Conflicts of Interest and the Future of Medicine

As most Americans know, conflicts of interest riddle the US health care system. They result from physicians practicing medicine as entrepreneurs, from physicians' ties to pharma, and from investor-owned firms and insurers' influence over physicians' medial choices. These conflicts raise questions about physicians' loyalty to their patients and their professional and economic independence. The consequences of such conflicts of interest are often devastating for the patients-and society-stuck in the middle. In Conflicts of Interest and the Future of Medicine, Marc Rodwin examines the development of these conflicts in the US, France, and Japan. He shows that national differences in the organization of medical practice and the interplay of organized medicine, the market, and the state give rise to variations in the type and prevalence of such conflicts. He then analyzes the strategies that each nation employs to cope with them. Unfortunately, many proposals to address physicians' conflicts of interest do not offer solutions that stick. But drawing on the experiences of these three nations, Rodwin demonstrates that we can mitigate these problems with carefully planned reform and regulation. He examines a range of measures that can be taken in the private and public sector to preserve medical professionalism-and concludes that there just might be more than one prescription to this seemingly incurable malady.
"Rodwin writes clearly, and he is soft-spoken but stinging in his account of organized medicine's resistance to limits on self-referral, enticements from Big Pharma, and other flows of lucre...an important book on an urgent topic, neglected by both political parties in the ongoing battle over health care reform."--Health Affairs

"Will be helpful to scholars as well as intriguing to readers new to the subject."--Journal of the American Medical Association

"Rodwin provides broad, well-documented coverage of financing mechanisms and the competing goals of state and markets...Recommended."--CHOICE

"Superb, comparative, fascinating...A valuable historical study which is also a major contribution to conflict of interest debates in US and international health care policy, suggesting practical alternatives for the future."--Rosemary A. Stevens, Distinguished Scholar, Weill Cornell Medical College-New York City

"Rodwin turns a critical eye to the current proposals...suggests new directions for reform...[and] offers important advice that policy makers must heed if we are to restore trust in our profession."--Jerome P. Kassirer, MD, Distinguished Professor, Tufts University School of Medicine, and Editor-in-Chief Emeritus of New England Journal of Medicine

"A wise, powerful, broad-ranging guide to saving the relationship between doctors and patients. Conflicts of Interest is meticulously researched and beautifully written. It explores the past, illuminates the present, and points us toward a promising future. We ignore Marc Rodwin at our peril."--James Morone, Professor of Political Science and Urban Studies, Brown University, co-author of The Heart of Power and author of Hellfire Nation

"Rodwin, whose earlier classic on medical conflicts of interest contributed importantly to the public debate, has deepened his analysis in a comparative perspective...He again enlarges and enlightens the debate and offers useful policy alternatives."TABLE OF CONTENTS ; FORWARD BY JEROME KASSIRER ; FRAMING THE ISSUES ; INTRODUCTION: PATIENT STORIES ; 1. THE HEART OF THE MATTER ; CASE STUDIES ; 2. THE EVOLUTION OF THE FRENCH MEDICINE ; 3. COPING WITH PHYSICIANS' CONFLICTS OF INTEREST IN FRANCE ; 4. THE RISE OF A PROTECTED MEDICAL MARKET: THE UNITED STATES BEFORE 1950 ; 5. THE COMMERCIAL TRANSFORMATION: THE UNITED STATES, 1950-1980 ; 6. THE LOGIC OF MEDICAL MARKETS: THE UNITED STATES, 1980 TO THE PRESENT ; 7. COPING WITH PHYSICIANS' CONFLICTS OF INTEREST IN THE UNITED STATES ; 8. THE EVOLUTION OF JAPANESE MEDICINE ; 9. COPING WITH PHYSICIANS' CONFLICTS OF INTEREST IN JAPAN ; IMPLICATIONS ; 10. REFORMS ; 11. PROFESSIONALISM RECONSIDERED ; CONCLUSION: THE WAY FORWARD ; APPENDIX: CONFLICTS OF INTEREST IDEAS: ORIGINS AND APPLICATION TO PHYSICIANS ; ACRONYMS AND GLOSSARY ; ACKNOWLEDGEMENTS ; ABOUT THE AUTHOR ; BIBLIOGRAPHY ; INDEX