David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Oxford University Press (1993)
Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change.
|Keywords||Medical ethics Decision making Physicians Professional ethics Medical care Cost control Conflict of interests Conflict of Interest Economics, Medical Ethics, Medical Morals Physicians|
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|Buy the book||$11.95 new (66% off) $36.95 direct from Amazon Amazon page|
|Call number||R725.5.R63 1993|
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James M. DuBois, Emily E. Anderson, Kelly Carroll, Tyler Gibb, Elena Kraus, Timothy Rubbelke & Meghan Vasher (2011). Environmental Factors Contributing to Wrongdoing in Medicine: A Criterion-Based Review of Studies and Cases. Ethics and Behavior 22 (3):163 - 188.
K. J. Holloway (forthcoming). Teaching Conflict: Professionalism and Medical Education. Journal of Bioethical Inquiry:1-11.
Barbara K. Redman & Arthur L. Caplan (2005). Off with Their Heads: The Need to Criminalize Some Forms of Scientific Misconduct. Journal of Law, Medicine & Ethics 33 (2):345-346.
Wendy K. Mariner (1995). Business Vs. Medical Ethics: Conflicting Standards for Managed Care. Journal of Law, Medicine & Ethics 23 (3):236-246.
Peter D. Jacobson, Elizabeth Selvin & Scott D. Pomfret (2001). The Role of the Courts in Shaping Health Policy: An Empirical Analysis. Journal of Law, Medicine & Ethics 29 (3-4):278-289.
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