Possible Conflict of Interest:Doctors Selling Products and Owning Stock

As a segue from complementary and alternative medicine, consider the physician selling to the patient, out of the office, potions and lotions of alternative medicine which may have equivocal efficacy. Consider, the physician selling pharmaceuticals which have proven benefit or other products which may also be found in drug stores. What do these action do to the doctor-patient relationship? If a doctor prescribes but also sells to the patient a medication, can the patient be sure that the doctor's prescription was not based on the doctor's self-interest rather than the interest of the patient? Would a cheaper medication that the doctor was not dispensing be equally as effective? Some have equated this action as equivalent to a physician referring the patient to a lab or X-ray facility of which the physician had financial interest. Are these behaviors on the part of the physician ethical?

One can also extend the ethical concerns to physicians who own stock in certain pharmaceutical companies or have been treated to some benefit by a pharmaceutical company. Should patients consider that the physician might be prescribing a particular brand of medicine because of this influence? Should each patient be made aware at the outset of all potential conflicts of interest that their physician bears? Or should the patient always assume that a physician's interest is always in the patient? Please write me your comments on this issue.



As a resource to learn more about the issue of the physician selling products from his or her office, read the position paper representing the Ethics and Human Rights Committee of the American College of Physicians titled "Selling Products Out of the Office" by

Gail J. Povar, MD and Lois Snyder, JD, for the Ethics and Human Rights Committee, Annals of Internal Medicine, 7 December 1999 | Volume 131 Issue 11 | Pages 863-864. Here is an abstract of that paper. ..Maurice.

The sale of products from the physician’s office raises several ethical issues and may affect the trust necessary to sustain the patient-physician relationship. When deciding whether to sell products out of the office and, if so, which ones, physicians should carefully consider such criteria as the urgency of the patient’s need, the clinical relevance to the patient’s condition, the adequacy of evidence to support use of the product, and geographic and time constraints for the patient in otherwise obtaining the product. Physicians should make full disclosure about their financial interests in selling the product and inform patients about alternatives for purchasing the product. Charges for products sold through the office should be limited to the reasonable costs

incurred in making them available.