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J Thorac Cardiovasc Surg 2009;137:1047-1049
© 2009 The American Association for Thoracic Surgery
Editorial |
a Cardiothoracic Surgery Associates of North Texas, Cardiopulmonary Research Science and Technology Institute, Dallas, Tex
b Division of Cardiothoracic Surgery, Department of Surgery, and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC
c American Association for Thoracic Surgery Ethics Committee (Drs Robert M. Sade, Charleston, SC [chair]; Cary W. Akins, Boston, Mass; Thomas A. D'Amico, Durham, NC; James W. Jones, Houston, Tex; Martin F. McKneally, Toronto, Ontario, Canada; Keith S. Naunheim, St Louis, Mo; and Andrew S. Wechsler, Philadelphia, Pa)
d The Society of Thoracic Surgeons Standards and Ethics Committee (Drs Robert M. Sade, Charleston, SC [chair]; Mark S. Allen, Rochester, Minn; David N. Campbell, Aurora, Colo; Richard M. Engelman, Springfield, Mass; Mark K. Ferguson, Chicago, Ill; Steven W. Guyton, Seattle, Wash; John W. Hammon, Jr, Winston-Salem, NC; Sidney Levitsky, Boston, Mass; John E. Mayer, Jr, Boston, Mass; Eric N. Mendeloff, Dallas, Tex; Mark B. Orringer, Ann Arbor, Mich; Ross M. Ungerleider, Cleveland, Ohio; Donald C. Watson, Biltmore Forest, NC; and Walter G. Wolfe, Durham, NC)
Received for publication February 3, 2009; accepted for publication February 4, 2009. * Address for reprints: Robert M. Sade, MD, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 409, PO Box 250612, Charleston, SC 29425. (Email: sader@musc.edu).
| The first 20% of the full text of this article appears below. |
The primary responsibility of specialists in cardiothoracic surgery is caring for the patient. The sine qua non of effective patient care is the patient's trust, manifested as an unwavering belief that our advice and decisions are driven by the patient's best interest. We are presented daily with real or potential conflicts of interest, such as remuneration for ordering tests or performing procedures, enrolling patients in clinical trials, attending expense-paid, industry-sponsored educational events, or accepting large or small gifts. To serve the best interests of our patients and maintain their trust, we must acknowledge the factors that expose us to risks of subordinating patients' interests to the interests of others, including our own. Some conflicts of interest are inevitable and some are evitable; we can manage conflicts by avoiding those we can and resolving those we cannot avoid in favor of our patients.
Most physicians view themselves as free from bias or conflicts of interest in carrying out their responsibilities to patients. At the same time, however, they see other physicians as being unduly influenced in making patient care decisions by such external factors as gifts from industry.1,2
We must always be aware of the universal human trait of self-deception in ourselves. Accepting that we are as subject to self-deception as our fellow professionals and are confronted with many conflicts of interest every day, we may serve our patients and profession best with standards for avoiding or appropriately managing such conflicts.
Relations Between Physicians and Industry
About half of the tremendous advances in human well-being during the past half-century have been brought to us by drug and device companies' research and development.3 Moreover, industry's marketing of new drugs and technologies should not be underappreciated—without effective marketing, introduction of innovations into clinical use would be far slower. To deliver state-of-the-art treatment to our patients most effectively,
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