Health Industry Practices That Create Conflicts of Interest

Abstract

Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.

Patients’ Beliefs and Preferences Regarding Doctors’ Medication Recommendations

“…15 Doctors' relationships with pharmaceutical representatives appear to influence prescribing practices 16,17 , and concerns exist related to gift-giving ethics. 18,19 Recent lay publications have also raised ethical questions about some doctors' relationships with the pharmaceutical industry. [20][21][22] Participants in our study described trust as important in accepting a doctor's recommendation for a medication.…”

The Intersection of Online Social Networking with Medical Professionalism

“…1 While professionalism is hard to objectively measure and difficult to teach, there has been progress in areas like patient confidentiality (e.g., the Health Insurance Portability and Accountability Act), communication skills, interactions with pharmaceutical companies, law and ethics. [2][3][4][5][6][7][8][9][10][11][12] However, despite extensive research and debate, it remains difficult to define or measure the domain that the ACGME calls the "professional accountability to society." 1,10,[13][14][15][16] Further, in this age of Internet communication, the identity of being a 'professional" is expanding, inadvertently blurring the interface between work and personal time.…”

Mixing Dinner and Drugs—Is It Ethically Contraindicated?

“…Making use of innovative solutions for addressing the conflicts of interest that flow from industry-HCP relationships is an ethical requirement to avoid harm to patients and to help improve the quality of pharmaceutical education. Strategies have been described for eliminating industry influence in practice at both large academic medical centers and family practice settings [22], sometimes termed being "pharma-free" [21]. With the advent of the patientcentered medical home, other options may begin to make more cultural sense, such as increasing utilization of the only medication experts in health care-pharmacists-in novel ways.…”