Profit And Duty

By investigating the group of pharmaceutical sales representatives in eastern China through participant observation and deep interview, this dissertation examine and delineate their authentic life in order to analyze how they could impact doctor’s determination of prescription and try to give a more plausible interpretation to the image of "doctor-pharma collusion"The characteristics of medical-care service have made patients’ right of self-determination disenable and created the actual principal-agent relationship between doctors (hospitals) and patients. Such determination and selection right of patients would become even puny while that of doctors become even more powerful as the seriousness and complexity of disease deepen. Thus it become available for doctors (hospitals) and pharmaceutical industries to collude, given the separation of service user from service consumption decision maker in the medical-care consumption. From the other hand, medical ethics and commonweal requires doctors (hospitals) to be completely divorced from self-interest. As a result, collusion has greatly destroyed authority of medicine field and patients’ trust of doctors. Nowadays when the purpose of medical institutes has converted from help into selling, they can only balance between duty and profit under the tension between medicine as a profession and profit as business.Pharmaceutical industries would usually inveigle doctors (hospitals) to pursuit prescriptions by means of medical information promotion, providing resources such clinical activities involvement and using pharmaceutical representatives to develop their personal relationships, whereas "informational promotion" has been widely considered as a more professional and legitimate way compared to the way called "involved in clinical activities". The former denials the profession of the later to establish its own legitimacy. Actually, given the concern of medicine field on maintaining its own interests and authority, even the purest informational promotion could not conceal their spreading purpose. Those resources offered by pharmaceutical industries to doctors (hospital) would be usually mixed by more of economic and academic content, resulting pharmaceutical industries’ vibrance between "informational promotion" and "involved in clinic activities". Therefore, the doctor (hospital)-pharma collusion should not be viewed as personal behavior of corruption, or the case maintained by interests, but a mutualistic relationship established under contemporary medical market and medicine environment.