Medical commerce, physician entrepreneurialism, and conflicts of interest

Cambridge Quarterly of Healthcare Ethics

Volumn 16, Issue 4, 2007, Pages 387-397

  Rodwin, Marc A ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PRACTICE; COMMERCIAL PHENOMENA; CONFLICT OF INTEREST; DOCTOR PATIENT RELATION; DRUG INDUSTRY; ECONOMICS; ETHICS; FINANCIAL MANAGEMENT; HEALTH CARE DELIVERY; HEALTH INSURANCE; HEALTH PERSONNEL ATTITUDE; HISTORY; HOSPITAL; HUMAN; MEDICAL ETHICS; MEDICAL SOCIETY; MEDICARE; REIMBURSEMENT; UNITED STATES;

AMERICAN MEDICAL ASSOCIATION; ATTITUDE OF HEALTH PERSONNEL; COMMERCE; CONFLICT OF INTEREST; DELIVERY OF HEALTH CARE; DRUG INDUSTRY; ENTREPRENEURSHIP; ETHICS, MEDICAL; FINANCING, GOVERNMENT; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HOSPITALS; HUMANS; INSURANCE, HEALTH; MEDICARE; PHYSICIAN'S PRACTICE PATTERNS; PHYSICIAN-PATIENT RELATIONS; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 34547960728     PISSN: 09631801     EISSN: 14692147     Source Type: Journal    
DOI: 10.1017/S096318010707048X     Document Type: Article

References (60)

