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Of mugs, meals and more: the intricate relations between physicians and the medical industry

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Abstract

Empirical research has proven the influence exerted by the medical industry on physicians’ decision-making. Physicians are the gatekeepers who determine how money is spent within the healthcare system. Hence, they are the target group of powerful lobbies in the field, i.e. the manufacturers of medical devices and the pharmaceutical industry. As clinical research lies in the hands of physicians, they play an exclusive and central role in launching new medical products. There are many ethical problems involved here: physicians may develop a mindset of entitlement; biased decisions may put patients at risk; academic interests and research activities will no longer be free if they are influenced considerably by financial incentives; fair resource allocation may be restricted. An aspect that has been neglected so far is the administrators’ involvement as they not rarely expect physicians to acquire external financial resources from industry as benefits often lie with the institutions. To “protect” physicians from undue sway may be in the best interest of patients in order to guarantee a fair allocation of resources and to prevent the application of technologies (and medications) that would not have been used according to current standards of care. The latter may and obviously does put patients at risk. On the other hand, medico–industrial relations are of great importance. A considerable part of medical progress is driven by private industry. Yet, any co-operation between those who care for patients and industry ultimately has to serve the patient. Hence, strong policies to guide conduct are sorely needed. The following points are held to be pivotal in order to secure ethical conduct: (1) professional codes of ethics; (2) a stronger academic attitude amongst medical staff, (3) rules of transparency for medico−industrial relations including online disclosure and limiting scale of payments, (4) establishing rules (and laws) that ban unethical conduct and mandate vigorous surveillance of adherence to guidelines.

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Notes

  1. For example: OnkoZert is the organisation entrusted by the German Cancer Society with accrediting centres for the treatment of cancer patients in Germany. One of the criteria employed for accreditation is the treatment of a certain percentage of the patients treated at a particular centre within the scope of clinical trials.

  2. In her review of books that examine medical doctors' relationship to industry, Marcia Angell presents more than only anecdotal evidence. Rather she complaints that it will be necessary to "wean" the medical profession from industry money.

  3. Of course there may be other reasons why results are not published, e.g. studies have not recruited enough patients to come to conclusions. Yet, the mere imbalance between the positive and negative studies published suggests a publication bias.

  4. It goes without saying that the ironic allusion does not tell us anything about John Rawls' approach to justice.

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Acknowledgments

The author is indebted to Volker Eckardt for his generous and perceptive comments on the topic as well as the enriching discussions we had.

Conflict of interest

The author received lecture fees from the Fresenius-Kabi and Falk-Foundation and together with his wife has shareholdings of less than 10,000,-Euros in pharmaceutical companies.

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Authors and Affiliations

  1. Medical Clinic I, Ketteler Hospital, Lichtenplattenweg 85, 63071, Offenbach, Germany

    Stephan Sahm

  2. Institute for History and Ethics in Medicine, Goethe University, Frankfurt/Main, Germany

    Stephan Sahm

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Correspondence to Stephan Sahm.

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Sahm, S. Of mugs, meals and more: the intricate relations between physicians and the medical industry. Med Health Care and Philos 16, 265–273 (2013). https://doi.org/10.1007/s11019-012-9391-y

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