Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: The Special Communication by Dr Brennan and colleagues1 effectively reviews how physicians' conflicts of interest provide challenges to their professionalism. However, we believe that the focus was too narrow and the proposed solutions were incomplete and possibly misguided.
Brennan et al implied that the only important conflicts of interest are those involving individual physicians and pharmaceutical or device manufacturers. However, conflicts posed by physicians' relationships with managed care may be just as important. Dr Kassirer, one the coauthors, has elsewhere written that “market driven health care creates conflicts that threaten medical professionalism.”2
Poses RM, Silverstein S, Smith WR. Academic Medical Centers and Conflicts of Interest. JAMA. 2006;295(24):2845–2849. doi:10.1001/jama.295.24.2846-b
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