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

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Marc A. Rodwin draws on his own experience as a health lawyer—and his research in health ethics, law, and policy—to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug).
Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals —lawyers, government officials, and businessmen—all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct.
Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change.

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

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 (
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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
  • 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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