Recently, Carl Elliott posted a link to a statement written by Jonathan Moreno, PhD, a renowned bioethicist at the University of Pennsylvania.
Dr. Moreno’s statement was in reference to an Oregon court case. The Oregon Department of Justice had accused two cardiologists of concealing information from patients. Apparently the cardiologists had put heart implants into patients without informing the patients that they (the cardiologists) had financial ties to the manufacturer of the implants.
These kinds of financial entanglements have become fairly common in medicine generally, and especially in psychiatry, where, in my view, it has been a major force in psychiatry’s drive to medicalize all human problems, and in the widespread corruption of psychiatric research.
Biotronik, the manufacturer of the implant, apparently asked Dr. Moreno to write an opinion for the court case. In this statement, dated July 23, 2013, Dr. Moreno pointed out that the cardiologists had no “…legal, regulatory or ethical duty…” to make the disclosures to the patients.
Essentially, Dr. Moreno’s position rests on the fact that the disclosure was not required by any written law, regulation, or ethical code. Therefore, he concludes, there was no ethical breach or wrongdoing.
The logic here is that professional people can do whatever they like provided there’s no written rule prohibiting it. This strikes me as a rather narrow way of looking at the field of ethics.
In general medicine, there is a legitimate assumption on the part of the patient that the physician will prescribe the treatment which, in his honest, unbiased view, is the best for the patient. If the physician has a financial interest in treatment A but not in treatment B, there will inevitably be a tendency to prescribe A, even though B might be more advantageous in the particular circumstances.
In the case of Biotronik and the cardiologists, it may be that Biotronik’s implant was the best choice for the patients concerned. But maybe it wasn’t. In such circumstances, the physician needs to guard against even the possibility of corruption, and the best way to accomplish this is through full disclosure to the patient. And this disclosure should mention other options besides Biotronik’s product, and an honest appraisal of the different products.
The fact that there’s no written rule requiring physicians to make such disclosures seems to me a matter of secondary importance. Full disclosures of this sort should be made in all branches of medicine, just because it’s the right thing to do.
On August 1, 2013, the two cardiologists reached an out-of-court settlement with the State of Oregon. Under the terms of the settlement, the cardiologists admitted no wrongdoing, but agreed to pay $25,000 each, and also agreed to inform future patients of their financial ties.
There’s a detailed account of the case on OregonLive.com. Carl Elliott, bioethicist at the University of Minnesota, is quoted in this article:
“You don’t need to be an ethicist to see that it’s wrong to take the money and hide that fact from your patients.”
Who could disagree with that, especially given the extent to which psychiatry has been corrupted by pharmaceutical money? Besides, what objection can there be to making full disclosures?