Medicine, Money, and Morals: Physicians' Conflicts of Interest / Edition 1

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Overview

Physicians' conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest; for hospitals to offer incentives to physicians who refer patients to them; or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs. In Medicine, Money, and Morals, Marc A. Rodwin examines these conflicts of interest, explains why the profession has failed to cope successfully with them, and shows how they have become worse over the past century. He looks at how - in response to dubious practices of the past such as fee-splitting, physicians' ownership of medical facilities, drug dispensing, and the like - the profession developed ethical guidelines but was unable to enforce them. He shows how current public policies and institutional practices now offer doctors financial incentives to promote various goals at odds with the interest of patients. These policies and practices, Rodwin writes, tie doctors' personal financial well-being to medical care providers - hospitals, medical suppliers, and pharmaceutical firms - and also to insurers and other third party payers. Doctors today are tempted to think of how they will fare financially by making particular clinical decisions. As a result, patients often receive too many or too few medical services, or the wrong kind, sometimes undergoing painful, dangerous, or unnecessary medical procedures. Rodwin shows what can be learned from the way society has coped with conflicts of interest involving other professionals (lawyers, government officials and financial professionals), all of whom are held to higher standards of accountability than doctors. He explains, too, why simplistic solutions such as public disclosure of conflicts or government ownership of health services won't work. He offers examples of what can be done to help reduce these problems by regulation, tax policy, audi

Offers examples of solutions to help reduce conflicts of interest in the medical profession.

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Editorial Reviews

From the Publisher
"Excellent...The first systematic examination of financial conflicts of interest in the medical profession. Rodwin's proposals for reform deserve very serious consideration."—The New England Journal of Medicine

"Medicine, Money, and Morals is about the effects of financial incentives on medical practice. It is not the first work to address these questions...but it is the best...Clearly will be of great use to those who have professional reasons to be interested...An important start to understanding the fundamental implications that financial incentives and decisions about the shape of the financing system hold for the ties that bind doctors and patients. Anyone practicing medicine or studying the health care system would benefit from its description and its analysis."—Journal of the American Medical Association

"Rodwin painstakingly scrutinizes medical practice in the USA, giving a fascinating insight into the dilemmas facing patients when medical decisions can affect the doctor's economic well being, the success or otherwise of a practice, or the survival of a hospital."—The Lancet

"Provides thorough, thoughtful, and practical analysis of this important problem. Rodwin canvassed not only the academic, trade, and popular literature on the subject but also comments on providers of proposed federal rules, investment prospectuses for medical joint ventures, and kickback trial records to come up with the most exhaustive catalogue available of the scope of the conflict-of-interest problem. The analyses and recommendations that follow make this book a must-read for those seeking to understand the current health care crisis."—Journal of Health Politics, Policy and Law

"A theoretically sophisticated, empirically detailed account of conflicts of interest and the physician's role....An impressive piece of work—broad in its scope, clear in its objectives, confident of its findings, certain of the policy implications."—The Journal of Legal Medicine

Booknews
A political analysis of the problems caused by the conflicts of interest in the world of medicine. Discusses how present policies have led to the current situation and offers possible solutions. Annotation c. Book News, Inc., Portland, OR (booknews.com)
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Product Details

  • ISBN-13: 9780195096477
  • Publisher: Oxford University Press, USA
  • Publication date: 4/28/1995
  • Edition description: REPRINT
  • Edition number: 1
  • Pages: 432
  • Sales rank: 1,018,924
  • Product dimensions: 6.38 (w) x 8.00 (h) x 0.83 (d)

Meet the Author

Marc A. Rodwin, Associate Professor of Law and Public Policy at Indiana University, Bloomington, has an M.A. from Oxford University, a J.D. from the University of Virginia Law School, and a Ph.D. from Brandeis University.

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Table of Contents

1. The Problem and the Profession's response: Physicians' conflicts of interest; The medical profession's response
2. Current Problems and Institutional Responses: Incentives to increase services: The range of practices; The dangers of incentives to increase services and the ineffectiveness of current responses; Incentives to decrease services in HMOs and hospitals; The dangers of incentives to decrease services and the ineffectiveness of current responses
3. Inferences for Policy: Fiduciary theory and the professions: Regulation of civil servants, business professionals and lawyers; What needs to be done?
4. Appendices

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