Ethics problems in Pharma

A recent op-ed piece in the New York times called “Drugs, Devices and Doctors” points out that conflicts of interest are the norm, rather than the exception, in the medical devices and pharmaceutical industries. In the piece, editorialist Paul Krugman argues that “growing conflicts of interest may be distorting both medical research and health care in general.”

(You have to have a subscription to see the full op-ed piece.)

Krugman goes into some detail regarding a questionable relationship between The Cleveland Clinic, some of its doctors and administrators, and pharmaceutical giant Merck. The story sounds complex, but in essence it all boils down to the fact that “crucial scientific research and crucial medical decisions have to be considered suspect because of financial ties among medical companies, medical researchers and health care providers.”

That should come as no surprise. The past quarter-century has seen the emergence of a vast medical-industrial complex, in which doctors, hospitals and research institutions have deep financial links with drug companies and equipment makers. Conflicts of interest aren’t the exception – they’re the norm.

The economic logic of the medical-industrial complex is straightforward. Prescription drugs and high-technology medical devices account for a growing share of medical spending. Both are products that are expensive to develop but relatively cheap to make. So the profit from each additional unit sold is large, giving their makers a strong incentive to do whatever it takes to persuade doctors and hospitals to choose their products.

What should come as a surprise is that almost all of the attention paid to ethical issues like this in the pharmaceutical industry has been paid by bioethicists and physicians. So far (and correct me if I’m wrong) the pharma industry has garnered relatively little attention from scholars in business ethics or corporate ethics activists. This is a shame. The problems outlined by Krugman in the NYT have precious little to do with the fact that the pharma industry is part of the larger world of health care, so there’s no particular reason bioethicists should be able to corner the market on criticizing an industry that behaves, on the whole, quite badly. Krugman points out rampant conflicts of interest, yet (no offence intended) I doubt most bioethicists could definte “conflict of interest.” It’s just not part of the standard range of problems in that field. But conflict of interest IS a standard problem in business, and so there’s a large lots written about it in both the business ethics and professional ethics literatures. It would be great (hint hint) to see scholars from those fields tackling the problems in pharma.

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