Healthy Skepticism Library item: 15821

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Benson MK.
Review of Medicine, money and morals: physicians' conflicts of interest
J Med Ethics 1995 Apr; 21:(2):24
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1376649&pageindex=1

Full text:

Although written from an American
perspective, this book is published at a
particularly appropriate time in the
evolution of the British health service.
Mark Rodwin is Associate Professor
of Law and Public Policy at Indiana
University and in this book he
examines the conflicts of interest
which arise within the medical profession
when decisions relating to patient
care are influenced by personal financial
incentives.
An opening section introduces how
conflicts of interest arise. Society in
general, and individuals in particular,
expect doctors to act on behalf of their
patients. Personal financial incentives
or divisions in loyalty can compromise
a physician’s commitment to patient
welfare. The move towards market
forces during the 1980s in both the
United Kingdom and the USA has
served to exacerbate such conflicts.
Professional medical organisations
have responded by drawing up ethical
guidelines to minimise potential
abuses. However, these guidelines
themselves reflect a degree of professional
ambivalence and in practice
have been difficult, it not impossible,
to enforce.
A second section illustrates and discusses
a range of financial incentives
which exist to increase as well as to
reduce services. Fee-for-service medicine
is an obvious example of a situation
whereby generation of additional
and possibly unnecessary services will
result in additional income. Gifts from
medical suppliers and drug manufacturers
may also influence choice of
treatment. Other practices which are
less familiar to British practitioners
include payment of ‘kickbacks’ for
referrals or admitting patients to
medical facilities in which the physician
has a direct or indirect financial
interest (physician self-referral).
Reducing expenditure by ‘risk sharing’
may persuade physicians to cut
out wasteful tests and procedures but
may also act to deprive some patients
of necessary care.
In the final section, Rodwin examines
the way in which society has
coped with conflicts of interest involving
other professionals such as
lawyers, financial advisers and government
officials. These all act as fiduciaries,
people with legal obligations to
serve others. From a British perspective,
the American models and
statutes used as illustrations again
have their limitations, but he presents
a broad range of strategies to minimise
potential conflicts. Perhaps the most
important is to try and separate
financial reward from clinical decision-
making. Other measures, such as
regulations and sanctions, are likely to
prove difficult to implement and
monitor. Financial incentives are
likely to be the most effective way of
influencing clinical decision-making.
Whether this is in the individual
patient’s best interests is debatable
and it will undoubtedly undermine
the trust which lies at the heart of the
doctor/patient relationship. This book
should provoke critical reflection on
the current reforms in health care.