Journal of Bioethical Inquiry

, Volume 12, Issue 4, pp 675–685

Teaching Conflict: Professionalism and Medical Education

Original Research

Abstract

Resistance by physicians, medical researchers, medical educators, and medical students to pharmaceutical industry influence in medicine is often based on the notion that physicians (guided by the ethics of their profession) and the industry (guided by profit) are in conflict. This criticism has taken the form of a professional movement opposing conflict of interest (COI) in medicine and medical education and has resulted in policies and guidelines that frame COI as the problem and outline measures to address this problem. In this paper, I offer a critique of this focus on COI that is grounded in a broader critique of neo-liberalism, arguing it individualizes the relationship between physicians and industry, too neatly delineates between the two entities, and reduces the network of social, economic, and political relations to this one dilemma.

Keywords

Conflict of interest Pharmaceutical industry Medical education Professionalism Neo-liberalism 

References

  1. Abraham, J., and R. Ballinger. 2012. The neoliberal regulatory state, industry interests, and the ideological penetration of scientific knowledge: Deconstructing the redefinition of carcinogens in pharmaceuticals. Science, Technology & Human Values 37(5): 443–477. doi:10.1177/0162243911424914.CrossRefGoogle Scholar
  2. Abramson, J. 2004. Overdosed America: The broken promise of American medicine. New York: HarperCollins.Google Scholar
  3. American Medical Student Association (AMSA). 2014. AMSA Scorecard 2014: About the AMSA Scorecard. http://www.amsascorecard.org/about. Accessed June 15, 2015.
  4. American Medical Student Association (AMSA). 2015. Just medicine campaign. http://www.amsa.org/AMSA/Homepage/TakeAction/JustMedicine.aspx. Accessed December 15, 2014.
  5. Angell, M. 2004. The truth about the drug companies: How they deceive us and what to do about it. New York: Random House.Google Scholar
  6. Angell, M. 2008. Industry-sponsored clinical research: A broken system. The Journal of the American Medical Association 300(9): 1069–1071. doi:10.1001/jama.300.9.1069.PubMedCrossRefGoogle Scholar
  7. Armstrong, P., and H. Armstrong. 2003. Wasting away: The undermining of Canadian health care. Don Mills: Oxford University Press.Google Scholar
  8. Association of American Medical Colleges (AAMC). 2008. Industry funding of medical education: Report of an AAMC task force. Washington: Association of American Medical Colleges.Google Scholar
  9. Avorn, J. 2008. Powerful medicines: The benefits, risks, and costs of prescription drugs. New York: Random House.Google Scholar
  10. Bell, S.E., and A.E. Figert. 2012. Medicalization and pharmaceuticalization at the intersections: Looking backward, sideways and forward. Social Science and Medicine 75(5): 775–783. doi:10.1016/j.socscimed.2012.04.002.PubMedCrossRefGoogle Scholar
  11. Busing, N. 2011. Canadian faculties of medicine not in denial. Canadian Medical Association Journal 183(4): 463.PubMedPubMedCentralCrossRefGoogle Scholar
  12. Campbell, E.G., J.S. Weissman, S. Ehringhaus, et al. 2007. Institutional academic industry relationships. The Journal of the American Medical Association 298(15): 1779–1786.PubMedCrossRefGoogle Scholar
  13. Chimonas, S., L. Patterson, V.H. Raveis, and D.J. Rothman. 2011. Managing conflicts of interest in clinical care: A national survey of policies at U.S. medical schools. Academic Medicine 86(3): 293–299. doi:10.1097/ACM.0b013e3182087156.PubMedCrossRefGoogle Scholar
  14. Coburn, D. 2000. Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Social Science and Medicine 51(1): 135–146. doi:10.1016/S0277-9536(99)00445-1.PubMedCrossRefGoogle Scholar
  15. de Melo-Martín, I., and K. Intemann. 2009. How do disclosure policies fail? Let us count the ways. The Federation of American Societies for Experimental Biology (FASEB) Journal 23(6): 1638–1642. doi:10.1096/fj.08-125963.CrossRefGoogle Scholar
  16. Doucet, M., and S. Sismondo. 2008. Evaluating solutions to sponsorship bias. Journal of Medical Ethics 34(8): 627–630.PubMedCrossRefGoogle Scholar
  17. Elliott, K.C. 2008. Scientific judgment and the limits of conflict-of-interest policies. Accountability in Research 15(1): 1–29. doi:10.1080/08989620701783725.PubMedCrossRefGoogle Scholar
  18. Fisher, J.A. 2007. Coming soon to a physician near you: Medical neoliberalism and pharmaceutical clinical trials. Harvard Health Policy Review 8(1): 61–70.PubMedPubMedCentralGoogle Scholar