1. Some writers argue that for-profit firms, particularly investor-owned firms, are the main source of problems for medical practice and that ownership of medical facilities should be limited to nonprofit organizations or government. Dr. Arnold Relman is often associated with this view. See Relman AS, Reinhardt UE. An exchange on for-profit health care. In: Gray BH, ed. For-Profit Enterprise in Health Care. Washington, DC: National Academy Press; 1986:209-23. However, Dr. Relman's views are more complex than this statement suggests. His writings are a major contribution in exploring physicians' conflicts of interest and focusing policy attention on them.
2. Among his numerous writings that discuss this subject are the following: Relman AS. The new medical-industrial complex. The New England Journal of Medicine 1980;303(17):963-70;
3. Relman AS. Dealing with conflicts of interest. New England Journal of Medicine 1984;310(18):1182-3;
4. Relman AS. Medicine as a profession and a business. In: McMurrin SM, ed. The Tanner Lectures on Human Values. Salt Lake City: University of Utah Press; 1986:283-313;
5. Relman AS. Salaried physicians and economic incentives. The New England Journal of Medicine 1988;319(12):784.
6. Rodwin MA. Medicine, Money and Morals: Physicians' Conflicts of Interest. New York: Oxford University Press; 1993. For definitions of conflicts of interest see pp. 8-11 and Appendix A.
7. The dictionary defines entrepreneur as "A person who organizes, operates, and assumes the risk for a business venture"; The American Heritage Dictionary of the English Language, 3rd ed. Boston: Houghton Mifflin; 1992.
8. There are four sources of physicians' conflicts of interest: (1) physician entrepreneurship; (2) physician incentives, arising from the way they are paid; (3) physician financial ties to third parties; and (4) physician employment by third parties.
9. For a review of the literature on for-profit healthcare, see Gray BH. The New Health Care For Profit: Doctors and Hospitals in a Competitive Environment. Washington, DC: National Academy Press; 1983;
10. Gray BH. For-Profit Enterprise in Health Care. Washington, DC: National Academy Press; 1986.
11. This history does not discuss in detail distinctions between kinds of medical markets and the role of professions in them. For an in-depth analysis, see Fligstein N. The Transformation of Corporate Control. Cambridge, Mass.: Harvard University Press; 1990;
12. Fligstein N. The Architecture of Markets. Princeton: Princeton University Press; 2001.
13. For an alternative short history, see Light DW. Ironies of Success: A New History of the American Health Care "System." Journal of Health and Social Behavior 2004;45(Extra Issue):1-24.
14. Starr P. The Social Transformation of American Medicine. New York: Basic Books; 1982:47.
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16. Shryock RH. Medical Licensing in America. Baltimore: The Johns Hopkins Press; 1967:1650-5.
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18. Fishbein M. A History of the American Medical Association 1847 to 1947. Philadelphia: W.B. Saunders; 1947.
19. Proceedings of the national medical convention 1846, 1847, reprinted in Reiser SJ, Dyck AJ, Curran WJ. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, Mass.: MIT Press; 1977:26-34.
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23. See Rosner D. A Once Charitable Enterprise. Hospitals and Health Care in Brooklyn and New York. Cambridge, UK: Cambridge University Press; 1982:1885-915; see note 14, Rosenberg 1987:237-61, Stevens 1971.
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26. See note 14, Rosenberg 1987, Stevens 1971.
27. See note 7, Starr 1982:105-20.
28. See note 7, Starr 1982:110; Burrows JG. Organized Medicine in the Progressive Era: The Move Toward Monopoly. Baltimore: Johns Hopkins University Press; 1977:49-51.
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31. See, for example, Group Health Cooperative of Puget Sound v. King County Medical Society, 29 Wash. 2d. 586, 237 P. 2nd 727 (1951); American Medical Association v. United States, 130 F. 2d 233 (D.C. Cir. 1942), affirmed 317 U.S. 519, (1943).
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34. A classic statement of the views of organized medicine is in the dissenting report of Committee on. Cost of Medical Care. Medical Care for the American People - The Final Report of the Committee on the Cost of Medical Care (Adopted October 31, 1932). Reprinted 1970, U.S. Department of Health, Education and Welfare. Public Health Service. Health Services and Mental Health Administration Community Health Services:175-6.
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37. Cunningham. R III, Cunningham R Jr. The Blues: A History of the Blue Cross and Blue Shield System. De Kalb: Northern Illinois University Press; 1997.
38. See note 2, Rodwin 1993:33-40, wherein these changes are discussed. Dispensing medicine permitted, AMA. Proceedings of the House of Delegates. 1955;(Jun):52. The 1957 AMA Code of Ethics allowed, physicians to earn income from professional services performed by others "under their supervision."
39. See American Medical Association. Digest of Official Actions 1846-1958, p. 276.
40. Selling drugs and remedies permitted, AMA. Proceedings of the House of Delegates. 1955;(Jun):52.
41. In 1959 the Judicial Council held that physicians could own stock in pharmaceutical companies "unless the patient was exploited." AMA Proceedings of the House of Delegates. 1962;(Jun):36-45.
42. This was broadened in 1961 to allow physicians to own or operate a pharmacy. Hirsch, Brendan D. 1984. History of the Judicial Council. AMA, p. 105. Citing the AMA's November 1961 Denver meeting. AMA. 1959. "Ownership of Pharmacies." Proceedings of the House of Delegates. (Dec 1-4)135-6.
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51. Michigan Optometric Association 106 F.T.C. 342 (1985); American Academy of Ophthalmologists, 108 F.T.C. 25 (1986); Iowa Chapter of the American Physical Therapy Association, No. 3242 (1988) (Consent Order); Wilk v. American Medical Association, 895 F. 2d 352 (7th Cir. 1990).
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58. Robinson JC. The Corporate Practice of Medicine: Competition and Innovation in Health Care. Berkeley: University of California Press; 1974.
59. See note 2, Rodwin 1993:67-78, 100-2.
60. Medicare and Medicaid anti-kickback statute, 42 U.S.C.A. Section 1320a-7b(b). Stark Law. OBRA Act of 1989, P.L. 101-239, Title 6., Section 620-4 Adding Section 1877 to Title 18 of the Social Security Act. For a history of this legislation see Hyman DA, Williamson JV. Fraud and abuse: Regulatory alternatives in a "competitive" health care era. Loyola University of Chicago Law Review 1988;19(4):1131-96.