts of interests I’m willing to wager that most of us immediately think about financial conflicts of interest but do you know what we’re forgetting? Conflicts of interest due to our relationships. All too often we’re willing to look the other way when there is a conflict of interest surrounding a relationship that we have and it can greatly affect our decision making and messaging.
Examples of Todd’s Personal Conflicts of Interest:
My friends, Quin and Porter, have a meal replacement company (Parachute). I really like these guys and want them to succeed; however, I must acknowledge that they aren’t the only meal replacement company out there and perhaps there are many people who would benefit from a different meal replacement or shouldn’t be consuming one at all.
I am employed part time as an adjunct professor at Johnson & Wales University - Denver and I would like to work there full time if they were to offer me full-time employment. I have every incentive to promote Johnson & Wales and higher education and no incentive to voice some of the reservations that I hold regarding higher education. In fact I am disincentivized to do so (I want a full time job). Despite this conflict, I have written about some of my reservations about higher education (Universities are a business and students are their customer) and could fill volumes on how I think we could improve it, but doing so offers me very little reward and lots of risk.
My friend Jeff is a personal trainer at LifeTime Fitness. I personally don’t agree with many of LifeTime’s training philosophies but saying this is a double whammy for me as 1) I don’t want to be overly critical of LifeTime and put my friend in hot water AND 2) I have given multiple paid talks at LifeTime, so why would I want to be overly critical and in the process destroy any future opportunities there? It’s best to play nice and keep my mouth shut.
Reasons for Conflicts of Interest:
We’re human. We’re social animals that crave acceptance. We want to see our friends succeed. Recently I finished the book, Skin in the Game by Nassim Taleb and in it he brought up a very interesting point. To be truly conflict free you cannot have any friends or family. I mean think about, you are always going to put friends and family above people that you don’t know or don’t have a personal relationship with. You’re always going to have these relationship-based conflicts of interest, unless you don’t have any friends or family, and to me that doesn’t sound like much of a life.
There are two other conflicts of interest that are much more difficult to detect, unconscious bias and those born out of our own ignorance. Let me ask you a question, does a conflict of interest occur when you’re not consciously aware of it? We all have biases that we’re not consciously aware of that go into the decisions we make. These biases are part of the mental shortcuts and framework for how we view the world. Even the most thoughtful individuals have unconscious biases that they are unaware of and would even be embarrassed at the realization that they feel that way deep down. In terms of our own ignorance, even the most highly educated and experienced health professionals can’t know everything about everything. The blind spots in the knowledge that we have prevent us from realizing that we may have a professional conflict of interest. We’re limited by our own knowledge and expertise and as a result we can’t help but take on the mentality of “I’m a hammer and this problem is a nail”.
The bottom line is, we’re limited by the relationships that we have, the unconscious biases we hold, and by the lack of our own knowledge and expertise.
The Dangers of Conflicts of Interest:
It should be quite obvious why conflicts of interest are dangerous to our ethical well-being but let’s take a further look at them one at a time.
First, 99.99% of people who sell health & wellness products and services are conflicted. If you’re working for a particular company or brand, public criticism of the company you work for is taboo as you’re making your living from working for that company. Why risk ruffling feathers and getting fired? You’ve got a lot at stake. If you’re self-employed, you are a slave to consumer preferences. For those of us who are unemployed or looking for work, conflicts of interest also prevent us from calling out bullsh@t when we see it. We don’t want to harm a relationship, potential collaboration, or future job. Each of these conflicts prevents us from giving the consumer the most accurate, contextual information possible.
If you have a relationship with another health & wellness professional, you’re more likely to promote their services or refer clients to them. You may or may not know that they are good at what they do or that referring someone to them is in the client’s best interest, but they are your friend and so you refer to them. Now granted, if they suck at what they do, it will reflect negatively on you but provided they are at least okay at what they do, it shouldn’t reflect poorly on you. But how do you know that your referral is what is best for that client?
How to Protect Yourself from Succumbing to Conflicts of Interest:
Conflicts of interest are more prevalent in our own lives than we want to believe or care to admit and they are preventing the field of health & wellness from providing truly evidence-based, contextual products and services. You could sit back, sell your niche product or service, stay in a state of relative ignorance or you can go out, seek opinions from other qualified individuals, broaden your perspective, and increase your professionalism. Staying in your own little bubble will allow you to always be in the right but in my opinion, this is sacrificing the quality of your services. Here are a few things that you should do to protect yourself from conflicts of interest and raise the collective bar in health & wellness.
Be True to What the Data Say: I have a saying that I try to incorporate into my products, services, and programming, “If it isn’t backed up by a citation, it is just an opinion”. Having a solid scientific rationale and reasoning behind everything you do provides transparency for your decision making and helps you create the best product possible. Health & wellness must be data-based so that we are all able to speak the same language. And of course there isn’t data for everything and every situation but my God, there is a tremendous amount of research out there. We at least have to start there.
I can’t tell you how many times I have networked with another health & wellness professional who says something so “out there” that I can’t help but roll my eyes, eliminate them as someone I could work with, and try to get out of that conversation as quickly as possible. You may think that I’m being an overly critical academic when I say this but, no, these are truly outrageous claims based on no evidence whatsoever. Now, if these individuals were teachable or receptive to learning, we could continue our conversation but they are so tied to their product/service and the explanation for why/how it works that engaging with them any further is a waste of both of our time. They do not belong in the version of health & wellness that I envision.
Measure Everything You Can: in your own practice, measure everything you can: if it doesn’t make a measurable difference, who are you really helping? How is that person better off using your product or service. They might actually be equally well off not using it at all. Realize that health is hard to measure. One of my biggest pet peeve’s is when a product or service claims to do something that it is incapable of doing or provides such a small effect that it is insignificant to the consumer’s overall health. We must collect and provide data to support our products or services.
