According to a story in The Australian, the drug company Merck has been accused of paying nurses to sift through patient medical records in search of potential candidates for the drug Vioxx. Here’s what nurse ethicist Douglas Olsen, who recently wrote a two-part article (here’s part one; part two is here) for AJN on nurses and the pharmaceutical industry, wrote to us about the story:
The news report demonstrates the public’s visceral sense that the Merck program in Australia was unethical. Nurses, as well as doctors and pharmacists, can anticipate righteous indignation whenever their clinical deliberations appear compromised by a company’s desire to sell a particular drug.
The claim is that nurses, hired by a third party, identified potential users of Vioxx from patient records with physicians’ permission and then initiated contact with the intention to offer Vioxx as an alternative to their present medication.
With its underlying goal of boosting sales of a particular medication, the program created an apparent conflict of interest.
Patients need to trust that nurses are acting in their best interests when giving information in service of a health care decision. Nurses have an obligation to be worthy of this trust. The clinical encounter fails to serve patients if they lack the ability to talk freely about their condition because they lack confidence that the nurse is there to solely serve them.
Because most nurses do practice ethically, making care the primary goal, patients largely do have this trust. In this situation, patient trust was exploited. Not only were the patients harmed by having health care decisions compromised by discussing options with nurses who had an apparent conflict of interest, the nursing profession was damaged by exploiting the trust patients feel when hearing, “I’m a nurse, let’s talk about improving your care.”
A particular product should be discussed when it’s the best alternative for the patient and not because it produces profits for a company. Profit motives should not interfere with the clinical relationship.
The question is whether the nurse knew that the program paying their salaries was not about helping patients but increasing drug sales. The most charitable assessment would suggest that the nurses did not know or that the program coordinators truly assumed that Vioxx was the most beneficial drug for patients. Still, the profit-driven nature of the drug company’s mission taints even a charitable assessment of its motives.
The good will nursing has established with the public through years of earnest work was exploited to sell more Vioxx. We don’t know if the nurses were aware of this, but we do know the company deliberately exploited and damaged the good reputation of nursing.
–Douglas P. Olsen is an AJN contributing editor who co-coordinates the journal’s Ethical Issues department. He is a nurse ethicist with the National Center for Ethics in Health Care at the Veterans Health Administration in Washington, DC. The views he expresses here are his alone and should not be construed as representing those of the National Center for Ethics in Health Care or the Veterans Health Administration.