Dr. Ahmadi Nasab Emran is a teaching assistant, Albert Gnaegi Center for Health Care Ethics, Saint Louis University (SLU), St. Louis, Missouri. He is also a candidate for a PhD in health care ethics at SLU.
Acad Med. 2015 Jan;90(1):30-2. doi: 10.1097/ACM.0000000000000525.
The pharmaceutical industry's wide range of interactions with physicians, trainees, and other medical professionals--interactions that include information transfer and financial incentives--has been the source of undue influences, especially on physicians' prescription behavior. Current literature has mainly been focused on the financial element of these influences, and the problems in medical professional-pharmaceutical industry interactions are mainly viewed in terms of conflicts of interest. There is often the assumption that physicians are intellectually competent but biased because of financial incentives.The author rejects that assumption and proposes an alternative explanation for the observed influence of the pharmaceutical industry on physicians' behavior by emphasizing the importance of the information-transfer side of the interactions and maintaining that physicians and other medical professionals need certain intellectual virtues (i.e., competencies) to properly assess the information, which is often unreliable and biased. These virtues are necessary for the practice of modern medicine and include mindfulness, the ability to understand practical implications of newly found evidence, to consider alternative explanations of data, to recognize and correct errors, to decide on the best available evidence, and to tailor that to the needs and values of individual patients. On the basis of this view, the author recommends that the best solution for the observed problems in physician-pharmaceutical industry interactions is to "vaccinate" physicians and other medical professionals by increasing efforts to inculcate the necessary intellectual virtues early in medical education and fostering them throughout those individuals' professional lives.
制药行业与医生、实习生和其他医疗专业人员之间广泛的互动——包括信息传递和经济激励——是产生不当影响的根源,尤其是对医生的处方行为产生影响。现有文献主要集中在这些影响的经济因素上,而医疗专业人员与制药行业互动中的问题主要被视为利益冲突。人们常常假设医生在智力上是有能力的,但由于经济激励而存在偏见。作者拒绝这种假设,并通过强调互动中信息传递方面的重要性,为观察到的制药行业对医生行为的影响提出了另一种解释,认为医生和其他医疗专业人员需要某些智力美德(即能力)来正确评估信息,而这些信息往往是不可靠和有偏见的。这些美德是现代医学实践所必需的,包括正念、理解新发现证据的实际影响的能力、考虑数据的替代解释、识别和纠正错误、根据最佳现有证据做出决策以及根据个体患者的需求和价值观进行调整。基于这一观点,作者建议,解决观察到的医生与制药行业互动中存在的问题的最佳办法是“接种疫苗”,即通过在医学教育早期就增加灌输必要的智力美德的努力,并在这些人整个职业生涯中培养这些美德。