Doctors, Charities, Conflict of Interest

From today’s NY Times, yet another story about physicians, drug & medical device companies, and conflict of interest: Charities Tied to Doctors Get Drug Industry Gifts

Around the country, doctors in private practice have set up tax-exempt charities into which drug companies and medical device makers are, with little fanfare, pouring donations — money that adds up to millions of dollars a year. And some medical experts see that as a big problem.

Now of course, many corporate donations are well-intentioned, and many of the foundations funded through corporate largesse do important research, educational work, and so on. But others are clearly thinly-veiled ways for companies to funnel money to physicians — money they can’t legally simply hand over to them — as part of a marketing strategy.

Patrick L. Meehan, the United States attorney in Philadelphia, whose office has a long history of prosecuting health care fraud, said the doctors’ charities could warrant scrutiny. “What we would be concerned about are end runs around the system,” Mr. Meehan said. “We want to be sure there is independent and fully informed medical judgment at the heart of the physician-patient relationship.”

Why this is a business ethics issue:

a) In most places, doctors are business-people, too. Even if they practice solo, they run offices, hire staff, and so on. And many become involved in larger partnerships, run major clinics, etc. They’re engaged in business, so they need to know (and help improve) the ethical rules that apply to the world of commerce.

b) The other side of the coin: for every physician (or every hundred physicians) involved in a conflict of interest, there’s a pharmaceutical or medical device company generating that conflict. Bioethicists are welcome to focus on the choices physicians make in getting themselves into such conflicts, and what they should do to avoid them. But from a business ethics point of view, there are serious, serious questions about corporate behaviour here. Whenever corporate actions — a donation, a consulting contract, whatever — put a professional or other trusted decision-maker into a conflict of interest, they are arguably doing a disservice both the the public that relies upon that decision-maker, and to the group of decision-makers (professionals, politicians, etc.) whose trustworthiness & integrity needs to be maintained.

c) Finally, this is a business ethics issue because business may well be better able to respond to it than the medical profession is. The medical profession is relatively fragmented, and made up by tens of thousands of individual decision-makers, all bound together only quite loosely by a relatively vague code of ethics. In addition, despite the fact that (as noted above) physicians are typically also business people, they’re not always the most savvy about the ethical perils of the world of commerce. Pharma and medical device companies may also be better able to respond to this problem just as a matter of numbers. Ask yourself this: which is easier to change, the behaviour of a single large company, or the behaviour of the dozens or hundreds of individual physicians and foundations to whom or through which that company funnels money?

Relevant Books:
On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, by Jerome Kassirer
The Truth About the Drug Companies: How They Deceive Us and What to Do About It, by Marcia Angell

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