Physician payments: Public trust is issue
Physician payments: Public trust is issue
Payments made to physicians by pharmaceutical companies may undermine the trust of patients and the general public in medicine and science, according to Henk ten Have, MD, PhD, director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, PA.
"The past decade has been characterized by many conflicts and scandals, where sometimes huge payments have been made to medical doctors and researchers without any disclosure," he says.
Although physicians ethically should reveal potential conflicts of interest, says ten Have, there is systemic underreporting since the disclosure is only voluntary.
"If my doctor is receiving extra payments for the medication he is prescribing from the company producing the medication, how can I be sure that I will receive the medication that is in my interest and not in the interest of the doctor?" he asks.
Similarly, ten Have asks, if virologists are advising governments to buy vaccines, how can the public know if they are acting for the public good or their own financial interests?
"Physicians should have only one primary goal: the best interest of the patient, as endorsed in virtually all codes of ethics," he says. If a physician is receiving additional gifts and payments besides a salary and usual income, it's possible that he or she continues to put the patient's best interest first, but the possibility of a conflict of interest is raised, ten Have explains.
"As a patient, I need to know whether this risk exists or not," he says. "If the information is publicly available — and I think it certainly should be — it can only be misleading if it is biased and not complete."
The information should indicate the source of the gift or payment, the quantity, and the frequency, he says, so that patients and the general public can assess the relevancy of the data made public.
If a patient learns that his surgeon received payments from a prosthesis manufacturer, for instance, he may choose to discuss this with the physician to ensure that the prosthesis is actually the best available device and not being recommended simply because of the doctor's financial interest.
After learning of a financial relationship, "patients may lose trust and confidence in a physician who they have regarded in high esteem for a long time," says ten Have. "But they can discuss the issue with the physician, and be reassured that the payments have not impacted patient care."
When physicians receive payments from pharmaceutical companies, they end up wearing two hats, according to Rosalind Ekman Ladd, PhD, a visiting scholar in philosophy at Brown University in Providence, RI.
Loyalty or bias toward the sponsoring company can conflict with the doctor-patient relationship, which requires always acting in the patient's best interest, she emphasizes.
"Many doctors claim that their clinical judgment is not affected by payments from drug companies. But the influence can be subtle and unrecognized," says Ladd. "Even small souvenirs such as inscribed pens or notepads can establish brand name recognition, which can affect prescription choice."
Ladd says that her best guess is that disclosure will not protect patients. "Let's face it: As a patient, you don't really know what prescription or treatment is best for you," she explains.
Even if a physician is unduly influenced by a relationship with a drug company, it may still be the case that that company's drug is objectively the best medication for a given patient.
"The downside of public disclosure is that it may erode trust in physicians in general, which would be an unfortunate result," says Ladd.
Payments made to physicians by pharmaceutical companies may undermine the trust of patients and the general public in medicine and science, according to Henk ten Have, MD, PhD, director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, PA.Subscribe Now for Access
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