We seem to prefer that medicine and medical care be provided through altruistic motives. Even the pharmaceutical industry justifies its behavior in terms of altruistic purposes. But economists have known since Adam Smith that self-interested behavior can create large and growing social benefits. This is true for medical care as well as for other goods. First, I consider specifically the case of pharmaceutical promotion, both to physicians and to consumers. I argue that such promotion is highly beneficial to patients and (...) leads to health improvements. I consider some criticisms of promotion, and show that they are misguided. I then provide some evolutionary explanations for our erroneous beliefs about medical care. (shrink)

It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.Adam Smith, Wealth of NationsAs the quote above indicates, economists generally are more comfortable with self interest as a motivating force for social benefit than with altruism. This is because in most instances in a market economy, self interest will lead agents to provide benefits for others. Ultimately this is because the butcher or baker (...) will not get paid unless he does something that others are willing to pay for. This is the source of the famous “invisible hand,” also discussed by Adam Smith.This might sound trivial, except that in discussing aspects of medicine we seem to lose sight of this mechanism and rely on other tools to provide benefits. These tools do not work as well as naked self interest would. Some might say that medicine and medical progress is too important to depend on the market. (shrink)

The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do so is a (...) prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment. (shrink)

(2010). Response to Open Peer Commentaries on “The Pitfalls of Deducing Ethics from Economics: Why the Association of American Medical Colleges is Wrong About Pharmaceutical Detailing”. The American Journal of Bioethics: Vol. 10, No. 1, pp. W1-W3.