Intersection, co-dependence and tension: The no-man’s land between medicine and pharma

Dr Wendy Lipworth1, Professor Miles Little1, Professor Kathleen Montgomery1,2

1University Of Sydney
2University of California

 

Medicine is deeply intertwined with the pharmaceutical industry, and much medical practice, research and policymaking takes place at this intersection. While connections between medicine and the pharmaceutical industry are strongly supported by some medical professionals, others worry about the corrupting influence that the industry has over doctors, researchers and policymakers. There is, of course, nothing wrong with ongoing disagreement about such a morally and politically complex issue, but participants in debates about industry influence have become entrenched in their views and dismissive of those who have opposing views. This both stifles progress in the management of industry influence and is likely to be confusing to the majority of practicing medical professionals who are simply trying to get their work done in an increasingly commercialized biomedical environment. One way through this impasse might be to generate a deeper understanding of the values of people on both sides of these debates, looking for areas of similarity as well as difference, and for key issues that remain unresolved. With this in mind, we conducted a qualitative analysis of a recent debate about industry influence and interactions that was triggered by a series of articles in the New England Journal of Medicine. Our results show that, while there is at least a degree of compatibility between the value systems espoused by the two groups, there are also a number of profound socio-political and epistemic points of difference. While it is unlikely that these differences will ever be completely resolved, our results do point to some implicit agreements and to a series of steps that might be taken in order to advance debates about medicine and the pharmaceutical industry.


Biography

I am a medically trained bioethicist and health social scientist, and Senior Research Fellow, at the Centre for Values, Ethics and the Law in Medicine, University of Sydney. My program of research focuses on the ethics and politics of biomedical (especially pharmaceutical) innovation.

My work is premised on the view that controversies about biomedical innovation are not just “technical” or organizational. Rather, they are about values and politics. I therefore use methods of “empirical bioethics” in which empirical research into the values of all key stakeholders is used in conjunction with theoretical analysis in order to address real-world problems.

Clinician-researcher dual role: What are the implications for planning, supervision and governance of ethically and methodologically sound research?

Jean Hay Smith1, Mely Brown1 Gareth Treharne2, Lynley Anderson3,

1 Department of Medicine, University of Otago, Wellington, New Zealand
2 Department of Psychology, University of Otago, Dunedin, New Zealand
3 Bioethics Centre, University of Otago, Dunedin, New Zealand

Clinician-researchers may find it difficult to shed their ‘clinician skin’ when moving to a research role with participants who are patients, even where there is no pre-existing clinical relationship with the researcher. This engrained orientation to patients’ needs may generate tension for the clinician-researcher within their research role, creating a need to grapple with the unavoidability and implications of dual role. Little is known about the range and implications of dual role experiences. The aim of this research was to develop a typology of common dual role experiences to help clinician-researchers (and those planning, supervising and approving research) grapple with ethical and methodological sequelae.

Five databases were systematically searched (inception to 28.07.2014). Full text of included articles was loaded in NVivo and coded for all examples of dual role. Searching located 7135 records. Forty-four primary investigations or first-person reports of clinician-researcher dual role were eligible. The majority of clinician-researchers in these identified studies were nurses or doctors, carrying out research that ranged from clinical trials through to in-depth qualitative studies. Our research identified 10 ways in which dual role is experienced regardless of research type, setting, or researcher’s profession including: managing participant questions; dealing with participant ‘agendas’; deciding when to assist colleagues with non-research tasks; making an incidental diagnosis; participants confusing research with therapy; unwarranted assumptions about participant data; reluctant participants; non-research related participant revelations; over-identification with clinical role; and manipulating participants.

These dual role experiences typically arise after ethics approval and research commencement. Equipped with this typology, clinician-researchers, their supervisors, and/or ethics committees may critically assess a developing research protocol for potential ethical concerns associated with dual role and act to mitigate or manage any issues that may arise.


Biography

Lynley Anderson teaches ethics and professional issues to undergraduate and postgraduate health professional students. Lynley has carried out research on the ethical issues in sports health care, and from that has written codes of ethics for health professional bodies including the Australasian College of Sports Physicians (2008), the NZ Physiotherapy Board and Society (2011), and NZ Sports Physiotherapists (2014). Lynley was a founding editors of the Journal of Bioethical Inquiry and editor of the New Zealand Bioethics Journal. She served on the Ethics Committee for Assisted Reproduction Technologies (ECART), and currently chairs the New Zealand’s Health Research Council Ethics Committee.