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(Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?

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Abstract

Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

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Notes

  1. But compare eg a recent experiment that have not found that financial incentives play a role in physician decision-making (Movsas et al. 2012).

References

  • American Medical Association. 2013. The American Medical Association Code of Medical Ethics opinions on the physician as businessperson. Virtual Mentor 15 (2): 136–140.

    Google Scholar 

  • Association of British Pharmaceutical Industry. 2016. Disclosure UK. http://www.abpi.org.uk/our-work/disclosure/Pages/disclosure.aspx.

  • Blum, J. 2014. CMS Modifies policy on disclosure of physician payment information. http://blog.cms.gov/2014/01/14/cms-modifies-policy-on-disclosure-of-physician-reimbursement-information/. Accessed 22 November 2016.

  • Camp, M. W., D. A. Mattingly, A. E. Gross, M. T. Nousiainen, B. A. Alman, and M. F. McKneally 2013. Patient’s views on surgeons’ financial conflicts of interest. The Journal of Bone & Joint Surgery 95 (2): e9.

    Article  Google Scholar 

  • Carlsen, B., and O. F. Norheim. 2005. “Saying No is No Easy Matter”: A qualitative study of competing concerns in rationing decisions in general practice. BMC Health Services Research 5: 70.

    Article  Google Scholar 

  • Code of Federal Regulations. Title 42 § 425.312(a); 76 Fed. Reg. 67982. https://www.law.cornell.edu/cfr/text/42/425.312. Accessed 22 November 2016

  • Cohen, S. 2012. The nocebo effect of informed consent. Bioethics 28 (3): 147–154.

    Article  Google Scholar 

  • Colla, C. H., V. A. Lewis, S. M. Shortell, and E. S. Fisher. 2014. First national survey of ACOs finds that physicians are playing strong leadership and ownership roles. Health Affairs 33 (6): 964–971.

    Article  Google Scholar 

  • Corrigan, O. 2003. Empty ethics: The problem with informed consent. Sociology of Health & Illness 25 (3): 768–792.

    Article  Google Scholar 

  • Crisp, R. 2015. The duty to do the best for one’s patient. Journal of Medical Ethics 31: 220–223.

    Article  Google Scholar 

  • DeAngels, C. D. 2015. The importance of physicians’ financial disclosure for public’s health. Milbank Quarterly 93 (4): 679–682.

    Article  Google Scholar 

  • Dyer, C. 2014. UK needs database of payments from industry to doctors, conference hears. BMJ, 349, g6197.

    Article  Google Scholar 

  • Emmanuel, E. J. 2012. Why accountable care organizations are not 1990s managed care redux. Journal of American Medical Association 307 (21): 2263–2264.

    Google Scholar 

  • European Federation of Pharmaceutical Industries and Associations. 2016. The EFPIA Code. http://transparency.efpia.eu/the-efpia-code-2.

  • Faden, R. 1997. Managed care and informed consent. Kennedy Institute of Ethics Journal 7 (4): 377–379.

    Article  Google Scholar 

  • General Medical Council. Financial and commercial arrangements and conflict of interests. 2013. http://www.gmc-uk.org/guidance/ethical_guidance/21161.asp, Accessed 7 June 2016.

  • Goldacre, B. 2014. Problems with ABPI proposals to release data on payments to doctors. BMJ 348, g236.

    Article  Google Scholar 

  • Gorawara-Bhat, R., T. H. Gallagher, and W. Levinson. 2003. Patient-provider discussions about conflicts of interest in managed care: Physicians’ perceptions. American Journal of Managed Care 9 (8): 564–571.

    Google Scholar 

  • Hall, M. A., and R. A. Berenson. 1998. Ethical practice in managed care: A dose of realism. Annals of Internal Medicine 128 (5): 395–402.

    Article  Google Scholar 

  • Haywood, T. T., and K. C. Kosel. 2011. The ACO model—a three-year financial loss? New England Journal of Medicine 364: e27.

    Article  Google Scholar 

  • Hoeyer, K., and N. Lynoe. 2009. An organizational perspective on ethics as a form of regulation. 2009. Medicine, Healthcare & Philosophy 12 (4): 385–392.

