"Compliance Perspectives from The New York Times Magazine Ethicist" Randy Cohen
The Healthcare Update News Service has made available a presentation by The New York Times ethicist Randy Cohen given in November 2006 at the Seventh Annual Pharmaceutical Regulatory and Compliance Congresses and Best Practices Forum. In the speech, after discussing the ethics of Benjamin Franklin, Aristotle and the pursuit of "Happiness" (yes, that's Happiness with a capital "H"), Cohen suggested that physicians are insulted by the insinuation that pharmaceutical companies' luxurious gifts have an effect on decision making. Scoffing at the notion that physicians can truly make independent decisions if they are given gifts by pharmaceutical companies (if gifts do not impact decisions, then are pharmaceutical companies providing them simply because they are altruistic?), Cohen questions whether the character of individual physicians is really what is at the root of the problem. Is the problem that individual physicians who allow gifts to impact decisions simply have poor character? Or is the real problem instead that the medical community has failed to set appropriate ethical standards and has ineffectively regulated, thereby leading to unethical decisions and corruption?
Instead of character determining behavior, circumstances and communities, he suggests, are what determine how human beings behave. If you place good apples in a bad barrel, Cohen says, the bad barrel corrupts everything. On the other hand, if you create moral and ethical communities, it's amazing how well people will behave. Most human beings behave in a similar way as their neighbors--the so-called "community effect."
If what Cohen says is true--that communities determine behavior--then the solution to the issue of the damaging impact of gifts by pharmaceutical companies to physicians requires a moral and ethical regulatory structure. Additionally, outside oversight (when someone from an outside community comes in and suggests that change is necessary), he suggests, helps. Decisions cannot be left only to individual judgment.
Moral conduct, Cohen concludes, is a function of circumstances. Good conduct is possible, but only in a just society.
Jayne,
This is a subject that is quite near and dear to my heart. And while I'm biased, seeing as how he is the Director of the Institute for Medical Humanities (where I attend grad school), I am about 5 chapters into Howard Brody's new book "Hooked," which assesses the enmeshment between the pharmaceutical industry and physicians, and it's a tour de force. Sheldon Krimsky's "Science in the Private Interest" is also terrific, and there's a great issue of the Am. J. of Bioethics that assesses the effect of these gifts on prescribing practices.