Environmental Factors Contributing to Wrongdoing in Medicine: A Criterion-Based Review of Studies and Cases

Abstract

In this paper we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research.

Understanding the Severity of Wrongdoing in Health Care Delivery and Research: Lessons Learned From a Historiometric Study of 100 Cases

“…An Environmental Factors Score Sheet was developed based upon (1) an extensive review of the psychological and social science literature on factors that correlate with or predict professional wrongdoing (DuBois et al 2012) and (2) qualitative analysis of the first 30 cases by the research team to identify any additional environmental variables that might predict the wrongdoing. It was modeled upon “benchmark” scoring guides used in other historiometric studies (O’Connor et al 1995).…”

“…Wrongdoing among researchers harms participants (DuBois 2008), pollutes the scientific literature (Titus, Wells, and Rhoades 2008), and damages public trust (Coughlin, Barker, and Dawson 2012). While many articles have been published on professional wrongdoing, our literature review found no studies that examined the rich contextual details of large sets of historical cases of wrongdoing (DuBois et al 2012). …”

“…Historiometry combines qualitative and quantitative methods to study variables that either for logistical or ethical reasons cannot be investigated using prospective or experimental methods. While we have reviewed many studies that use surveys or experimental procedures to understand wrongdoing (DuBois et al 2012), examination of actual cases provides rich, ecologically valid information that would be difficult to otherwise obtain because it would be unethical to try to induce professional wrongdoing in the actual care of patients or enrollment of research participants.…”

“…Therefore, we conducted a thorough review of environmental factors associated with professional wrongdoing (DuBois et al 2012). We identified ten variables that data suggest play a contributing role in wrongdoing by providing means, motive, or opportunity (MMO): conflicting roles (Grover 1993; Levine 1992); wrongdoing financially rewarded (Jennings 2006; Rodwin 1993); others benefitting from wrongdoing (Victor, Trevino, and Shapiro 1993); protagonist (wrongdoer) being penalized for right behavior (Hegarty and Sims H 1978; Jansen and Von Glinow 1985); others being penalized for right behavior (Schuchman 2008); the mistreatment of the protagonist or perceived organizational injustice (Greenberg 1993; Keith-Spiegel and Koocher 2005; Martinson et al 2006); ambiguous professional norms (Davis 2003; DuBois and Dueker 2009; Meyer and Jr. 2002; Shah et al 2004; Simonton 2003;); particularly vulnerable victims (Bandura, Underwood, and Fromson 1975; Zimbardo 2007); oversight failures (Bramstedt and Kassimatis 2004; Marshall 1999); and the protagonist being in a position of authority over co-workers (Milgram 1965; Trevino, Butterfield, and McCabe 1998).…”

A Mixed-Method Analysis of Reports on 100 Cases of Improper Prescribing of Controlled Substances

“…However, it did not systematically examine environmental factors that might be correlated with IPCS. A review article by DuBois and colleagues identified 10 environmental factors that may be correlated with professional wrongdoing in medicine (DuBois, et al, 2012). By reviewing empirical studies and actual cases, a series of environmental factors were identified that may contribute to wrongdoing by providing motive, means, or opportunity—three elements common to general forensic theory (Jones, 2010; Maguire, Reiner, & Morgan, 2007).…”