Reflections on Patient Care
page 4
Olivia Arkell photo.jpg
The Commercialization of 
Our Medical Institutions

by Olivia Arkell

The advancements made in the last couple of decades has made medicine and its related practices and relationships incredibly complex. The healthcare industry has become commercialized over the last few decades, something we’ve feared it happening.  This has led to ethical concerns related to medical practices and financial arrangements. These concerns were anticipated by the American Medical Association in 1957.

For-profit corporatization of healthcare poses many ethical concerns. This has led to unethical relationships and arrangements involving the physicians who are prescribing drugs, those who are conducting the research, and those companies who are providing the drugs. This is problematic because it can promote incentives, enticements and compensation for particular patterns of practice.

The American Medical Association (AMA) worked toward avoiding these turning medical practices into business affairs. The AMA tried to nurture this trust by developing codes and guidelines in 1957 that would prevent the medical profession from becoming a business. To make these expectations more concrete, the AMA declared that medical judgment should be free of financial interest: “A physician should not dispose of his services under terms or conditions that tes to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause a deterioration of the quality of medical care” (Shwartz & Sharpe, 2010). The AMA expected physicians to refrain from advertising and financial arrangements with drug and device manufacturers; they heavily pushed for the separation of prescribing pharmaceutical drugs from the sale of the drug itself.

 However, in the era of commercialization and pursuit for profit, our medical institutions have inevitably built such relationships with related affiliations. Although arranging a profitable relationship between physician and a pharmaceutical institute violates many of the AMA Code of Ethics, it still occurs. Disobeying these standards by valuing pharmaceutical enticements and financial compensation over the treatment of the patient is an indisputable unethical act. Furthermore, it completely disregards the pivotal virtues a physician ought to possess. These arrangements have a tendency to undermine devotion to the profession, making it more difficult for physicians to balance the main objective of the profession and the financial compensation that comes with it. As shown, a physicians' financial relationship with pharmaceutical firms is a massive ethical concern that has raised important questions on the virtues of a good physician. Physicians are expected to treat their clients with advanced medical knowledge, virtue, and practical wisdom. Interference of personal financial gain will inevitably skew the way these physicians treat their clients due to underlying motivations.

The medical industry's involvement in financial, organizational, and legal arrangements in drug research, marketing, and regulation is worthy of consideration. These arrangements tend to weaken institutions' proficiency in advancing medical knowledge, drug safety and public health. This decreases the integrity of pharmaceutical institutions and the physicians involved.  In the article, “The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns (1992),” it was made apparent that some physicians lack the willingness to further advance their knowledge on certain topics and drugs. When incentives are offered, this leads to a tendency to ignore important factors that physicians wouldn’t typically ignore. Even more surprisingly, some physicians were inclined to prescribe these incentivized drugs even after given a limited analysis of data. The lack of objective data made these drugs look more appealing which helped them confirm their desire to prescribe them, regardless if they were receiving enticements or incentives.

Not only can these corrupt relations negatively influence the treatment of patients, but even more concerning, the entire research and clinical trial of prospective drugs. Arrangements involving a physician and a pharmaceutical firm is one unethical dilemma, but institutional corruption involving the drug research itself is a whole other dilemma. The relationships with physicians and pharmaceutical firms is also interconnected with pharmaceutical firms' relationship with research and development organizations.

The primary problem isn’t necessarily physicians' virtues and ethics, rather it is an implication of the structures of our organizations. Physicians' ethical virtues (or lack thereof) is part of the problem but they are also a product of the problem. This has contributed to the commercialization of our healthcare system and the relationships that promote it. With that being said, the systems in place are ultimately the main culprit, not the individual physicians who might lack ethical and virtuous standards.

Although it may be unethical for physicians to participate in such arrangements, in some instances the structures they are under don't make it easy to resist these temptations. It is clear the pursuit for profit is present in our current culture. We are faced with corruption and incentives on different levels and within different intuitions. Changing systems organization and financial interests in the medical setting might seem like the practical way to go about this. However, I would argue this is unattainable given the pace of development we are facing and the culture we are in. Since we are in a profit-driven era, I find it much more practical to adapt to the demands and climate around commercialization. I don’t believe we will be able to completely eradicate temptations within the profession. We must discover ways in which we can alter our systems in an innovative and creative way that is compatible with the society we live in.  Finding a way to make these relationships ethical is crucial if we want to sustain the integrity of our healthcare systems and the physicians that are employed by it.

 

AMA Principles of Medical Ethics - https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics

 

The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns

https://pubmed.ncbi.nlm.nih.gov/1623766/

 

Schwartz & Sharpe, Practical Wisdom: The Right Way to Do the Right Thing

https://www.researchgate.net/publication/276750185_Practical_Wisdom_The_Right_Way_to_Do_the_Right_Thing_by_Barry_Schwartz_and_Kenneth_Sharpe

Olivia Arkell is a recent graduate from Hamline University who studied psychology, philosophy, neuroscience, and political science. She has a strong interest in biomedical ethics and the psychotherapeutic value of psychedelics. Olivia is always looking for ways she can expand her understanding on how we can transform the way we treat mental illness in the clinical setting. She demonstrates this passion through researching and interpreting literature then translating it into a short article/blog form that is easy, reliable, and comprehensible for the general public to read. Olivia joined the editorial team at Today’s Patient with the goal of initiating important conversations on topics related to wellness, mental health, neuroscience, and psychology and educating people on patient rights and advocacy.

July 2022  page 4