Avoiding conflicts of interest. Doctors and nurses are often prime targets of promotions from pharmaceutical, medical device and equipment manufacturers. That’s why more hospitals are banning free-meal presentations, pens, notepads and other logo items, said Kirk Hanson, MBA, professor and executive director of the Markkula Center for Applied Ethics at Santa Clara University in California’s Silicon Valley. “Recent studies show that physicians’ behavior is even influenced by trivial freebies,” he said. Among these is a July 2007 report in Obstetrics & Gynecology that found, "Even small gifts produce in their recipients a disproportionately powerful willingness to reciprocate in some manner."
The industry has made some efforts at self-regulation, including the Pharmaceutical Research and Manufacturers of America, which published an updated code of conduct for interactions with healthcare professionals in January 2009, and the Council of Medical Specialty Societies which announced their own voluntary ethics code in April 2010, seeking to limit the influence of for-profit enterprises. Despite these measures, new research in the June 2010 issue of Archives of Surgery shows many physicians don’t mind accepting free samples from drug companies or collaborating with medical device manufacturers. The same perception applies to meals and travel expenses. Of the 590 doctors and medical students who replied to the survey, 72.2 percent said that industry-sponsored lunches were appropriate.
While encouraging their clinicians to turn down giveaways and any compensation that might influence their decision-making, hospital management teams are also scrutinizing whether their trustees and boards of directors should be allowed to maintain financial ties to the institution or health system, such as selling their own goods or services. And amid healthcare reform’s emphasis on containing costs, hospitals and practices are taking a closer look at their purchasing employees’ favoritism for certain suppliers. “Very few hospitals have ethical guidelines to govern the behavior of their purchasing professionals,” Hanson said.
2. Balancing profit with serving patients and providing charity care. “Nurses are a scarce resource. So is cash. Healthcare organizations must balance the books to keep their doors open ― ‘No margin, no mission,’” said Nancy Berlinger, Ph.D., M.Div., deputy director and research scholar at The Hastings Center, a national nonpartisan bioethics institution.