    Article  Google Scholar 

  • Jacobson, P. D. 2002. Strangers in the night: Law and medicine in the managed care era. New York: Oxford University Press.

    Google Scholar 

  • Johnson, J., and W. Rogers. 2014. Joint issues—conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest. BMC Medical Ethics doi: 10.1186/1472-6939-15-63.

    Google Scholar 

  • Jost T.S. 2001. Pegram v. Herdrich: The supreme court confronts managed care. Yale Journal of Health Policy. Law & Ethics 1 (1): 187–193.

    Google Scholar 

  • Kassirer, J. P. 2007. By financial disclosures, we’re fixing the wrong problem. Medscape General Medicine 9 (3): 61.

    Google Scholar 

  • Katz, D., A. L. Caplan, and J. F. Merz. 2003. All gifts large and small: Towards an understanding of the ethics of pharmaceutical industry gift-giving. American Journal of Bioethics 3 (3): 39–46.

    Article  Google Scholar 

  • Kukla, R. 2007. How do patients know? Hastings Center Report 37 (5): 27–35.

    Article  Google Scholar 

  • Loewenstein, G., and D. Moore. 2005. The dirt on coming clean: Perverse effects of disclosing conflicts of interest. Journal of Legal Studies 34: 1–25.

    Article  Google Scholar 

  • Loewenstein, G., S. Sah, and D. M. Cain. 2012. The unintended consequences of conflict of interest disclosure. JAMA: The Journal of the American Medical Association 307 (7): 669–670.

    Article  Google Scholar 

  • Mayes, C., W. Lipworth, and I. Kerridge. 2016. Declarations, accusations and judgment: Examining conflict of interest discourses as performative speech-acts. Medicine, Healthcare and Philosophy 19 (3): 455–462.

    Article  Google Scholar 

  • McCartney, M. et al. 2014. Letter: Why the GMC should set up a central registry of doctors’ competing interests. British Medical Journal, 348: g236.

    Article  Google Scholar 

  • Mehlman, M. J. 2006. Dishonest medical mistakes. Vanderblit Law Review 59: 1137–1173.

    Google Scholar 

  • Moore, V.1990 Regents of the University of California 51 Cal. 3d. 120.

  • Morain, S. R., C. Flexner, N. E. Kass, and J. Sugarman. 2014. Forecast for the physician payment sunshine act: Partly to mostly cloudy? Annals of Internal Medicine, 161(12): 915–916.

    Article  Google Scholar 

  • Morreim, E. H. 2006. High-deductible health plans: New twists on old challenges from tort and contract. Vanderblit Law Review 59: 1207–1261.

    Google Scholar 

  • Movsas, T. Z., E. Wells, A. Mongoven, and V. Grigorescu. 2012. Does medical insurance type (private vs. public) influence the physician’s decision to perform caesarean delivery? Journal of Medical Ethics 38 (8): 470–473.

    Article  Google Scholar 

  • Neade v. Portes et al. 193 Ill. 2d 433. 2000.

  • Oakes, J. M., H. K. Whitham, A. B. Spaulding, L. A. Zentner, and S. R. Beccard. 2015. How should doctors disclose conflicts of interest to patients? A focus group investigation. Minnesota Medicine 98 (1): 38–41.

    Google Scholar 

  • O’Neil, O. 2003. Some limits of informed consent. Journal of medical ethics 29: 4–7.

    Google Scholar 

  • Pacarini,P.A. 2012. The financial aspects of accountable care organizations. In Pavarini P.A., C.I. McGinty and M.E. Schaff (Eds.), The ACO handbook: A guide to accountable care organizations. Washington, DC: American Health Lawyers Association. (1st ed.) (pp. 17–27).

    Google Scholar 

  • Pearson, S. D., and T. Hyams. 2002. Talking about money: How primary care physicians respond to a patient’s question about financial incentives. Journal of General Internal Medicine 17: 75–78.

    Article  Google Scholar 

  • Pearson, S. D., K. Kleinman, D. Rusinak, and W. Levinson. 2006. A Trial of disclosing physicians’ financial incentives to patients. Archives of Internal Medicine 166: 623–628.

