A conflict of interest exists when a primary ethical or professional
interest clashes with financial self-interest, a situation that arises commonly
in medical practice. When physicians are remunerated for performing specific
tests and procedures, they face a conflict of interest when they also recommend
those same tests and procedures. When they are paid for referrals to clinical
trials, physicians are in the conflicted position of deciding whether their
patients are appropriate for the studies. Performing industry-supported research,
physicians face an implicit demand for a positive finding to obtain further
financial support. And, when pharmaceutical companies court high-volume prescribers,
writing prescriptions becomes an act not only with financial and health consequences
for patients, but also with financial consequences for the physician. This
last source of conflict of interest is the central focus of this commentary.
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