Debating Conflicts: Medicine, Commerce, and Contrasting Ethical Orders

This article, prepared in the context of a conference at Hofstra in October 2006 ( Biomedical Research and the Law ) considers contrasting responses to conflicts of interest occasioned by physicians\u27 financial links to the pharmaceutical industry. Debate about the appropriate relationship between physicians and industry is grounded in the development known to historians of ideas as the shift in western culture from status to contract. The article summarizes the shift and then describes its consequences for and effects within the world of health care. The paper focuses on comparing an ethical order that continues to reflect traditional patterns in directing physicians\u27 conduct with an ethical order firmly committed to the values of the marketplace. Physicians\u27 contrasting attitudes toward links with industry, and more specifically, toward rules of disclosure as a potential antidote to bias, illustrate the parameters of debate. The article concludes that the depth of the ideological divide among physicians, apparent in discourse about links with industry, and more generally, in discourse about the medical professions\u27 self-identity and scope, may augur a dramatic division of medicine into two essentially distinct professional groups