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June 22, 1994

Medicine, Money, and Morals: Physicians' Conflicts of Interest

Author Affiliations

Stanford Law School Stanford, Calif

JAMA. 1994;271(24):1964. doi:10.1001/jama.1994.03510480090043

Medicine, Money, and Morals is about the effects of financial incentives on medical practice. It is not the first work to address these questions—or probably even one of the first thousand. But it is the best.

In considering financial arrangements between doctors and others, the author, Marc Rodwin, treats two types: arrangements that encourage doctors to provide more care or care only through certain facilities or means, and arrangements that encourage doctors to provide less care. He details at great length the evidence concerning the effects of these incentives on treatment decisions and on quality of care and then suggests policy reforms to mitigate the excesses of either approach.

Self-referral arrangements, pharmaceutical company gifts, health maintenance organization risk-sharing contracts—these and other topics that Rodwin dissects have been discussed before at great length. Four features set this book apart, however, all stemming from the broader context in which it locates the

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