Medical merchants: conflict of interest, office product sales and notifiable conduct

Abstract

Professional ethical codes identify the issue of conflict of interest, which can distort doctors’ objective judgements concerning the best interests of patients. Legal fiduciary duties may be owed by doctors to patients in situations of potential conflict of interest. Prescribing and dispensing functions have been largely legally separated to prevent conflicts of interest arising. The advent of integrative medicine has been accompanied by an apparent growth of in‐house selling of therapeutic products. Medical merchandising constitutes a prima‐facie conflict of interest and may amount to notifiable conduct under the Health Practitioner Regulation National Law provisions. We believe that doctors who sell therapeutic products should adhere to strict conditions to avoid significantly departing from accepted professional standards. Doctors who have a reasonable belief that a colleague is failing to comply with these conditions could consider notifying the Medical Board of Australia.

Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice

“…Respondents expressed concern at the growing influence of manufactured CAM product in their practice. The phenomenon of CAM being increasingly recognised as a commercial healthcare ‘product’ have been raised previously by commentators [37], as have the potential conflicts of interest of product sales by CAM clinicians [22,38]. The cautious views of naturopaths in this study on this issue seem not only consistent with external critics of the CAM industry, but also with CAM practitioner views elicited in other studies, which have highlighted practitioner concerns with the increasing commercialisation of CAM, with practitioners expressing concerns that the increase in prevalence of commoditised form of CAM may force practitioners to take a ‘business-like’ attitude to CAM, often at the expense of an altruistic focus on patients [31].…”

The interface with naturopathy in rural primary health care: a survey of referral practices of general practitioners in rural and regional New South Wales, Australia

“…The fact that high levels of GP support for major elements of naturopathic practice, such as herbal medicine and nutritional and vitamin therapy, have not translated to high levels of support or referral to naturopaths would appear to support the notion that professional tensions exist between these two groups. Such tensions may suggest that opposition is related more to perceived risks associated with the practice behaviours of naturopaths, such as perceived conflict of interest in product sales [27] or variable training [8], than they are to specific elements of naturopathic practice. Given the recent high-profile attacks on CAM practitioners garnered in the Australian medical media [19], further examination of differences in perception and attitudes of GPs to medical and non-medical practice of CAM may offer valuable insights into how these therapies are integrated in primary health care.…”

Sale of medicines by Registered Medical Practitioners at their clinics: Legal and ethical issues

“…RMPs selling medicines at their clinics to their patients may represent a significant potential conflict of interest against the medical ethical principles of autonomy, beneficence, and non-maleficence. [ 7 8 ]…”

“…Many medical ethics guidelines took the position that RMPs selling drugs through his/her own pharmacy was prohibited because of “conflict of interest,” and it amounts ethical violation under “fee-splitting.”[ 3 6 7 ] The Indian Medical Council Act, 1956 (102 of 1956), section 20A, read with section 33 (m) the Medical Council of India with the prior approval of the Central Government, have notified the regulations relating to the Professional Conduct, Etiquette and Ethics for RMPs and it is titled “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (Amended on 2016).”[ 17 ] In the above regulations, section 6.3 clearly states that an RMPs should not run an open shop for sale of medicine for dispensing prescriptions prescribed by RMPs other than himself or for sale of medical or surgical appliances. [ 17 ] It is not unethical for RMPs to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient.…”