This new blog will be another one of our trips into the various ethical debates that surround medicine and the medical profession. This particular entry will deal with the ‘conflict of interest’ discussion, and what effects a conflict of interest may have on medical professionals. These ethical scenarios and discussions are obviously just a small introduction into a much wider and complex issue, though I hope to provide a brief introduction, which may help you in your future practice and more importantly in your interview preparations! Indeed, during interview, you are likely to be asked to consider, or comment on, various ethical challenges, which may include a scenario about conflict of interest.
Firstly, a conflict of interest typically refers to the influence external parties may have on a doctor, which creates a situation where the doctor may be tempted or pushed into a particular action that may not be in their own best interest or worse, in their patient’s best interests. The classic example here is that of the drug company which may give a ‘free’ holiday to medical professionals, and concurrently advertise their products to these benefitting doctors. Evidently, the company is not forcing them to do anything, but through granting a favour to the doctors, they create an expectation that the doctor should return the favour, which may mean the doctor is more inclined to prescribe that company’s products.
These days, pharmaceutical and equipment companies are not permitted to undertake overly extravagant acts such as buying holidays, but they certainly still get significant face-time with doctors in a number of ways. For example, pharmaceutical companies generally send representatives to provide food for morning teas for staff at GP clinics, or purchase a small buffet for journal clubs or other events in the hospital setting. Typically, the representative will then have an opportunity to discuss a product or service in front of the attending medical/health staff. Companies are also able to give out pens, notepads, satchel bags and other minor items at conferences and other meetings.
Protecting students from a conflict of interest is also of a concern at medical schools (though this fluctuates in importance depending on the school or time of year). Medical schools will generally have a policy relating to a conflict of interest, which they impose with varying severities – there has been threats from such institutions to forcibly stop the ability for external companies to sponsor events at student medical/surgical societies (which may in turn negatively affect the ability for these not-for-profits to deliver highly important services), though this appears to not have been carried out. Despites claims of strong conflict of interest policies, Schools can sometimes, curiously enough, permit representatives from certain companies to come in and discuss their equipment under the veil of ‘equipment education’ (which still involves product discussion, and handing out brochures etc). I experienced this at Griffith University and must admit to being a little puzzled by the experience.
The question that you should be asking yourself is, does it really matter? I am of the view that external sponsorship for medical events is almost a necessity, as many, many events would not be able to run otherwise. However, it must be regulated and monitored, to ensure that there is not a pressure from companies more than what any regular person may experience from commercial advertising. This is not so much because doctors are especially sensitive and easily influenced, but it is important to recognise that we, like all other human can be biased and manipulated. In addition, I would argue that there is a need to ‘play fair, and appear to be playing fair’ (adapted from the legal saying of ‘the need to do justice, as well as being seen to do justice’ – basically meaning that you have to be seen to be doing the right thing in order to keep confidence from the public).
I will leave you at this point to consider this question, and I recommend you take a look at this article in the Conversation that has demonstrated significant changes in prescribing practices when companies buy doctors a $16 meal here (
https://theconversation.com/drug-companies-are-buying-doctors-for-as-little-as-a-16-meal-61364).
