An Essay on the Impact of Conflict of Interest in Healthcare

This essay delves into the pervasive issue of conflict of interest within the healthcare sector, focusing on the relationships between healthcare professionals, the pharmaceutical industry, and medical device companies. It explores how financial and non-financial interests can influence decision-making processes, potentially compromising patient care and research integrity. The essay examines the ethical implications of accepting gifts, the impact of industry influence on evidence-based medicine, and the challenges faced by the Food and Drug Administration (FDA). It highlights both the negative consequences, such as biased prescribing practices and increased healthcare costs, and the potential positive aspects of these relationships. The conclusion emphasizes the need for strategies to mitigate the negative impacts of conflict of interest and maintain ethical standards in the healthcare sector.

Running head: IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
Name of the Student:
Name of the University:
Author’s Note:

1
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
A conflict of interest is a circumstance where a person or an organisation have several
interests, either financial or non-financial and accomplishing one interest may lead to
working against the other. In such a situation, the personal interest of the organisation or
individual may get severely affected and have an impact on the decision-making process, thus
helps in offering benefits to a third party. According to Stark (2001, 4), conflict of interest is
an issue in a specific domain that do not involve ordinary self-interest in guiding to taking
decision being impartial, unbiased or independent in nature. The presence of such a scenario
may involve inappropriateness in the occurrence and thus, need to be defused in a voluntary
manner before the occurrence of any mishaps. It involves the creation of risk factors that
indicate the fact that that the decision has been influenced by other people, secondary sources
and other influential factors. The aim of the essay is to discuss and analyse the effect of
conflict of interest on the relationship of the healthcare professionals and industries related to
pharmaceutical and medical devices.
The importance of conflict of interest in different types of profession is a complex
issue. On a virtual ground, each professional, as well as business code of ethics, has an
endowment of conflicts of interest including medical institutions (Pritchard 1996, 1305).
Based on the rules and laws of a specific organisation, the existence of situation related to
conflict of interest may not occur, demonstrating that there is a wrongdoing. In many
professional sectors, it cannot be stated that complete avoidance of such situations can be
done from time to time basis. In a critical scenario, it takes the form of a legal implication
where the individual tries to influence the decision due to personal benefits. The moral
implication of the conflict of interest involves compromising the decision in case of acting on
behalf of a third party. Nevertheless, in some cases, there is the involvement of damage in the
decision-making process of an individual or making it less reliable in nature. The pragmatic
contemplation is found to weigh more than the definition of the conflict of interest stated by

2
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
McNunigal. Thus, making it difficult to assess whether the case is related to these aspects
until the moral questions are justified or harmed. As per the definition postulated by him or
other similar types of definitions, a circumstances cannot be considered to be a conflict of
interest in any profession unless there is the justification that proves it harms others. As per
the finding, four systems, institutions or bodies that are critical in this case encompass law,
cultural, religion and ethics that help in guiding the direction in life (Carson 2004, 163). The
most predominant professional areas that involve a conflict of interest are law, business,
academics, market and healthcare. For evaluating the morality of the risks imposed on others,
it is important to know the profession and duties.
The conflict of interest is a critical part of the medical profession because of the fact
that every situation that is encountered in medical practice can be ineffaceable. However,
with efforts, it can be limited which do not harms the public specifically patient (Davis 1998,
12). On a contemporary basis, the conflict of interest exists when there is disagree or collision
of interest on the professional ground or primary ethical aspect in the medical practice. It can
be seen that while performing tests and procedures, physicians deem to face conflict of
interest as well as when they are recommending based on the tests. The physicians' faces
conflicted scenario while paid for referrals in clinical trials or deciding for choosing
participants in the studies. From the general findings, it can be stated that there is a strong
association between the medical professionals and the pharmaceutical and medical devices
industries. The industry offer products that cannot be directly sold to the patients (Pritchard
1996, 280). For buying medicines, patients require prescriptions from the physician or
consultation from medical staffs and on the other hand, the medical professionals are unable
to treat patients without drugs or equipment. Therefore, there is an interdependent
relationship with a common objective. It is important to assess the ethical principles of
advanced medical practice including beneficence, autonomy, non-maleficence and justice. It

3
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
can be stated that in all partnerships, the conflict exists among the different stakeholders. The
promotional drive of the pharmaceutical and medical device industry is done specifically
through the medical representative and there is one representative for four to five doctors.
Thus, there is a critical association between the industry and physicians. The offering of gifts
and free samples by the representatives to the medical professionals are very common which
has a significant impact on the care process. As per the study conducted by Dana and
Loewenstein (2003, 252), the bias effect of accepting gifts is stated to be deliberate choice
thus, have an impact on the relation between the medical profession and the industries of
pharmaceutical and medical devices. The traditional perspective of accepting gifts suggest
that physicians become biased due to personal gains, which is unethical in nature. This
viewpoint demonstrates that the resentment with which, the doctors may respond because of
the fact that gifts are responsible for creating bias are common. Many policies within the
companies deal with the conflict of interest that is found to be explicitly associated with
biasness (Davis 1998, 24). As per the recent guidelines of the Pharmaceutical Research and
Manufacturers of America and the recommendations of the Office of Inspector General of
Health and Human Services have defined gift to be having more value that normal and
inappropriate in nature. As per the survey, it was revealed that physicians view small gift to
be ethically accepted than the larger gift (Wazana 2000, 378). This is because it is not
tempting in nature and are not able to influence the medical services provided by the
physicians. The gifts from the pharmaceutical industry are found to increase the cost of
medical treatment and more specifically, the expenditure of prescription drugs. As per the
data, the retail spending on the drugs had rapidly increased and doubled from a figure of
$64.7 billion to $132 billion over a period of 1995 to 2000. It further increased by 17% in
2001 that had been estimated to result from the shift of prescribing of more costly drugs by
the physicians and other medical professionals (Dana and Loewenstein 2003, 252). The