    Article  Google Scholar 

  • Pegram v. Herdrich 530 U.S. 211. 2000.

  • Pellegrino, E. D. 1997. “Managed care at the bedside: How do we look in the moral mirror?” Kennedy Institute of Ethics Journal 7 (4): 321–330.

    Article  Google Scholar 

  • Rittenhouse D.R., S.M. Shortell, and E.S. Fisher. 2009 Primary care and accountable care – two essential elements of delivery system reform. New England Journal of Medicine, 361, 2301–2303.

    Article  Google Scholar 

  • Sade, R. M. 2011. Full disclosure: Where is the evidence for nefarious conflicts of interest? Annals of Thoracic Surgery 92 (2): 417–420.

    Article  Google Scholar 

  • Sah, S., and G. Lowenstein. 2014. Nothing to declare: Mandatory and voluntary disclosure leads advisors to avoid conflicts of interest. Psychological Science 25 (2): 575–584.

    Article  Google Scholar 

  • Sah, S., G. Loewenstein, and D. Cain. 2013. The burden of disclosure: Increased compliance with distrusted advise. Journal of Personality and Social Psychology 104 (2): 289–304.

    Article  Google Scholar 

  • Sahm, S. 2013. Of mugs, meals and more: The intricate relations between physicians and the medical industry. Medicine, Healthcare and Philosophy 16 (2): 265–273.

    Article  Google Scholar 

  • Shea v. Esensten 107 F. 3d 625, 629 (8th Cir. 1997).

  • Sommers, R., S. D. Goold, E. A. McGlynn, S. D. Pearson, and M. Danis. 2013. Focus groups highlight that many patients object to clinicians’ focusing on cost. Health Affairs 32 (2): 338–346.

    Article  Google Scholar 

  • Spece, R. G., D. V. Yokum, A. G. Okoro, and C. T. Robertson. 2014. An empirical method for materiality: Would conflict of interest disclosures change patients decisions. American Journal of Law & Medicine 40: 253–274.

    Article  Google Scholar 

  • Sperling, D. 2017. Revising the requirement of informed consent in an era of privatization, managed care and ACOs: Implications for bioethics and the connection between law and ethics. Journal of International Aging Law & Policy, 10.

  • Sulmasy, D. P. 1992. Physicians, cost control, and ethics. Annals of Internal Medicine 116 (11): 920–926.

    Article  Google Scholar 

  • Thompson, D. 1993. Understanding financial conflicts of interest. New England Journal of Medicine 329: 573–576.

    Article  Google Scholar 

  • Transparantieregister zorg. 2016. Raadpleeg het Transparantieregister. http://www.transparantieregister.nl/nl-NL/Raadpleeg-het-Transparantieregister.

  • Trostorff, D.L. 2012. Certification and Licensure. In Pavarini P.A., C.I. McGinty and M.E. Schaff. (Eds.) The ACO Handbook: A Guide to Accountable Care Organizations, 137–158. Washington, DC: American Health Lawyers Association.

    Google Scholar 

  • Veatch, R. M. 1995. Abandoning informed consent. Hastings Center Report 25 (2): 5–12.

    Article  Google Scholar 

  • Wen L. 2014. Patients can’t trust doctors’ advice if we hide our financial connections with drug companies. British Medical Journal, 348: g167.

    Article  Google Scholar 

  • Whitehead, S. 2014. ABPI efforts to increase transparency about competing interests. BMJ, 348, g1300.

    Article  Google Scholar 

  • Wilson, M.H. 2014. The need to eliminate commercial conflicts of interest from medicine. BMJ, 348, g1735.

    Article  Google Scholar 

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Acknowledgements

The author wishes to acknowledge with many thanks the academic support of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School inspiring this article.

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  1. University of Haifa, Haifa, Israel

    Daniel Sperling

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  1. Daniel Sperling
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Sperling, D. (Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?. Med Health Care and Philos 20, 179–186 (2017). https://doi.org/10.1007/s11019-017-9751-8

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