Transcript Dynamic Mutualism and other tools to aid Ethical Decision Making

Dynamic Mutualism and other tools to
aid Ethical Decision Making for the
Urogynaecologist
Bernie Brenner
Consultant Urogynaecologist— Pelvic Floor Clinic, Auckland,
New Zealand
Email: [email protected]
The literature
• Although prolific in regard to the physician
and the pharmaceutical industry [1,2,3] it
is rather sparse in the specific area of
urogynaecology.
• Jerry G. Blaivas [4] and Don Ostergard [5]
have contributed significantly in editorials
or journal articles relating to Ethics and
Incontinence.
The Problem
Potential conflict of interest - stakes are much higher these
days
Gifts to the profession
Industry supported research and journal advertising
High cost of Medical Devises deprive developing world of
advances in urogynaecology
Solution 1
The ethical theories provide
infrastructure that aids in ethical
decision making
Solution 2
Dynamic Mutualism— View the
relationship between physicians and
the pharmaceutical industry
analogous to a biological system
where mutualism is an interaction
between two or more species where
both species derive benefit.
Dynamic Mutualism
Two Cleaner Wrasses
(Labroides dimidiatus)
remove parasites from a
Batfish (Platax teira).
This is a mutualistic
relationship - the wrasses
benefit by gaining a steady
and reliable source of food,
while their customers benefit
by having harmful parasites
removed
Solution 3
Integrity— The integrity of
the physician, an
Aristotelian Virtue and
part of Hippocratic Oath
must remain the guardian
of the relationship
between the physician
and the industry
Solution 4
The Disclosure Principle - Would
you feel comfortable if your
relationship with the industry was
published in tomorrow
newspaper? Are you happy for
your patients, colleagues, family
and friends to know about the
“rewards” you receive from the
pharmaceutical and instrument
supply industry. Meaningful
disclosure is necessary.
Solution 5
The Prisoner’s Dilemma (Game Theory)
'cooperate' or 'defect' as one way to
understand how cooperation might persist.
In a one-time encounter, the safest
strategy to use for each side would be to
defect.
However, cooperation might persist when the
interacting organisms remember and react
to previous behaviour of their partner in
strategies such as 'Tit for Tat', where
defecting or cooperating follows the
behaviour of the partner in the last round.
If the partner defected, I should defect and
vice versa. This strategy could lead, in
some systems to stable cooperation
References
1. Kassirer JP, On the Take: How Medicine’s Complicity With Big
Business Can Endanger Your Health. 2004: Oxford, UK, Oxford
University Press.
2. Moynihan R, Who pays for the pizza? Redefining the relationships
between doctors and drug companies, I: entanglement. BMJ, 2003.
1189-1192.
3. Wager E, How to dance with porcupines: rules and guidelines on
doctors' relations with drug companies. BMJ, 2003. 326:1196-1198.
4. Blaivas JG, Peer Review. Neurourology and Urodynamics, 2004.
23:617.
5. Ostergard DR, The Epochs and Ethics of Incontinence Surgery: Is The
Direction Forward or Backwards? Int Urogynecol J, 2002. 13:1–3.