Ethics Abandoned: What do shameful practices among some military medical personnel have to do with innovation?

This week saw the release of a long-awaited report on doctors in the US military, and it concluded that some had been complicit in the torture of detained suspects.  This report makes interesting and at times depressing reading, but it should be noted that these are a tiny tiny minority of healthcare professionals, and this is certainly not an indictment of modern medicine as a whole.  You can read more here, with a link to the report itself at the bottom of the post: http://www.theguardian.com/world/2013/nov/04/cia-doctors-torture-suspected-terrorists-9-11

While this failure to adhere to ethical codes and professional standards was probably a greater problem in the USA, the UK profession has not been immune (the best example being Derek Keilloh, struck off for his complicity in seeking to cover up the fatal injuries of Baha Mousa received while detained by the British Army).  There is much written on these emotive subjects, and those who are interested can find plenty to digest and debate elsewhere.  This did, however, make me think more broadly.  The interesting questions here then are do professional standards and ethical codes for doctors and dentists matter in the world of health technology innovation, and if they can be eroded in a military setting could they also be undermined when working with businesses or even universities? 

In my dealings with healthcare professionals, I am always impressed by the strong emphasis of what is in the best interests of the patient above all other considerations.  This strong moral foundation is not new, it can be traced back to (among others) Hippocrates and the oath that is still taken by many physicians today (including in the UK and USA).  Clinicians and their professional bodies take a dim view of colleagues who fall short of these high standards, and thankfully the available evidence shows that very few doctors do transgress.  That said, this tiny minority includes a number of clinicians who were perhaps overly influenced by commercial factors, or who at least paid insufficient attention to the of the medical devices they were using.  One example was the use of poor quality PIP breast implants by countless surgeons, where the major determinant of implant selection appeared to have been (low) price.  This may not be a fair example, it is unlikely that the surgeons themselves were involved in procurement, but I have argued in a previous article (The PIP breast implant scandal: lessons for dental implantology Faculty Dental Journal volume 3 pages 68 to 72) that perhaps surgeons should concern themselves more with the quality of medical devices being purchased by their hospitals, and if purchasing decisions are made solely on the basis of the lowest price then quality will fall and ultimately patients will suffer (if you disagree, just think about the contents of Tesco's value lasagne).  Of course this is not wilful disregard for professional standards or even dishonesty, and where new health technology innovations go wrong it is very unlikely that deliberate clinical malpractice is to blame.  What the behaviour of a few US military doctors, Derek Keilloh, and some surgeons associated with the PIP scandal, tells us is that working environment and prevailing culture can have a subtle but sometimes very negative impact on personal and professional ethics.  Society would be wise to consider this risk when we place medical professionals in places where their training may not have prepared them fully for the new environment.

If this subject attracts some interest and comments, then I would be happy to follow up with some more detailed analysis of medical device disasters, ancient and modern, and we can look at the roles of the professional and the industry.  For now though, I remain very confident that the vast majority of clinicians engaged in the development and evaluation of new healthcare technologies do so because that are motivated by the highest values of the caring professions, and therefore what is in the best interest of the patient.

Link to the IMAP report: http://www.imapny.org/medicine_as_a_profession/interrogationtorture-and-dual-loyalty