Financial Conflict of Interest: An Unresolved Ethical Frontier

By Kassirer, Jerome P. | American Journal of Law & Medicine, January 1, 2001 | Go to article overview

Financial Conflict of Interest: An Unresolved Ethical Frontier


Kassirer, Jerome P., American Journal of Law & Medicine


Financial conflict of interest has become one of the most contentious issues in medicine today. Several decades ago studies disclosed that physicians who had investments in medical facilities were referring patients for more tests and procedures than physicians who had no such investments. More recently, physicians who forego expensive tests and treatments for patients have been accused of skimping on care for personal financial gain. Physicians who emphatically tout certain treatments have been criticized for possessing hidden financial ties to the manufacturer of the products. Some physicians engaged in clinical trials have been suspected of enrolling patients who do not strictly conform to the research protocols so that they can collect fees from contract research organizations. And in the aftermath of deaths and complications in gene therapy experiments, some scientists and their institutions have been criticized for possessing a financial stake in companies that are involved in the studies.

In the past, such issues have been handled locally and quietly behind the closed doors of hospitals and medical schools. However, highly publicized examples of financial conflict of interest have stimulated the Federal Government to develop new guidelines to minimize or eliminate conflicts of interest, impose stringent rules to protect human subjects, strengthen government oversight of clinical research, and consider legislation that would levy large monetary penalties for violations.'

Have financial incentives gone too far? Has medical care been compromised because of incentives to do too much or too little for patients? Has money motivated for-profit insurance companies to deselect patients, to price gouge, to cherry pick? Is the loyalty of young physicians and students being captured inappropriately by meals and gifts from industry? Most scientists and physicians believe that they cannot be bought, especially by paltry gifts or trips to resorts for meetings. How can we be sure? How large is the hidden epidemic of financial conflict of interest, and what impact does it have on the practice of medicine and the cost of medical care?

This essay looks at the origins of the expanding relationship between academia and industry and the benefits and pitfalls of this collaboration. It assesses available information on the extent of such conflicts and considers the concern that financial conflicts of interest have become pervasive in academic medicine and have led to overt bias on the part of physicians and clinical investigators. This article then examines how the conflicts of interest in medicine fit into the broader aspects of changing societal norms, and finally makes recommendations that might limit the impact of such conflicts.

1. HEALTH CARE AND OUR CAPITALIST SOCIETY

Is medicine just another commodity and should we be treating it as such? Some argue that health care, being a service, is just that: a suitable object of commerce that is enhanced by rigorous competition. However, the major components of health care, namely medical care, education, and research, have only recently been exposed to the full force of the free market. The economic force of this free market has achieved dramatic social and economic consequences.

Financial incentives are powerful inducements to all the major stakeholders in medicine, just as they are in other walks of life. In the past, a fee-for-service payment system motivated physicians to spend more money on medical care; now capitated systems motivate them to spend less. DRG-based reimbursement2 motivated hospitals to reduce their patients' length of stay. Ownership of laboratories or imaging facilities motivated physicians to refer more patients for testing. Payment for accepting patients in clinical trials motivated physicians to enhance enrollment. Financial reward is and continues to be a strong inducement for physician-entrepreneurs to generate new ideas and develop new equipment, technology, products and computer applications.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Financial Conflict of Interest: An Unresolved Ethical Frontier
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.