A Libertarian Approach to Medical Conflicts of Interest

I begin with a confession: I am an “on-the-fence-libertarian,” the kind that thinks people should be allowed to do (basically) what they want, that free markets work, and that regulation is usually bad, but also the kind that has never quite embraced libertarianism completely. Consequently, the readings leave me flummoxed, with my intuitions screaming for regulation of doctor-pharmaceutical company relationships, even though I generally despise any kind of centralized regulation.

However, as someone of Mill’s persuasion, to know if these intuitions are justified, a question I ask is this: Do these putative conflicts of interest violate the “Harm Principle”?

My knee-jerk answer is “yes,” but it is really not so clear-cut: Imagine Pfizer develops a drug which extends the lifespan of AIDS patients by 50%. To “get the word out,” doctors are treated to a lavish, paid symposium where findings on the drug are shared. Doctors then prescribe this very drug (over others) to AIDS patients, and their lifespans are extended. Has there been a conflict of interest? Probably. Any harm? No. Each party in this story benefits: Pfizer makes money, doctors get knowledge, and patients live longer. Everyone wins, and the consistent libertarian cannot justify government action against any of the described transactions (since none violate the harm principle).

Of course, the above case may not be representative of all “conflicts of interest” cases. Still, we should ask exactly who or what is wronged by the conflicts of interest we read about. In many cases, I daresay the answer may only be our idealized image of what medical practice should be.

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