Physician Conflicts Of Interest Research Articles

Perceptions of Financial Conflict of Interest and Knowledge of the Sunshine Act Among Orthopedic Surgery Patients.

The orthopedic surgical specialty is strongly tied to partnerships with industry that have fostered innovation and greatly enhanced patient care. A substantial number of orthopedic surgeons currently receive some form of industry support. These relationships are highly scrutinized because they present the possibility of both personal and financial conflicts of interest (COI). The authors examined orthopedic patients' awareness of existing regulation and perceptions of financial COI by performing a prospective survey-based study of patients seen in an academic orthopedic department. Data were collected during 1 year, in a cross-section of hospital-based and community clinical settings. The authors collected 513 surveys during a 1-year period between 4 clinical locations. Of all respondents, 55% were unconcerned regarding gifts or direct compensation their physicians received from industry, and only 16% were very or extremely concerned regarding these benefits. Patients' opinions regarding possible influence of benefits were similarly ambivalent, with 54% of patients minimally or not at all concerned regarding the potential influence of industry gifts or compensation. Seventy-six percent of patients had never heard of the Sunshine Act, and only 3% indicated that they were aware of the legislation and its intention. The income of the respondents and their level of education were positively correlated with increased concern about handling of COI, as well as knowledge regarding the Sunshine Act. These data suggest that orthopedic surgery patients are widely unconcerned regarding physician COI, but specific subsets of patients may be more likely to have concerns regarding these relationships. [Orthopedics. 2021;44(5):e682-e686.].

(Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?

Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study

ObjectiveTo better understand the origins, manifestations and current policy responses to patient–physician mistrust in China.DesignQualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust.SettingGuangdong Province, China.ParticipantsOne...

A Two-Tier Health Care System: The New Zealand Story

The Canadian health care system is at a crossroads. Litigation building on the Supreme Court of Canada’s decision in Chaoulli that could lead to the establishment of a parallel private tier is underway in several provinces. For example, in a challenge set to proceed to trial this fall, Dr. Brian Day and six patient plaintiffs are challenging several British Columbia laws that restrict parallel private care. Provincial governments across Canada employ various laws to protect public Medicare, including bans on private insurance for publicly insured services, limits on dual practice by physicians (i.e. prohibiting those who are paid through the public insurance plan from also being paid from the public purse), and bans on extra-billing for insured services (i.e. preventing physicians from topping up public payments by charging patients more). Plaintiffs in the upcoming cases allege that the combination of long wait times in the public system and limits on private care infringe their Charter rights to life and security of the person. As judges evaluate these claims, a key consideration will be whether restrictions on private care are essential to preserving quality, efficiency, and accessibility within Canada’s public health care system. In assessing the impact of liberalizing these laws, courts will rely on the comparative experience of countries that also have universal public health insurance, but that allow parallel private care. However, too often, the subtleties of foreign countries’ experiences with two-tier care and contextual differences between health care systems are downplayed or ignored, in favour of simplistic conclusions. For example, in Chaoulli, Chief Justice McLachlin accepted a “common sense” argument that prohibiting private health insurance was not related to the provision of quality public health care, given the experiences of several western democracies with “medical services that are superior to and more affordable than the services that are presently available in Canada,” without addressing the differences that exist between Canada and these countries. This paper draws lessons for Canada from New Zealand’s health care system, which permits two-tier health care. After briefly comparing the two systems, we address the claim that New Zealand’s shorter wait lists coupled with its permissive approach to a parallel private system suggest that Canada should loosen its own restrictions on privatization. We argue that not only are there concerns with the reliability of New Zealand’s wait list data, but that its method of organizing wait lists and its permissiveness of dual practice raise serious concerns with equitable access, quality of care, and physician conflicts of interest. We conclude by arguing that the uncertainty inherent in adapting comparative health policy literature to the Canadian context necessitates judicial deference to policy-makers in the upcoming constitutional challenges.

Nephrologists’ Professional Ethics in Dialysis Practices

Although the number of incidents is unknown, professional quality-oriented renal organizations have become aware of an increased number of complaints regarding nephrologists who approach patients with the purpose of influencing patients to change nephrologists or dialysis facilities (hereinafter referred to as patient solicitation). This development prompted the Forum of ESRD Networks and the Renal Physicians Association to publish a policy statement on professionalism and ethics in medical practice as these concepts relate to patient solicitation. Also common but not new is the practice of nephrologists trying to recruit their own patients to a new dialysis unit in which they have a financial interest. This paper presents two illustrative cases and provides an ethical framework for analyzing patient solicitation and physician conflict of interest. This work concludes that, in the absence of objective data that medical treatment is better elsewhere, nephrologists who attempt to influence patients to change nephrologists or dialysis facilities fall short of accepted ethical standards pertaining to professional conduct, particularly with regard to the physician-patient relationship, informed consent, continuity of care, and conflict of interest.

Current Trends to Consider With Evidence-based Medicine’s Importance

Evidence-based medicine and its quality work products enter current clinical practice at a time when physicians face a confusing, contradictory, and changing practice environment. Disparate expectations by patients and policy makers; physician conflicts of interest, and an assumption that doctors control the cost of healthcare, contribute to fears that evidence based medicine in general and guidelines and performance measures in particular, will be misused. An integrated framework for developing evidence based tools is presented.

Making Transparency Matter

Making Transparency Matter

Regulating self-referrals and other physician conflicts of interest.

