I concur with the interesting article by Sulmasy et al1 regarding cost-control arrangements that are perceived as ethically objectionable by physicians. Having practiced primary care medicine for 20 years, I have witnessed the change in medicine as loyalty to managed care companies for cost containment has taken precedence over loyalty to patients. But there is more.
Goldstein MR. Cost-Control Arrangements and Misdirected Loyalty. Arch Intern Med. 2000;160(16):2546. doi: