Neglect of focus on income and private practice in ethics textbooks

Learning about conflicts of interest should be one of the core aspects aspect of clinical ethics in undergraduate and postgraduate training. However, the focus may direct more to external factors such as ties with, or inducements from, pharmaceutical interests rather than inherent fallibilities and motives of practitioners. At first sight it would appear that there is very limited concentration on the impact of income or private versus public practice on clinical practice in ethics textbooks.

A list of clinical/medical ethics textbooks available on open shelves was established in the libraries of Trinity College Dublin, a deposit library alongside Oxford and Cambridge, each of which has rights to a copy of all publications originating in the British Isles. Two researchers independently established the presence and proportion of text relating to income or private practice in each textbook. In cases of disagreement, the senior author adjudicated. Descriptive statistics were used.

Of 123 ethics textbooks examined, 304 out of 38,410 pages (mean 2.5 (0.89%), standard deviation 1.73, median 0) were dedicated to the issue of income and private practice.

Leaders in clinical ethics should devote more emphasis to scrutiny and debate on the impact of income in addition to private and dual practice in education and research. There is significant opportunity to enhance such teaching by incorporating an informed approach to the wit and wisdom of the reflections on doctors and their income by Plautus, Molière and GB Shaw.