Device representatives in hospitals: are commercial imperatives driving clinical decision-making?

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.

LanguageEnglish
Pages589-592
Number of pages4
JournalJournal of medical ethics
Volume44
Issue number9
Early online date4 Jul 2018
DOIs
Publication statusPublished - Sep 2018

Fingerprint

health professionals
decision making
Equipment and Supplies
industry
sales representative
dual role
survey research
meals
outsourcing
Industry
surgery
sales
qualitative research
expertise
Health
expert
responsibility
Outsourced Services
costs
Qualitative Research

Keywords

  • health care economics
  • informed consent
  • professional - professional relationship
  • surgery
  • technology/risk assessment

Cite this

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title = "Device representatives in hospitals: are commercial imperatives driving clinical decision-making?",
abstract = "Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.",
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Device representatives in hospitals : are commercial imperatives driving clinical decision-making? / Grundy, Quinn; Hutchison, Katrina; Johnson, Jane; Blakely, Brette; Clay-Williams, Robyn; Richards, Bernadette; Rogers, Wendy A.

In: Journal of medical ethics, Vol. 44, No. 9, 09.2018, p. 589-592.

Research output: Contribution to journalArticleResearchpeer-review

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