White Coat, Black Hat Adventures on the Dark Side of Medicine

26Oct/122

The Ethicator: Should I accept money for referrals?

Not your friend.

Dear Ethicator,

I am a psychiatrist, and I have a deeply fulfilling relationship with a contract research company. Whenever I send them a schizophrenic patient for one of their research studies, they send me a referral fee. Win-win, right? I score some coin for my kids’ college funds, and my patients get a 3 week vacation on a locked ward with cable TV. (Okay, they have to test unapproved drugs and wear a rectal sensor, but those things are not as uncomfortable as people say they are.) Problem is, there have apparently been some “adverse events” in these studies, whatever that means, and I am worried that the trial lawyers may claim that these referral fees are a conflict of interest. So my question for you is: how do I resolve my conflict of interest so that I can keep taking the money?

The Ethicator responds:

Here we go again. I'm flat-out sick of this talk about conflict of interest. Why do people always assume conflicts of interest are about money? Not all of them are. There are plenty non-financial conflicts of interests out there, not the least of which is your own conscience. That's a bias too, you know. If you're an overweening, sanctimonious prick who refuses to accept any money for advancing medical progress, how much integrity are you going to have making life or death decisions?

Same story, every time: Take a little money from people who make the world better, and the anti-pharma zealots will squeal like stuck pigs. But run around flouting your anti-pharma biases, and nobody says a word. Show me a ProPublica database of socialist nutballs bent on making the world sicker. Show me a journal article that discloses: "Carl Elliott is an attention-seeking media whore, salvaging his foundering career by pissing on the work of hard-working medical professionals. He also doesn't pay for websites" Think you'll see that anytime soon? Don't hold your breath.

Whether you're working for 2 mil in stock options or just want big-ups from your hippie lawyer fans, you've got a conflict of interest somewhere. The other guys are no better. Don't be bullied; just disclose and move on. Sleep well.

The Ethicator

Send your questions to the Ethicator:  info@whitecoatblackhat.com

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  1. I’m terribly disappointed, Ethicator. You missed the clear solution to the entire problem, which is to simply have the money given to the hospital or academic institution that the psychiatrist works for before it is then distributed to the psychiatrist. Once the dollar bills from pharma go into the pot with all the other dollar bills, you can’t tell where they’ve come from when they’re handed out. I mean, it’s not like each bill from each company is stamped. This way, the money comes from work, and voila! No conflict of interest.

    Ethical money laundering 101, really.

    • But I am an ethicist, Kelly, not a money launderer. Money laundering is for sissies. Hide the money, and it looks like you’re doing something wrong. Even worse, it shows fear, and your enemies can smell that from a mile away. That’s why I advise the reader to face the problem head on. Sure you’ve got a conflict of interest, but so does the other guy, and pretty much everybody else pointing fingers. Call it even. I’m an ethicist; I know these things. And what’s the point of being an ethicist if all it means is playing by other peoples’ rules?


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