Medicine, Money, and Morals

Physicians' 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; for hospitals to offer incentives to physicians who refer patients to them; or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs. In Medicine, Money, and Morals, Marc A. Rodwin examines these conflicts of interest, explains why the profession has failed to cope successfully with them, and shows how they have become worse over the past century. He looks at how - in response to dubious practices of the past such as fee-splitting, physicians' ownership of medical facilities, drug dispensing, and the like - the profession developed ethical guidelines but was unable to enforce them. He shows how current public policies and institutional practices now offer doctors financial incentives to promote various goals at odds with the interest of patients. These policies and practices, Rodwin writes, tie doctors' personal financial well-being to medical care providers - hospitals, medical suppliers, and pharmaceutical firms - and also to insurers and other third party payers. Doctors today are tempted to think of how they will fare financially by making particular clinical decisions. As a result, patients often receive too many or too few medical services, or the wrong kind, sometimes undergoing painful, dangerous, or unnecessary medical procedures. Rodwin shows what can be learned from the way society has coped with conflicts of interest involving other professionals (lawyers, government officials and financial professionals), all of whom are held to higherstandards of accountability than doctors. He explains, too, why simplistic solutions such as public disclosure of conflicts or government ownership of health services won't work. He offers examples of what can be done to help reduce these problems by regulation, tax policy, audi