IÂ’ve experienced a lot of what is right with the American healthcare system. But I have also seen enough fraud, abuse and unethical behavior to sicken even the heartiest soul. This characteristic of American healthcare is far too prevalent, and it undermines our efforts to control cost, build access and--most importantly--assure quality care.He then went on to list a variety of examples of unethical behavior, starting with "pharmaceutical companies have paid for and published studies in distinguished professional journals, but left out results that reflected poorly on their products," and ending with "many healthcare executive have enjoyed extraordinary compensation while fraud and abuse occurs, and is even encouraged under their watch."
Most of the examples will be familiar to readers of Health Care Renewal, although Goldstein named no names. He seemed to leave out some particularly egregious examples, especially involving leaders of hospitals and academic medical centers (e.g., UMDNJ operating under a deferred prosecution agreement, see most recent post here), and pharmaceutical companies' extensive efforts to manipulate the clinical evidence base (e.g., see this recent post). He also seemed to bend over backwards to give doctors (an equally bad) time, (e.g., criticizing doctors' failure to practice evidence-based medicine as an ethical flaw, rather than a result of inadequate training, limited resources, and external pressure). But all in all it was a pretty good list of examples.
Goldstein further noted that:
Unethical behavior exists among healthcare organizations and professionals of all types. Organizations that try to do the right thing are often outmanuevered by those that do not. Self-interest is often hidden behind a facade of patient concern.Yet he failed to provide a ringing plea for change:
Worse, these self serving behaviors have become so common that professional outrage has been dulled. But to save healthcare, we can't just take these acts for granted. The prevalence of inappropriate actions in healthcare drives additional margins in the industry's supply, delivery and financing sectors. It is at the root of our cost explosion and our healthcare crisis. And, it is based on an ingrained acceptance of unethical behaviors.
The recent movement toward transparency and quality reporting will shine a bright light on some of these practices, and should tone down the environment of opportunism. But many of these behaviors have been well known for years. I have little faith that, with so much money at stake, any reforms can be substantial enough to turn around the industry. This is especially true if change does not support and engage much more participation from payers and consumers.It's nice to see something about the ethics of health care show up in a place where health care organization leaders might notice it. It's too bad that it contained a list of anecdotes that named no names, pulled its punches, and seemed to bend over backward to give weight to physicians' misdeeds. It's also too bad that its call for solutions was somewhat muted, and did not include health care professionals. But despite these criticisms, or this carping perhaps, Goldstein's piece was a real step forward. I wonder if any health leaders will listen?
I am not naive and do not expect that a plea for ethics will have much impact.
Thanks to the Health Care Blog for the tip.