  19. Freidson, E. 1970a. Professional dominance: The social structure of medical care. New Brunswick: Transaction Publishers.Google Scholar
  20. Freidson, E. 1970b. Profession of medicine: A study of the sociology of applied knowledge. Chicago and London: The University of Chicago Press.Google Scholar
  21. Goozner, M. 2004. The $800 million pill: The truth behind the cost of new drugs. Berkeley: University of California Press.Google Scholar
  22. Hafferty, F.W., and B. Castellani. 2011. Two cultures: Two ships: The rise of a professionalism movement within modern medicine and medical sociology’s disappearance from the professionalism debate. In Handbook of the sociology of health, illness, and healing, edited by B.A. Pescosolido, J.K. Martin, J.D. McLeod, and A. Rogers, 201–219. New York: Springer.CrossRefGoogle Scholar
  23. Hébert, P.C., N. MacDonald, K. Flegel, and M.B. Stanbrook. 2010. Competing interests and undergraduate medical education: Time for transparency. Canadian Medical Association Journal 182(12): 1279.PubMedPubMedCentralCrossRefGoogle Scholar
  24. Holloway, K. 2014. Uneasy subjects: Medical students’ conflicts over the pharmaceutical industry. Social Science & Medicine 114: 113–120.CrossRefGoogle Scholar
  25. Institute of Medicine. 2009. Conflict of interest in medical research, education, and practice. Washington, DC: The National Academies Press.Google Scholar
  26. Kassirer, J.P. 2005. On the take: How America’s complicity with big business can endanger your health. New York: Oxford University Press.CrossRefGoogle Scholar
  27. Lave, R., P. Mirowski, and S. Randalls. 2010. Introduction: STS and neoliberal science. Social Studies of Science 40(5): 659–675. doi:10.1177/0306312710378549.CrossRefGoogle Scholar
  28. Leys, C. 2010. Health, health care and capitalism. Socialist Register 46: 1–28. http://socialistregister.com/index.php/srv/article/view/6761#.VXt0Fvm6fIU.
  29. Liaison Committee for Medical Education (LCME). 2015. Data collection instrument (DCI). http://www.lcme.org/survey-connect-dci-download.htm. Accessed June 15, 2015.
  30. Loertscher, L.L., A.J. Halvorsen, B.W. Beasley, E.S. Holmboe, J.C. Kolars, and F.S. McDonald. 2010. Pharmaceutical industry support and residency education: A survey of internal medicine program directors. Archives of Internal Medicine 170(4): 356–362. doi:10.1001/archinternmed.2009.524.PubMedCrossRefGoogle Scholar
  31. Newson, J., and C. Polster. 2010. Academic callings: The university we have had, now have, and could have. Toronto: Canadian Scholars’ Press.Google Scholar
  32. No Free Lunch. n.d. [Home page.] http://www.nofreelunch.org/aboutus.htm. Accessed December 15, 2014.
  33. PharmedOut. 2006–2011. About us. http://pharmedout.org/aboutus.htm. Accessed December 15, 2014.
  34. Relman, A.S. 1985. Dealing with conflicts of interest. The New England Journal of Medicine 313(12): 749–751. doi:10.1056/NEJM198509193131209.PubMedCrossRefGoogle Scholar
  35. Rodwin, M.A. 1995. Medicine, money, and morals physicians’ conflicts of interest. New York: Oxford University Press.Google Scholar
  36. Rodwin, M.A. 2011. Conflicts of interest and the future of medicine: The United States, France, and Japan. New York: Oxford University Press.CrossRefGoogle Scholar
  37. Schafer, A. 2004. Biomedical conflicts of interest: A defence of the sequestration thesis—learning from the cases of Nancy Olivieri and David Healy. Journal of Medical Ethics 30(1): 8–24. doi:10.1136/jme.2003.005702.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Shnier, A., J. Lexchin, B. Mintzes, A. Jutel, and K. Holloway. 2013. Too few, too weak: Conflict of interest policies at Canadian medical schools. PLoS ONE 8(7): e68633. doi:10.1371/journal.pone.0068633.PubMedPubMedCentralCrossRefGoogle Scholar
  39. Sierles, F.S., A.C. Brodkey, L.M. Cleary, et al. 2005. Medical students’ exposure to and attitudes about drug company interactions: A national survey. The Journal of the American Medical Association 294(9): 1034–1042.PubMedCrossRefGoogle Scholar
  40. Slaughter, S., and G. Rhoades. 2009. Academic capitalism and the new economy: Markets, state, and higher education. Baltimore: The Johns Hopkins University Press.Google Scholar
  41. Therapeutics Initiative. 1994–2010. Therapeutics Initiative. http://www.ti.ubc.ca/. Accessed December 15, 2014.

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2015

Authors and Affiliations

  1. 1.Dalhousie UniversityHalifaxCanada

Personalised recommendations