The organized American medical profession's response to financial conflicts of interest: 1890-1992

Recent issues of financial conflicts of interest for physicians are illuminated by the history of similar issues from 1890 to 1992 and the response of the organized medical profession to activities like payment of commissions, or "fee splitting," physical ownership of medical facilities, and dispensing of drugs. The medical profession tried to confront these and related conflicts early in the century, in some cases by adopting ethical codes, but was unable to enforce standards of conduct. Since the 1950s, substitutes for fee splitting emerged and were tolerated by the profession. Moreover, its stance became weaker as it abandoned its earlier clear ethical prohibitions and relied instead on subjective standards and, more recently, on disclosure to patients. The medical profession still favors voluntary codes of ethics, setting aspirational goals, promoting a patient-centered ethos, and relying on the good will of individual doctors--tactics for dealing with financial conflicts of interest that this review of recent history suggests are inadequate. Instead, public intervention is required to address these problems.