COMMENTARY

Response to AMA's Council on Ethical and Judicial Affairs Draft Report on "Ethical Guidance for Physicians and the Profession With Respect to Industry Support for Professional Education in Medicine"

Thomas P. Stossel, MD

Disclosures

June 12, 2008

Conclusions

Medical institutions have recently addressed the large interface between medicine and business as a reaction to accusations from critics echoed by the news media and by politicians that medicine is in a crisis state that demands correction of defective ethical norms by sanitizing medicine of its commercialism through imposition of bureaucratic management or elimination of commercial subsidies. In contrast, I argue that the medical-business frontier is a practical matter involving thousands of minute details that defy minute regulation. The key questions, therefore, are whether these interactions help physicians deliver the most effective medical care and relentlessly increase that effectiveness through innovation, minimizing inevitable risks associated with both care delivery and innovation. Only if an objective risk-benefit analysis confirms that corruption is prevalent leading to an answer in the negative should we engage in radical ethical reforms, and if we do, we must clearly define the ethical framework. I believe that the risk assessment answers the question in the affirmative and that individuals bent on altering our behavior base their recommendations on their own narrow ethical platform.

The challenges of medical care, medical innovation, and medical education are not well served by recrimination and sanctimony and certainly not by the poor scholarship represented by Brennan and colleagues. I recommend rejection of The Draft Report, which epitomizes these characteristics. Instead, I suggest that as recommended by the Association of American Medical Colleges Task Force on Industry Funding of Medical Education, we work in a spirit of mutual respect with our industry colleagues to improve physicians' and physicians-in-training's understanding of medical product development.[38] This effort can yield a more sophisticated physician workforce better equipped to address the growing menu of medical product choices. By working together with industry colleagues, we can explain to the public that the contributions of corporations to medicine are on balance more beneficial than harmful and that both medicine and the industries that provide it with its technologies are worthy of public support. Cooperation, instead of antagonism, can help industry market its products with the highest integrity, keep physicians current on the best available evidence, and provide excellent patient care. This plan, not woolly ethical generalities, is the proper model of medical professionalism.

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