4
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
hiring of the representatives by the pharmaceutical industry involves the aggressive
promotion of the expensive medicines and medical devices produced by the companies.
There is a positive link between the cost of treatment choice made by the physicians and
contact with the industry related to pharmaceutical and medical devices. According to
empirical studies, the interaction of physician’s interaction with those companies lead to an
increase in the cost of prescribed drugs and non-rational prescribing. It is evident that the
relationship exhibits a negative impact on the patient population by elevating the cost of care.
The evidence-based medicine (EBM) had offered clarity to the medical practice as it
is based on the use of most appropriate evidence to the practitioners thus, offering a ground
for effective decision-making. According to Rogers and Ballantyne (2009, 3), various studies
on EMB have raised the issue on clinician and patient’s autonomy due to use or misuse of
evidence in relation to healthcare resources. The conflict of interest, in this case, lead to
unpredictable bias; thus, affect the decision making to be unreliable in nature. The industry
sponsorship specifically limits the experts of the Food and Drug Administration (FDA) to
investigate the efficacy and safety of drugs that are marketed. From a study conducted related
to FDA decision, it was found that there is a minimum of one advisory committee member in
73% of the meetings having a financial conflict (Rogers and Ballantyne 2009, 14). Therefore,
it is evident that the biased incident occurring in this type of conflict of interest is irregular
and inconsistent in nature. Therefore, the major challenges in the current healthcare system
affects the validity and reliable of the research include meta-analysis were under-represented
in population due to discrimination. Disproportion in research agenda that was mostly driven
by financial gain than gaining benefits of community and the CROs and pharmaceutical
companies had collaborated in order to produce biases in the decision-making process are
also critical and challenging in nature (Elliott 2008, 154).

5
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
Even though the conflict of interest has a negative impact on the healthcare sector as a
whole, however, it is a positive side associated with it in case of FDA. As per the study, it
was evaluated that in each case where a committee member has a conflict, there is a 10%
greater chance that the drug is under review. Even though it is difficult to quantify the effect
of the conflict of interest however, it is reasonable to predict that when a certain level of bias
exist in FDA, it is opined to be equal to or greater in term of performance of the researchers
and commercial funders in case of reviewing research (Elliott 2004, 20). Therefore, there are
positive sides to maintain a strong relationship between medical professionals and the
industrial players in the healthcare sector. Thus, conflict of interest cannot be blamed at all
the time for the downfall in treatment and care procedure, as various other factors affect the
system as a whole that needs to be taken into consideration.
From the essay, it can be concluded by stating that the conflict of interest is a
situational aspect that commonly occurs in every profession. It is important in the medical
field because it may involve a negative effect on a long-term basis for the patient in question
or health professionals and in severe cases, the ineffective decision-making process may lead
to even death. Thus, the implications of scenario related to conflict of interest can be
detrimental in nature. One of the most crucial aspects that had been reviewed is the impact of
the relationship between healthcare professionals and industry related to pharmaceutical and
medical devices. The negative aspects of the association have been assessed with respect to
EBM and taking gifts, which have a biasness pertaining treatment and care procedure adopted
by healthcare staffs. Even though there is a positive side of the relationship, which has been
highlighted. However, the negative aspects weigh more than the positive side; thus, it is
important to address the issue in a critical manner and strategies need to be implemented to
mitigate the impact.

6
IMPACT OF CONFLICT OF INTEREST IN HEALTHCARE SECTOR
References
Carson, T.L., 2004. Conflicts of Interest and Self-Dealing in the Professions: A Review
Essay-Conflict of Interest in the ProfessionsMichael Davis and Andrew Stark New York:
Oxford University Press, 2001; ISBN 0-19-512863-X. Business Ethics Quarterly, 14(1),
pp.161-182.
Dana, J. and Loewenstein, G., 2003. A social science perspective on gifts to physicians from
industry. Jama, 290(2), pp.252-255.
Davis, M., 1998. Conflict of interest. Encyclopedia of applied ethics. Chadwick, RF.
Elliott, C., 2004. Pharma goes to the laundry: Public relations and the business of medical
education. The Hastings Center Report, 34(5), pp.18-23.
Elliott, C., 2008. Guinea-pigging: healthy human subjects for drug safety trials are in
demand. But is it a living?. New Yorker (New York, NY: 1925), pp.36-41.
Pritchard, M.S., 1996. Conflicts of interest: conceptual and normative issues. Academic
medicine: journal of the Association of American Medical Colleges, 71(12), pp.1305-1313.
Rogers, W. and Ballantyne, A., 2009. Justice in health research: what is the role of evidence-
based medicine?. Perspectives in biology and medicine, 52(2), pp.188-202.
Stark, A., 2001. Comparing conflict of interest across the professions. Conflict of Interest in
the Professions, pp.335-52.
Wazana, A., 2000. Physicians and the pharmaceutical industry: is a gift ever just a
gift?. Jama, 283(3), pp.373-380.