The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics
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The ubiquitous nature of medical conflicts of interest is attracting increased attention from physicians, policymakers, and patients. However, little work has examined the psychological processes at play in the presence of such conflicts. I investigate the subtle influences arising from conflicts of interest that change behavior in both physicians and patients. ⋯ This increased pressure occurs because patients want to avoid appearing as though they believe that the (now disclosed) conflict of interest has corrupted their doctors' advice. Thus, instead of being merely a warning, disclosure can become a burdensome request to comply with advice the patient trusts less. These results highlight potential pitfalls that new policies intended to address conflicts of interest should seek to avoid.
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Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver "educational" talks to groups of physicians in the community to help market the company's brand-name drugs. Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. ⋯ This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking.
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Physicians and patients rely on medical journals as trusted sources of medical information. Unfortunately, conflicts of interest (this article primarily considers financial conflicts of interest) may undermine the credibility of the medical literature. Improved policies and practices at journals should address the conflicts of interest of authors, reviewers, editors, and journals. Medical journals should manage and eliminate conflicts, not just improve the disclosure of financial relationships.
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The case for U. S. health system reform aimed at achieving wider insurance coverage in the population and disciplining the growth of costs is fundamentally a moral case, grounded in two principles: (1) a principle of social justice, the Just Sharing of the costs of illness, and (2) a related principle of fairness, the Prevention of Free-Riding. These principles generate an argument for universal access to basic care when applied to two existing facts: the phenomenon of "market failure" in health insurance and, in the U. ⋯ S. moral culture by conservatives and liberals alike. Similarly, across the political spectrum, the fact of market failure is not contested (though it is sometimes ignored), and the guarantee of access to emergency care is rarely challenged. The conclusion generated by the principles is not only that insurance for a basic minimum of care should be mandatory but that the scope of that care should be lean, efficient, and constrained in its cost.
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When physicians' conflicts of interest arise from ties with drug firms, we should shift our focus to the pharmaceutical industry and improper dependencies that cause institutional corruption. This article analyzes eight forms of improper dependencies on pharma and proposes reforms.