for "Preventing Ethical Disasters in the Practice of Medicine" We define "ethical disasters in medicine" as cases of serious professional wrongdoing by physicians that attract significant publicity. Ethical disasters harm trust in medicine, waste scarce health care dollars, and reduce timely access to physicians, which can exacerbate health disparities. Three of the more common forms of serious wrongdoing are abuse of prescription privileges (APPs), fraudulent unnecessary procedures (FUPs), and sexual abuse of patients (SAPs). The proposed project has three specific aims:
AIM 1 : Determine which factors best describe instances of APP, FUP, and SAP. Our data sources will be synopses of 225 cases-75 each of APP, FUP, and SAP-from 1992 or later. We will categorize the kinds of wrongdoing represented in the case using a taxonomy of 14 kinds of wrongdoing in medical practice and will describe how kinds of wrongdoing cluster together. (Although APP, FUP, and SAP are our primary focus, our preliminary data indicate most published cases involve 3 or more kinds of wrongdoing.) We will extract data on the wrongdoer, a series of environmental predictor variables, and how the case concluded. Environmental factors include financial conflicts of interest, oversight failures, and vulnerable patient populations, including older adults.
AIM 2 : Determine which factors statistically predict APP, FUP, and SAP. Using multivariate logistic regression with 75 cases each of APP, FUP, and SAP, we will identify the variables that predict each kind of wrongdoing. Using our theoretical causal model of motive, means, and opportunity (MMO), we will conceptually analyze the relative role of individual and environmental factors in providing the motive, means and opportunity for serious wrongdoing.
AIM 3 : Determine which promising practices for research policy, oversight, and education are indicated by the study's data.
This aim fosters the dissemination of results and their translation into improved medical practice by engaging experts and stakeholders. We will recruit two panels of experts to participate in webinar meetings, during which we will present study findings using slides to facilitate teleconference discussion of the implications of the data for policy, oversigh and education. Meetings will be conducted using a consensus-building approach. Recommendations from these panels will be incorporated into papers published from this study.

Public Health Relevance

Preventing Ethical Disasters in the Practice of Medicine Ethical disasters-or highly publicized instances of wrongdoing in medicine-harm trust in medicine, waste scarce health care dollars, and reduce timely access to physicians, which can exacerbate health disparities. We will research and analyze 225 cases of serious wrongdoing in medicine involving abuse of prescription privileges (APPs), fraudulent unnecessary procedures (FUPs), or sexual abuse of patients (SAPs). We will identify the individual and environmental factors that predict each of these three forms of wrongdoing, and will seek a consensus among experts on how our findings might inform medical education, policies, and oversight practices to reduce the rates and the duration of serious wrongdoing.

National Institute of Health (NIH)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Bhattacharyya, Partha
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Washington University
Internal Medicine/Medicine
Schools of Medicine
Saint Louis
United States
Zip Code