Mayes Christopher, Williams Jane, Kerridge Ian, Lipworth Wendy
Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia.
Alfred Deakin Institute, Deakin University, Waurn Ponds Campus, Victoria, Australia.
J Eval Clin Pract. 2018 Oct;24(5):939-944. doi: 10.1111/jep.12843. Epub 2017 Nov 3.
This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed.
We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student-run medical society and faculty e-mail lists. Forty-nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to "science" in the management of COI and applied theoretical analyses of scientism.
The students in our study suggested that science and evidence-based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care.
More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings.
本文报告了对澳大利亚医学生进行的6个焦点小组的研究结果。这些焦点小组旨在探寻学生对于如何管理商业利益对医疗实践和教育的影响的看法。
我们在澳大利亚新南威尔士州对医学生进行了6个焦点小组的研究。参与者通过学生运营的医学社团和教师电子邮件列表招募。新南威尔士州6所医学院的49名学生参与了研究。研究团队思考了学生在多大程度上不加批判地将抽象的科学作为利益冲突的管理解决方案。数据分析主要采用归纳法，寻找科学术语、循证医学的使用情况，以及在利益冲突管理中对“科学”的诉求，并应用了对科学主义的理论分析。
我们研究中的学生认为，科学和循证医学而非伦理或职业精神，是应对不当影响和偏见的最佳工具。本文运用科学哲学文献对这些将科学和循证医学作为管理制药代表和商业利益影响手段的科学主义诉求进行批判性审视。我们认为，医学课程强化了一种科学主义的推理方式，学生需要意识到支撑科学、医学和循证医学的认识论假设，以应对与商业化医疗保健相关的伦理挑战。
需要做更多工作来构建医学课程，以反映实践的复杂性和科学的现实情况。然而，仅课程改革不足以解决与医学商业利益相关的问题。要实现真正的变革，需要就医学与产业互动的方式进行更广泛的社会和专业辩论，并进行结构性变革，以限制或减轻教育、研究和政策环境中的商业影响。
