We live in times of tectonic change in medicine on every level: the science, the technology, the politics, the patients, and the marketplace are all in flux. But some things never change. Even with the dishes rattling in the cupboards and the earth shaking underfoot, what is ethically correct remains so, and what is ethically wrong is just wrong.
Health care providers who induce referrals with “premiums” that include trips to Bermuda and private parties with Britney Spears lookalikes (true story) are violating legal and ethical principles. They need to play by the rules.
Physicians who refuse to treat trial lawyers who specialize in medical malpractice and their wives (however tempting) are violating the Hippocratic oath and the ethical principles of their profession. They ought to grow up (and lobby for tort reform).
And radiologists who bill Medicare for unnecessary procedures not ordered are violating federal regulations and ethical principles. (It is not so long ago that patients thought physicians were God: let them down easy.) They should hang their heads.
Medicine appears to be catching the same ethical malaise that has befallen the world of business. Have we lost our way?
Perhaps, but that is why we need people like New York Attorney General Eliot Spitzer and National Institutes of Health director Elias Zerhouni, MD. Spitzer has cleaned house on Wall Street and now Zerhouni is cleaning up the NIH. About a year ago, a scathing series in the Los Angeles Times reported on an atmosphere highly conducive to ethical abuse at the NIH, including excessive amounts of consulting going on among NIH researchers, some of whom were earning multiples of their salaries consulting for vendors. Zerhouni has proposed:
- Limiting NIH employees’ outside work to 400 hours a year, with payment limited to 25% of an employee’s base salary.
- Prohibiting the practice of paying NIH employees in stock; prohibiting some from holding stock in medical companies; and holding others to a limit of $5,000.
- Prohibiting any consulting by senior NIH officials with grant decision-making responsibilities.
Zerhouni should be commended for making the difficult decision to institute what will most certainly be very unpopular policies. These policies, if instituted, could result in some attrition. But why should government-funded researchers be earning twice their salary from industry? That arrangement is a tailor-made conflict of interest.
Zerhouni breathes the rarified air of government research, and he wields considerable control over the workplace environment and its governing policies. But most of us live out in the world. We have competitors who use business practices that are unfair, unsavory, unethical, and sometimes illegal. In a society that values success at all costs, and devalues accountability, responsibility, and honesty, where is our ethical barometer? Answers to ethical questions are not always clear-cut, but where is the discussion? Without an oversight mechanism, our companies, our hospitals, and our group practices are rudderless.
With the exceptions of Spitzer and now Zerhouni, there is no ethics police: that job is yours.