Introduction
Expert opinion is one of the evidence that is used in court to assert the facts alleged by the prosecutor. An expert opinion is when a specialist in a particular field analyses the evidence and facts provided and gives a well-explained conclusion on it ( Grundy et al. (2018). This paper seeks to question several issues that have been discussed in the expert opinion given by Sunita Sah in the case of United States v Scios incorporation and Johnson &Johnson on the effect that gifts and other incentives play on health care professionals. The paper will further address the issues she has not fully considered in the report submitted and what she ought to have included and left it out.
Conflict of interest
The first issue, Sunita Sah, addresses is the issue of Conflict of interest that arose between healthcare providers and their patients. A conflict of interest arises when an individual especially a professional allows his personal interests to come between them and the recipient of their services. In this case we see that the health care providers were given incentives as well as gifts in order to participate in the distribution and marketing of the drug Natrecor that the defendants which is a pharmaceutical company produced and wanted its consumption rate to increase ( Pavlovic et al. (2017). In her paper, she looks at three concepts concerning Conflict of interest: Firstly, the reason why professionals have a material interest, secondly the extent to which Conflict of interest impacts bias advice and the factors that play a significant role in the increase and decrease of Conflict of interest. Lastly, she looks at the impact of Conflict of interest on advice given to patients.
On the first issue of why physicians have a clash between their professional responsibility and their interests, she addresses it from the view that the incentives and gifts given by the defendants were quite generous, and their economic status did not allow them to decline the offer given. On this issue, I will give a contrary opinion that health care providers are professionals who have a code of conduct that they ought to uphold at all times. The needs of the patients, who are the recipients of their services, are their priority at all times. If a conflict of interest arises, the medical professional, especially the physicians, are prone to give a biased opinion ( Latten et al. (2018). Therefore, there is no substantial reason as to why the health care professionals would accept gifts and incentives that cause them to intentionally give biased advice, although the expert states that physicians receive gifts as they deem themselves deserving of the gifts as it gives them a sense of belonging.
Secondly, the gifts given by the p-pharmaceutical companies included the attendance of the events such as continuing medical programs, paid trips to medical symposia, honoraria, and paid for research studies play an essential role in the life of the medical practitioner. This has been viewed as a way in which they increase their knowledge in the medical field as she puts it in her expert opinion ( Ott & Olsen, 2019). She further states that that is an opportunity to network and promote the drug that the Scios Company was promoting. I do not concur with what she analyzed; the question that arises is whether the health care professionals would have received all the gifts and yet gives the patients an unbiased opinion? The answer is yes, and the physicians would have given the right advice to the patients and still markets the drugs in the events that they attended.
The second issue that is addressed in the expert opinion on Conflict of interest is the impact of gifts on impartial advice to outpatients and the factors that play a vital role in the increase and decrease of biasness. One of the comments given by the expert is that most physicians are unaware of their biasness at their workplace or when giving advice; unconscionable biasness ( Song, 2018). It is prudent to note that upon a professional’s acceptance of a gift that affects his daily duties, he or she is prone to make a poor judgment that is not relied on the gift given. Most physicians believe that their judgment will not be affected, but gifts and incentives give one a sense of owing, and it is for this reason that there is involuntary giving of advice.
The expert opinion is quite defensive on the part of physicians. It is quite important to observe that once a health care provider is given a gift by a pharmaceutical company and requested to perform a specific action, he or she would not decline because the gift they received has clouded their judgment. Therefore it impacts their ability of the physician to give a clear judgment willingly and unwillingly ( Victot et al. (2018). I would differ with the opinion that the expert projects that the physician will not be affected are quite shaky as they are subject to subtle manipulation by the companies making them prone to unbiased opinions.
There are certain factors that Sah addresses that increase the acceptability of gifts, which later increases the chances of a conflict of interest to arise. One of the factors that make health care providers accept gifts is their working conditions ( Pavlovic et al. (2017). Most medical practitioners deem it essential for them to accept a token of appreciation for the work done, for example, when they market drugs during a talk, and they receive authorship even though they did not provide any research or contribution towards the talk. Secondly, medical training is another factor that increases the acceptability of physicians to receive gifts, and lastly, the pay is entirely on the lower in comparison to the work done.
A dissenting opinion can be given on the factors raised by the expert on what escalates the chances of a health care service provider in taking and receiving of gifts. The factors provided are the shortcomings that come with the job. The physicians should perform the work they were trained for, and if the pay is on the minimum, there are various ways of increasing the pay than jeopardizing their integrity and transparency at their workplace ( Grundy et al.(2018). Therefore the factors provided cannot be substantiated as every medical practitioner will have a reason to receive gifts that will impact their objectivity as health care providers.
Another concurring opinion on the factors that the expert raises is that health care professionals are unaware of their biasness but can observe in their colleagues. It is noted that there are various training that has been carried out by medical organizations, both public and private, to train medical practitioners on the importance of integrity and transparency at their workplace and to patients ( Lattenet al. (2018). The relationship that exists between a health care provider and a patient is mainly based on trust and confidentiality; therefore, a health care provider should disclose factual and accurate and unbiased information to the patient.
