by Craig Klugman, Ph.D.
In this week’s episode (Season 1, Episode 7 -12/8), an FDA reviewer trades a case so that she can review a compassionate use request for a new drug at the hospital where her husband is the chief of staff. Her spouse was even was a participant in the proposal presentation to her for approval. Meanwhile, the owner of the hospital asks his chief of staff to be his doctor for his neurodegenerative disease—serving as the physician for his boss, in an area that is outside his specialty. Both of these are examples of conflict of interest. A conflict of interest exists when a person owes fealty to more than one party and where loyalty to a second party may influence one’s choices to the first. Such conflicts are supposed to be avoided and if unavoidable, declared. But declaration is not sufficient, as steps must be taken to ensure that the dual interest does not affect real decisions. Of course we now live in an era where a president-elect has conflicts between his business dealings and running the country and even being executive producer of a television show. So perhaps my idea that conflicts of interest are problematic is simply outdated.
Similar to conflict of interest is unprofessional behavior. In this episode, the hospital owner asks one of the doctors at the hospital, his employee, on a date. She politely declines and he later throws a fit. Although this scenario is a common trope of medical shows and sadly, happens often in real life, there is not a situation in which it is acceptable for a boss to date (or even ask out) his or her employee. The employee could make a claim of sexual harassment or toxic workplace. Ethically, such a situation has a high potential of harm for both the employer and the employee. Such a situation ought to be avoided.
The show seems to be justifying itself by suggesting that boutique, high cost medicine is assisting social justice by association. In this episode, a civil rights attorney is pursuing a case to find justice for a transgender woman. The attorney says she can only continue her good work if the hospital can save her life from her terminal seizure disorder. I suppose this is the heart of my problem with this show: a) it treats all patients as guinea pigs, b) it believes that there is never a time to stop or to accept that a person may die, c) it holds that there is not limit to what should be done to save a single life (even if that cost runs in the millions of dollars or requires sacrificing resources on a very long shot that only works theoretically but never in practice). While most medical shows demonstrate strong commitment to the single patient, they often do so in light of a social mission—whether a county hospital, or one with a clinic, or a medical unit—but in Pure Genius there is not even a pretension of social justice.