For better or worse, the federal government is actively regulating physician conflicts of interest, including referrals of Medicare and Medicaid patients for health services in which physicians have a financial interest. The government's ever-increasing role in regulating physician conduct is a response to the profession's own failure to adequately deal with conflict of interest problems, as well as a function of the government's greater stake in funding clinical practice and research. This article addresses the implications of the growing role of government for the continuing professionalism of physicians, given that professionalism is commonly thought to include the ability of a profession to regulate itself in the public interest. The author describes how professional societies and individual physicians still have a significant role to play in regulating self-referrals and other conflicts of interest, but that physicians must first correct serious deficiencies in their ideological treatment of conflicts of interest. To begin, they must distinguish between the pervasive conflicts of professional practice, which are open, obvious, and unavoidable, and true conflict-of-interest problems, in which the conflicts are hidden and avoidable. The article then articulates a general approach to resolving true conflicts-of-interest problems, borrowing doctrine from the well-developed field of legal ethics. The article ends with an application of the general approach to physician self-referrals, concluding that clients are often capable of informed consent, but that physicians are well-advised to issue their own self-referral guidelines that take into account the legitimate interests of third-party payers like the government, at least when such interests do not clearly conflict with the interests of patients.

HMOs and physician conflicts of interest.

In a recent issue of this journal, Francis Beckwith's "The Ethics of Referral Kickbacks and Self-Referral and the HMO Physician as Gatekeeper: An Ethical Analysis" provided an admirably provocative defense of the claim that Health Maintenance Organization (HMO) physician gatekeepers are morally indistinguishable from physician referral kickbacks and self-referrals. Here I will argue that Beckwith's defense is weak. I will also make some tentative suggestions about approaching the issue of physician conflicts of interest.

Trusting Doctors: Tricky Business When it Comes to Clinical Trials

This article examines the troublesome ethical dilemmas arising out of physician conflicts of interest in the context of research on human beings. It focuses on the inevitable conflict between the objectives of clinical investigators and those of their human subjects to illuminate subtle divergences of interest in doctor-patient relationships that patients often do not recognize - or want to believe. Once perceived, however, these potentially corroding conflicts can stun research subjects and their families, and leave them feeling deeply betrayed by their clinicians. The article concludes that a researcher's substantial financial conflicts constitute material information which, absent compelling circumstances, the researcher ought to disclose to human subjects as a matter of course.

An Engelhardtian analysis of interactions between pharmaceutical sales representatives and physicians.

Physician conflict of interest has been of concern since Hippocrates and rarely is this concern more evident than in the relationship between pharmaceutical sales representatives (PSR) and physicians. Given the acrimonious public debates concerning this issue a careful exploration of the concerns at sake and the conceptual arguments which support such concerns is called for. In this piece I will take as heuristic the conceptual philosophical framework argued for by H. Tristram Engelhardt. This framework would sanction interactions between PSRs and physicians given that such relationships are free and without coercion. Further, patients must be informed, uncoerced and free in choosing such relationships with physicians who engage in interactions with PSRs. I consider four major criticisms which claim that PSR-physician interactions are morally impermissible: 1) influence, 2) "patients do not choose, but they pay," 3) violation of ethical principles, and 4) erosion of the patient-physician relationship. Each is shown to be unpersuasive under Engelhardtian philosophy. As long as the principle of permission and informed consent obtain without coercion than the interaction between PSRs and physicians would be construed to be morally permissible.

ACC/AHA guidelines for cardiac catheterization and cardiac catheterization laboratories. American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization.

It is evident that the practice of cardiac catheterization has undergone, and continues to undergo, marked change. Most prominent are the recent very rapid proliferation of catheterization laboratories in general and the development of newer types of catheterization laboratory. No uniform definitions exist for these newer laboratories, so meaningful communication is difficult. The new settings are of particular concern because their location, mobility, organization, and ownership raise questions about the quality of patient care. Most difficult to address are the questions about patient safety and physician conflict of interest. There are no objective data in peer-reviewed literature to support the reported safety and cost savings of these newer settings. Through deliberations, surveys, interviews, and correspondence with the cardiology community embraced by the ACC and the AHA, the task force generally found that in freestanding catheterization laboratories, access to emergency hospitalization may be delayed, and appropriate oversight may be lacking. Additionally, opportunities for self-referral may be fostered and the perception of commercialism and entrepreneurial excess in practice created. All of these problems must be avoided. The growth and development of some freestanding facilities, particularly the mobile laboratories, do not seem to have been driven by an increased need in remote communities or for temporary support but rather almost exclusively by a desire to capture market share. Accordingly, a series of definitions, guidelines, and recommendations for the laboratories as well as for patient selection has been developed. The consensus was that a very restrictive and cautious attitude to the newer settings is appropriate at this time. The justification for development or expansion of cardiac catheterization services must be patient need. Documentation of this need must be based on objective estimates of the number of patients with known or suspected cardiac disease who meet generally accepted indications for laboratory study. Concerns about the lack of data from prospective clinical trials of patient safety in such a group necessitate a very cautious attitude toward any new catheterization services, in particular those without in-house cardiac surgical support. In view of the lack of appropriately controlled safety and need data for hospital-based, mobile, or freestanding laboratories operating without on-site (accessible by gurney) cardiac surgery facilities, the task force reaffirms the position that further development of these services cannot be endorsed at this time. In addition, there is reason for major concern that such proliferation in catheterization services may contribute to increasing costs and troubling ethical questions.

Cardiac Catheterization Laboratories: Should Every Hospital Have One?

It is obvious that times have changed. Cardiac catheterization laboratories are everywhere. The concerns that must be addressed continually are: 1. Patient safety and quality of patient care. 2. Access to emergency hospitalization. 3. The overseeing of these laboratories. 4. Physician conflict of interest. 5. Need for the laboratory in the region In order to add a new cardiac catheterization laboratory to any region, patient need must be documented. Patient need is the only justification for the development of a new laboratory. I fail to understand how the continuing development of new laboratories will decrease costs, and am concerned that more catheterization laboratories will mean more studies of patients with borderline indications for the procedure.