Synopses & Reviews
Our society has long sanctioned, at least tacitly, a conflict of interest in medical practice and research as an unavoidable consequence of the different interests of the participants in health care: the physician or clinical researcher, the patient or research subject, insurance companies or research sponsors, the government, and society as a whole. This multidisciplinary effort draws from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I reviews the theoretical background, including basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with clinical research in several contexts, including institutional review boards, clinical trials, research agreements between the government and private researchers, brokerage of research subjects by contract research organizations, and cost-effectiveness studies.
Table of Contents
I. Conflicts of Interest: A Conceptual Overview
1. Introduction, R.G. Spece, Jr. and D.S. Shimm
2. Conflicts of Interest in Medicine: A Philosophical and Ethical Morphology, E.L. Erde
3. Discovering the Ethical Requirements of Physicians' Roles in the Service of Conflicting Interests as Healers and as Citizens, R.G. Spece, Jr. and D.S. Shimm
4. Conflicts of Interest in the Classic Professions, G.C. Hazard, Jr.
5. Is There a Medical Profession in the House, A.E. Buchanan
6. Screening, C.W. Wolfram
II. Clinical Practice
7. An Introduction to Conflicts of Interest in Clinical Practice, R.G. Spece, Jr. and D.S. Shimm
8. Entrepreneurial Doctors and Lawyers: Regulating Business Activity in the Medical and Legal Professions, N.J. Moore
9. Physicians' Conflicts of Interest in HMOs and Hospitals, M.A. Rodwin
10. Physician Rationing and Agency Cost Theory, M.A. Hall
11. Conflicts of Interest for Physician Entrepreneurs, E. Haavi Morreim
12. Informed Consent to Medical Entrepreneurialism, Jay Katz
13. Physician Joint Ventures and Self-Referral: An Empirical Perspective, J.M. Mitchell
III. The Pharmaceutical Industry's Influence on Clinical Practice and Referrals
14. Conflicts of Interest in Relationships Between Physicians and the Pharmaceutical Industry, R.G. Spece, Jr., D.S. Shimm and M.B. DiGregorio
IV. Clinical Research
15. An Introduction to Conflicts of Interest in Clinical Research, R.G. Spece, Jr. and D.S. Shimm
16. Regulation of Government Scientists' Conflicts of Interest, T.L. Kurt
17. Conflicts of Interest in Industry-Funded Clinical Research, E.J. Huth
18. Conflicts of Interest and the Validity of Clinical Trials, Baruch A. Brody
19. IRBs and Conflicts of Interest, L. Francis