Conflict of interest: Pulmonary medicine as a business

Financial and nonfinancial conflicts of interest have always existed in medicine. New and more problematic conflicts of interest have been created between patients, physicians, and corporations by the integration of business methods into clinical practice. These conflicts threaten to erode the therapeutic relationship between patients and physicians, as well as the professional identity and responsibilities of physicians. Mechanisms to resolve these conflicts include strengthening and enforcing professional guidelines on behavior and ethics, reevaluating the penalty and reward systems used by many prospective payment corporations, and avoiding or divesting those financial arrangements that have been shown to place patient interests second to financial profit. We also suggest that the same professional standards used to define ideal physician behavior be applied to all persons or corporations that participate in the health care delivery system.