Commercial Pressures and Professionalism

Most of us are not unfamiliar with how alluring commercial influences are, and how pervasive conflicts of interest have become in our medical profession. However, few can pinpoint its cause.

Richard A. Deyo and Donald L. Patrick in “Hope and Hype” point out how we are trapped in the struggle between commercial pressures and professionalism:

In most cases, these conflicts exist precisely because of the incentives created by new advances. And commercial pressures of various types have become a major obstacle to practicing evidence-based medicine.

Furthermore, with due recognition to how better training in evidence-based medicine and professionalism (or so-called “medical ethics”), they provide a more practical way:

…… more support for primary care medical practice may help deflect some of the pressures to use unproven treatments. Unlike the cardiologist or the orthopedist, primary physicians have little to gain from using new procedures or gadgets although they may be susceptible to blandishments from the drug companies. They can therefore afford to be more dispassionate about them. The primary-care doctor—typically a family doctor, general internist, or pediatrician—can serve the role of providing unbiased information and assisting patients with many difficult medical decisions.

Furthermore, such practitioners handle the majority of complaints as effectively as specialists, and usually in a lower-tech style. Their role shouldn’t be that of gatekeeper-a role that they dislike, that patients’ distrust, and that’s proved to be ineffective. Instead, they can serve the role of knowing the patient and his or her values best, handling most routine problems, and offering objective advice on more specialized, more technological care.