The prelims comprise: The Distinctiveness of the Ethics of Medicine The Distinctive Ethics of Medicine The Priority of Professional Ethics over Personal Morality Conclusion Notes References.

Medical leaders today call increasingly for patient-centered care, which is often contrasted with doctor-centered care and disease-centered care. One threat to patient-centered care which does not easily fit into these categories, however, is what one might label drug-centered care. Drug-centered “care” arises when pharmaceutical industry marketing exerts a deleterious influence over both the medical profession and the general public. This influence is easy to detect when it assumes blatant forms such as financial incentives to overprescribe but is harder to perceive (...) when it takes the form of changing the way we think about disease and indeed about human life. Two case studies that illustrate this deleterious influence are antidepressant drugs and drugs for type 2 diabetes. The inverse benefit law explains why these forms of pharmaceutical marketing constitute a threat to the public’s health. (shrink)

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at its core (...) it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

The Physician Payments Sunshine Act requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest and build patient trust—crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were (...) wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company “perks.” Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data. (shrink)

As the debate over how to manage or discourage physicians? financial conflicts of interest with the drug and medical device industries has become more heated, critics have questioned or dismissed the concept of ?conflict of interest? itself. A satisfactory definition relates conflict of interest to concerns about maintaining social trust and distinguishes between breaches of ethical duty and temptations to breach duty. Numerous objections to such a definition have been offered, none of which prevails on further analysis. Those concerned about (...) conflicts of interest have contributed to misunderstandings, however, by failing to demonstrate when social arrangements leading to temptations to breach duties are in themselves morally blameworthy. Clarifying ?conflict of interest? is important if we are eventually going to develop productive modes of engagement between medicine and for-profit industry that avoid the serious ethical pitfalls now in evidence. (shrink)