Academic journal article Health Sociology Review

Conflicts of Interest in Neoliberal Times: Perspectives of Australian Medical Students

Academic journal article Health Sociology Review

Conflicts of Interest in Neoliberal Times: Perspectives of Australian Medical Students

Article excerpt

Introduction

In recent years, relationships between medical professionals and the pharmaceutical industry have been the subject of considerable scrutiny, leading to numerous policies and processes aimed at managing the 'conflicts of interest' that are believed to result from these relationships. While many people have concerns about conflict of interest (COI) - arguing that they get in the way of doctors''primary commitments' to their patients - others have begun to push back against efforts to curtail relationships between medicine and the pharmaceutical industry. In a recent series of articles in the New England Journal of Medicine, for example, cardiologist Lisa Rosenbaum questioned the need, justification and extent of COI policies in health and medicine (Rosenbaum, 2015). In response, the British Medical Journal published a series of editorials criticising Rosenbaum, questioning the wisdom of the New England Journal of Medicine for raising doubts about COI policies, and reiterating the need for vigilance in the face of industry influence (Godlee, 2015; Steinbrook, Kassirer, & Angell, 2015).

These papers, and numerous accompanying blogs, are illustrative of the polarising, and often polemical, nature of debates surrounding conflicts of interest in health and medicine. They are also illustrative of the fact that debates about COI in health and medicine are usually opinion-based rather than being based on an empirical analysis of the ways in which individuals engaged in the practice of health and medicine understand, experience and manage COI. This is a problem because there may be little resemblance between the attitudes, values and practices of those engaged in medical practice, and those espoused in political and theoretical debates.

In seeking data on the attitudes, values and practices that may be relevant to discussions of COI, it is important that we first identify all the perspectives that are likely to be salient to these debates. While this would clearly include the perspectives of established practitioners, it is also important to understand the attitudes, values and practices of medical students, as these are in formation and in flux. By asking students about commercial norms, and the potential for these to clash with their perceptions of what it means to be a good doctor, we can understand - and potentially intervene in - the processes of professionalisation.

Sociologists have long been interested in the role of professions, especially medicine (Freidson, 1989; Larson, 1979; Macdonald, 1999; Montgomery, 2014). There has also been significant attention to the socialisation of medical students into professional roles and institutions (Becker, Hughes, Geer, & Strauss, 1965; Merton, Reader, & Kendall, 1957) - for example how students make sense of the collision of values surrounding the desire to care, the need to assimilate technical knowledge, and the necessity to function effectively within often rigid hierarchies of power and social control (Conrad, 1988; Hafferty, 2008; Maheux & Béland, 1987; Pitkala & Mantyranta, 2003; Wright, Wong, & Newill, 1997). And while we know something about the way debt and potential income influence speciality choice (Morra, Regehr, & Ginsburg, 2009; Newton, Grayson, & Foster Thompson, 2010; Rosenblatt & Andrilla, 2005), we know little about the values, attitudes and practices that shape how commercial forces and conflicts of interest are perceived and managed by medical students.

A further reason it is important to study medical students ' perspectives of COI is that they are being enculturated not only into a profession, but also into particular systems, practices and structures of health care. More specifically, they are being enculturated into a neoliberal health system in which commercial interests are inevitably manifest and frequently valorised. Despite the increasing influence of commercial norms in medical education and practice (Field & Lo, 2009; Horton, 2007; Komesaroff, Kerridge, Isaacs, & Brooks, 2015; Mackintosh & Koivusalo, 2005; Pollock, 2005; Rogers & Forman, 2013), and the large literature examining con fl icts of interest in medicine (Field & Lo, 2009; Krimsky, 2004; Rodwin, 1993), it is significant that there is no substantial analysis of medical students' perspectives on COI or the influence of commercial norms in a neoliberal context. …

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