Put It Into Context: so much of health & wellness is one off and niche, isolated on its own, the product or service will neither harm nor help an individual. Products and services need to be put into the context of an individual’s entire life, not just some little part of it. This is by far one of my biggest beefs with health & wellness and specifically the field that I am in, nutrition. Nutritionists tend to want to drown you in facts, when in reality, facts don’t matter all that much. Education doesn’t matter, execution does.
Human health is highly interconnected, complex, and dynamic and you can’t solve all of your clients’ problems. And you may feel like you’re doing your part and that someone else needs to help them with the other parts of their life. Trying to help a client with ALL the aspects of his/her life can be extremely paralyzing as a practitioner and can leave you feeling like you are insignificant, that what you’re doing doesn’t matter. But this is exactly why we need to team up with other high-level practitioners that can help us fill in all the gaps in our knowledge.
Establish a Great Referral System: first, the ability to refer out demonstrates that you’re not the expert at everything, nor should/can you be. You should also be comfortable with turning down business that isn’t in the best interest of the consumer or the best match between consumer and practitioner. Furthermore, rather than relying on just one or two people, develop a robust referral system and have your client try out 2-3 potential services to see what they think of them before “buying in” figuratively and literally to that product or service.
Find Great Peers to Hold You Accountable: we all need peers that are willing to take the time to engage with your content, product or service and to be completely open and honest with you. And not only do these individuals need to be honest and open with you but as Ray Dalio in his book, Principles, has said, they need to be “believable”, that is, they have to have a track record of knowing what they are talking about.
I also completely agree with one of Ray Dalio’s core principles of “radical truth and transparency”. Don’t confuse this with a “tell it like it is” philosophy. Most people who “tell it like it is” don’t know what they are talking about, i.e. they aren’t “believable”. Radical truth and transparency is an open two way dialogue, not a one way scolding or condemnation. If possible, data should be at the core of this conversation. Surround yourself with people that are willing to challenge you. Being in an echo chamber is just as bad as not talking to anyone at all, maybe even worse.
Eliminate Shallow Relationships & Work: social media, continuing education, and networking groups tend to offer very little return on your investment. I used to try to be as active as I could on social media. What did I really get out of it? Nothing really. To me, being active on social media just made me worry that I wasn’t keeping up on everything or that I was missing out on some crucial piece of information that would prevent me from being the best professional that I could be. So much of social media is one-upsmanship, showing everyone what event you happen to be attending or pure product promotion. Very few people take any time to educate us and so many people are busy showing us that they are busy but don’t have anything to teach us or are unwilling to do so.
To me, continuing education is nothing more than a professional organization forcing you to pay them money for a piece of paper that lets you say you’re still a professional. Learning is not the primary objective of continuing education, making money is. You can’t force people to learn, they have to be willing to do it on their own by seeking out opportunities to learn.
Maybe I’m the only naïve one out there but networking is a lot like speed dating. You have to talk to a lot of people before you find someone you can settle down with. To use a fishing metaphor from my dad, sometime the fish are biting (they like your ideas) but you have to do a lot of sorting to find any keepers. Networking isn’t about developing business that day but for developing relationships with people you can work with down the road.
Find People You Can Learn From: sure, you can find thought leaders on social media but any connection you may have with them tends to be shallow and one sided. Social media companies brag about how accessible it makes people but how many great, not good, but great conversations can you have with a social media “influencer” and how truly accessible are they? Interacting with them is like a one-time meeting with a celebrity but where are they when you want to run something by someone or need some help with a particularly hairy problem you’re dealing with?
Social media is also full of internet trolls, naysayers, and people taking pot shots at you from the upper deck (often anonymously) with no skin in the game. We all need to develop more lasting relationships and frequent contact with people that are accessible, hold us accountable, and help educate us. This can be done online but more often than not; it is easier to do in person or at the very least having a mix of the two.
Be Mindful of Conflicts of Interest: being mindful is about more than the optics of your decision and what others may think, it is about holding yourself to the ultimate standard, holding yourself accountable. Don’t expect others to do it for you. If they have to start doing it for you (intervene) that means that your ethics have more than fallen off the wagon, they’ve jumped off a cliff. Although it is difficult to take the emotion out of our decision making, try to think objectively and somewhat coldly. Remove yourself from the situation and see how it looks.
Consumers Need to Think More Like Scientists: scientists are a very skeptical population. You need to produce the data to convince us that something is actually occurring and also be able to quantify its meaning or significance. Consumers should be unwilling to accept products and services at face value. We need to be able to “prove it” to them. While this creates a lot of additional work for the practitioner, it’s only going to improve the quality of your services.
Conflicts of interest are more than just financial, they are based upon the relationships we have, the unconscious biases we hold, and the blind spots in knowledge each of us possess. We tend to view conflicts of interest as something that affects someone else, not us, and if we do acknowledge that, yeah, we probably have some, they’re not something we’re actively working to correct. They are an annoyance and a hinderance, just another thing that we’re supposed to work on that we don’t have time for. Whether we want to admit it, they affect everything we do and frankly they are preventing the field of health & wellness from being more data-driven and evidence based.
No one can force you to learn and you’re responsible for setting your own ethical standards but finding great peers that you can learn from and hold you accountable will definitely help. You also need to be receptive to their advice (which can be really hard) but at the end of the day if we want to move the health & wellness field forward and out of pseudoscience, we need to meet our conflicts of interest head on. To that end, this is why I have started The Nutrition Advocate. So that data-driven, evidence based health & wellness professionals can come together to help educate one another and the consumer. For those of you in Denver, Colorado, I will also be starting an official Meet-Up, called Culture4Health for those high-level professionals who want to make a difference in people’s lives and move the field of health & wellness forward.