Attention Dan Brock (Director, Harvard University Program in Ethics and Health):
On May 4-5 the Harvard Business School Health Alumni Association along with the Young Presidents Organization/World Presidents' Organization (YPO/WPO) sponsored a conference in Washington, DC, "Health Reform at the Intersection of Government and Markets.” After two days of robust debate and discussion over a wide range of issues, the event ended with a troubling episode.
So troubling, in fact, that one physician in attendance along with another independent businessman felt obligated to write to Randy Cohen, who pens “The Ethicist” column at the New York Times, with the following query:
“We were attending a conference on health reform which had included an impromptu presentation on the swine flu pandemic. As the conference was closing, a physician was introduced and he said that as a “treat” for all his fellow attendees he would write prescriptions for TAMIFLU and that if he ran out of scripts, he would send one to anyone who emailed him a request. A large line immediately formed of people eager to avoid the risk of shortages or rationing. When confronted with our question as to the ethics and legality of his offer, he explained that he was a physician and had worked with the CDC and was confident he was acting in a morally and professionally correct manner – was he? For that matter, were the conference organizers in ethically troubling territory?”
To which Cohen replied:
“As you know, it is a violation of medical ethics to prescribe to a non-patient, i.e. to someone you've not examined (albeit a violation committed by, one study suggests, 100% of physicians). It is also a more general ethical transgression for a healthy person to stockpile a medication that might end up in short supply. In a more just world, this guy would have his license suspended. But I wouldn't count on that happening.”
Over lunch the other day, my doctor friend shared the rest of the story:
“From every angle, this was reprehensible and should not have been permitted. From a medical professional code of conduct point of view, it is an abuse of prescriptive authority to offer Rx of any drug to people who are not patients of a prescribing physician. It is medically irresponsible to give access to drugs which are not without risk as any adverse event could not be accountable (or appropriately handled) to this particular physician prescribing Tamiflu.
This is an act that can be considered illegal in several states, ethically wrong, medically reckless and dangerous, and inexcusable, especially in the manner it was presented to the conference attendees. From a "conflict-of-interest" point of view, this physician was offering Rx as a "treat" (code word: perk/kickback) to conference attendees who had paid to come to the conference. So, while there is no direct exchange of money for the Rx which will benefit this physician, it could easily be interpreted that he was an agent of the conference (since the conference organizers condoned the offer by allowing him the podium to present his offer and did not rebuke or stop him from doing so) and therefore Rx access was exchanged for money. From a supply chain, he was encouraging stockpiling of Rx, which is to give people access to a Rx for storage in their medicine cabinets (which will likely not be used) and taking it out of the supply for the nation.
Given how much we were talking about economic forces of supply/demand affecting behavior, it is highly ironic that this was permitted. From a public health perspective, this physician took advantage of a perceived panic (pandemic only means "widespread" and does not indicate severity) and called his actions "giving access" to a "needed therapeutic" during a "pandemic." It seems interesting that if he truly felt that way, then why did he not go out onto the streets or to the inner city and offer his scripts to others (who wouldn't necessarily have access). Funny how he should only offer this to people who most easily can gain access to their physician should they want and need the Rx (members of HBS Health Alumni Association). This could also be interpreted as an odious way to win friends and influence people.
And finally, from a medical practice point of view, Tamiflu is not without risk. When challenged, this physician merely mentioned that he was asking everyone if they had kidney problems (a contraindication for prescribing the Rx), but he did not warn anyone that there have been quite a number of cases internationally of behavioral changes that are reported with the use of Tamiflu. Without discussing risk and only touting benefit could be defined as medical malpractice.
As organizers of this event, this behavior should not have been encouraged nor condoned. Silence is the wrong action because it is not recognizing that everything this did in the final two minutes, in effect, undermined the intention and perception of the conference.”
Indeed.
Dr. Brock – what can you do about this?
On May 4-5 the Harvard Business School Health Alumni Association along with the Young Presidents Organization/World Presidents' Organization (YPO/WPO) sponsored a conference in Washington, DC, "Health Reform at the Intersection of Government and Markets.” After two days of robust debate and discussion over a wide range of issues, the event ended with a troubling episode.
So troubling, in fact, that one physician in attendance along with another independent businessman felt obligated to write to Randy Cohen, who pens “The Ethicist” column at the New York Times, with the following query:
“We were attending a conference on health reform which had included an impromptu presentation on the swine flu pandemic. As the conference was closing, a physician was introduced and he said that as a “treat” for all his fellow attendees he would write prescriptions for TAMIFLU and that if he ran out of scripts, he would send one to anyone who emailed him a request. A large line immediately formed of people eager to avoid the risk of shortages or rationing. When confronted with our question as to the ethics and legality of his offer, he explained that he was a physician and had worked with the CDC and was confident he was acting in a morally and professionally correct manner – was he? For that matter, were the conference organizers in ethically troubling territory?”
To which Cohen replied:
“As you know, it is a violation of medical ethics to prescribe to a non-patient, i.e. to someone you've not examined (albeit a violation committed by, one study suggests, 100% of physicians). It is also a more general ethical transgression for a healthy person to stockpile a medication that might end up in short supply. In a more just world, this guy would have his license suspended. But I wouldn't count on that happening.”
Over lunch the other day, my doctor friend shared the rest of the story:
“From every angle, this was reprehensible and should not have been permitted. From a medical professional code of conduct point of view, it is an abuse of prescriptive authority to offer Rx of any drug to people who are not patients of a prescribing physician. It is medically irresponsible to give access to drugs which are not without risk as any adverse event could not be accountable (or appropriately handled) to this particular physician prescribing Tamiflu.
This is an act that can be considered illegal in several states, ethically wrong, medically reckless and dangerous, and inexcusable, especially in the manner it was presented to the conference attendees. From a "conflict-of-interest" point of view, this physician was offering Rx as a "treat" (code word: perk/kickback) to conference attendees who had paid to come to the conference. So, while there is no direct exchange of money for the Rx which will benefit this physician, it could easily be interpreted that he was an agent of the conference (since the conference organizers condoned the offer by allowing him the podium to present his offer and did not rebuke or stop him from doing so) and therefore Rx access was exchanged for money. From a supply chain, he was encouraging stockpiling of Rx, which is to give people access to a Rx for storage in their medicine cabinets (which will likely not be used) and taking it out of the supply for the nation.
Given how much we were talking about economic forces of supply/demand affecting behavior, it is highly ironic that this was permitted. From a public health perspective, this physician took advantage of a perceived panic (pandemic only means "widespread" and does not indicate severity) and called his actions "giving access" to a "needed therapeutic" during a "pandemic." It seems interesting that if he truly felt that way, then why did he not go out onto the streets or to the inner city and offer his scripts to others (who wouldn't necessarily have access). Funny how he should only offer this to people who most easily can gain access to their physician should they want and need the Rx (members of HBS Health Alumni Association). This could also be interpreted as an odious way to win friends and influence people.
And finally, from a medical practice point of view, Tamiflu is not without risk. When challenged, this physician merely mentioned that he was asking everyone if they had kidney problems (a contraindication for prescribing the Rx), but he did not warn anyone that there have been quite a number of cases internationally of behavioral changes that are reported with the use of Tamiflu. Without discussing risk and only touting benefit could be defined as medical malpractice.
As organizers of this event, this behavior should not have been encouraged nor condoned. Silence is the wrong action because it is not recognizing that everything this did in the final two minutes, in effect, undermined the intention and perception of the conference.”
Indeed.
Dr. Brock – what can you do about this?
