The ethical controversies of office-based dispensing in academic health centers

Office dispensing of cosmecuticals has become a widespread practice in private dermatology offices and even has begun to appear in academic dermatology settings. Proponents of the practice state that in-office dispensing is beneficial for the patient and the physician and can be ethically accomplished with the patient remaining the primary concern of the care provider. This requires the maintenance of professionalism and the sale of efficacious, reasonably priced products that are not misrepresented. Opponents believe that in-office dispensing undermines the physician- patient relationship and may produce an inherent conflict of interest. In academia, additional concerns include how students and residents perceive this activity. Does selling products negatively affect professionalism in an academic environment? In an academic teaching environment there is a paramount need to model ethical behavior to medical students and residents. We will discuss the opposition and rationalization for the practice of in-office dispensing in academic teaching settings.