The last concept that Sah evaluates in her expert opinion is the impact of the biased advice on the patient. Firstly, the biased opinion is a breach of the duty owed to the patient by the health care provider when he or she intentionally does not disclose the right information to the patient ( Song, 2018). The patient depends or instead acts upon the information given, and if the information is wrong, there are higher chances of them experiencing adverse medical conditions and even psychological torture. Secondly, there is broken mistrust between the patient and the health care provider, which can amount to legal proceedings against the individual and the medical institution even when the Conflict arose from gifts received from the pharmaceutical company, Scious Company.
Conflict of interest arises in any profession; it is upon the professional to exercise discretion and discernment and act by the professionalism laws and statutory provisions ( Ott & Olsen, 2018). Therefore, as the expert states that the issue of Conflict of interest affects the patients in some ways, they should bear the legal burden with the intentional breach of contract between them. The expert also raises a point in the issue that the damage caused is not as adverse as the physicians are the only ones who are in breach of their duty and not all medical professionals.
The allegations, in this case, involving a pharmaceutical company, Scious Incorporation and Johnson & Johnson, had used the off- label marketing and promotion. The off – label marketing included the provision of gifts and incentives to health providers; physicians. The gifts were quite lucrative and generous to the physicians that they could not resist the offer given, which would ultimately affect their discernment in their work( Song, 2018). The health care providers used the drug, Natrecor for outpatient, serial, and scheduled infusion, as instructed by the pharmaceutical company. The allegations brought forward are that the defendants intentionally provided incentives to health care providers knowing that the gifts
Sunita Sah’s ideas reflect that the health care providers would not have used the drugs, were it not for the pharmaceutical company providing financial and financial incentives to them. She has extensively discussed how Conflict of interest arises, its impact, and the various types of Conflict of interest (Victor et al. (2018). In her expert opinion, she states that when a conflict of interest arises, the physicians are vulnerable to give biased advice to the patients intentionally or unintentionally. She also explains that physicians only accept the gifts and incentives because of their working conditions, their minimal pay, and medical training, while others feel that they deserve the gifts as gratitude for the work they do. In her opinion, she concludes that gifts and incentives affect a physician’s ability to give an impartial opinion.
It is critical to note that her expert opinion has mainly been premised on Conflict of interest as the only impact that arises from giving gifts and other financial and non-financial rewards. There are other issues that arise from health care providers accepting gifts not only conflict interest and biased opinion ( Grundy et al.(2018). It is also crucial to note that there are no study cases in the expert opinion that can be used as a comparative analysis to help the court to make an analysis of the different circumstances and make a conclusive decision from them. The importance of comparative analysis is it denotes the extension of the expert’s opinion and research that she has carried out in order to come up with her conclusion. The conclusion has substantively been founded on her work and research, which is not sufficient for the court to make the right decision.
The information provided by the expert lacks an objective perspective of the health care provider to accept the gifts as well as professional code of physicians. The expert opinion has utilized substitutive literature that can persuade the court, but the scope of the books has been majorly limited to the scope of Conflict of interest its reasons and the various types but not the impact. It has mainly addressed why health care providers receive gifts and incentives given by pharmaceutical companies and not decline ( Pavlovic et al. (2017). Her opinion mainly seeks to justify the actions of health care providers and to prove that pharmaceutical companies take advantage of the vulnerable situations of health care providers, and for that reason, they prey them.
In her expertise, she does not consider the autonomy of health care providers and their ability to discern and make decisions fully aware of the consequences of their actions. She generally looks at them as vulnerable people of the society who can quickly be taken advantage of ( Ott & Olsen. (2019). She tends to ignore the fact that some of the health care providers are willing to provide their services, and for that reason, they are given the gifts and incentives. She has also not considered whether the off label market strategy carried out by Scious is legal to give gifts to health care providers and to request them to market their products and, in this case, Narcetor drug.
In her expert opinion, various aspects were expected to be seen, and some concepts were present while others were absent. One of the aspects lacking in the expert opinion is objectivity from a professional perspective and a well-researched study of why health care providers on why they should not be liable for their actions. Another expectation in her work was other impacts that arose from the impact of Scious Company giving gifts to health care providers ( Latten et al. (2018). The issue of Conflict of interest has been explained and exhausted but is not the only impact of gifts by a pharmaceutical company. A practical case was expected to be incorporated to give a substantive opinion to the court of what happened in that case study and its impact on the expert’s opinion.
The expert opinion given by Sunita Sah has sufficiently addressed the concept of Conflict of interest among health care providers. The paper has also addressed counter-arguments on opinions provided by the expert and what the paper lacks. This paper has also highlighted the factors she would have considered but has not considered as well as a summary of the allegations and ideas on the impact of gifts to health care providers from pharmaceutical companies such as Scious incorporation and Johnson & Johnson Company.
References
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Keller, F., Marczewski, K. and Pavlovic, D., 2017. Physicians and Pharmaceutical Industry: Need for Transparency by Conflict of Interest Declaration and Independent Ethical Oversight. Bioethics-medical, ethical and legal
Latten, T., Westra, D., Angeli, F., Paulus, A., Struss, M. and Ruwaard, D., 2018. Pharmaceutical companies and healthcare providers: Going beyond the gift–An explorative review. PloS one, 13(2).
Ott, M.J. and Olsen, G.H., 2019. Impact of quality assessment on clinical practice, Intermountain healthcare. In Quality Spine Care (pp. 301-313). Springer, Cham
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Victor, A., George, C.E., Inbaraj, L.R. and Norman, G., 2018. Benefit or harm? A study on impact of collusion on the quality of life among palliative care patients. Indian journal of palliative care, 24(1), p.61.