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Summary. The dominant business model of the pharmaceutical sector is based on the massive promotion of drugs that often do not represent any significant therapeutic advance. Clinical research is therefore run like a promotional campaign. The data obtained from clinical research are primarily used to boost and support sales rather than to improve prescribing behaviour. Three common and widely used corporate strategies are used to this end: ghostwriters are employed to inflate the number of publications showing the drug in a positive light; results that would harm sales are not published (publication bias); and negative data are suppressed, sometimes going as far as to intimidate troublesome independent academics and whistle-blowers. The objective of these strategies is to enable the new drug to gain market share from its competitors. If medicine is to progress, research must be more independent and freed from the commercial imperatives of the pharmaceutical industry.

Summary. This article begins with a simple empirical claim – that professionals (doctors, lawyers, and psychologists, among others) may either facilitate or prevent human rights violations. They possess this power by virtue of their expertise, access and social status. Building on this claim, I argue that states are dependent upon the assistance of professionals in order to comply with their international human rights obligations. Compliance with these obligations is an essential condition of the legitimacy of states; non-compliance is a matter of global concern and, if systemic, renders the state liable to interference from external agents in the international community. It follows that states are, in this fundamental respect, dependent upon professionals. But professionals are also dependent upon states; their ability to perform their professional functions in full is contingent upon privileges and protections accorded to them by the state. Given this mutual dependence, I advance a contractarian account of the relationship between professionals and the state – one that gives rise to a duty on the part of professionals to assist the state with the performance of its human rights obligations. The content of that duty varies across professions and among professionals, since it depends upon the nature of the professional’s expertise, and the degree of access and social status she possesses. This account offers both theoretical and practical benefits. First, it avoids human rights foundationalism because it ties the ethical obligations of professionals to international legal norms, rather than to human rights conceived as ethical claims. Second, the account offers a further approach for bridging the gap that scholars and advocates have identified between human rights commitments and compliance. The incorporation of human rights norms into domestic law, political institutions and corporate governance may all contribute to this. But the essential role professionals can play in the acculturation of and compliance with human rights has been neglected. The account advanced here has a number of important practical implications – not least, the need for more (and better) human rights education and mentorship for professionals.

Summary. This paper explores the empirical evidence regarding the impact financial relationships on the behavior of health care providers, specifically, physicians. We identify and synthesize peer-reviewed data addressing whether financial incentives are causally related to patient outcomes and health care costs. We cover three main areas where financial conflicts of interest arise and may have an observable relationship to health care practices: (1) physicians' roles as self-referrers, (2) insurance reimbursement schemes that create incentives for certain clinical choices over others, and (3) financial relationships between physicians and the drug and device industries. We found a well-developed scientific literature consisting of dozens of empirical studies, some that allow stronger causal inferences than others, but which altogether show that such financial conflicts of interests can, and sometimes do, impact physicians' clinical decisions. Further research is warranted to document the causal relationship of such changes on health outcomes and the cost of care, but the current base of evidence is sufficiently robust to motivate policy reform.

Summary. This essay explores the ethical issues raised by the promotion of foods for their purported health benefits, and compares the U.S. and E.U. regulatory frameworks governing such claims.

Summary. The modern capitalist society, characterized by decentralized decision making and increasingly sophisticated products and services, turns on relationships of epistemic reliance, where laypersons depend upon advisors to guide their most important decisions. Yet many of those advisors lack real expertise and may be biased by conflicting interests. In such situations, laypersons are likely to make suboptimal decisions that sometimes aggregate into systematic failures, from soaring health care costs to market crashes. Regulators can attempt to manage the symptoms and worst abuses, but the fundamental problem of biased advice will remain. There are many potential policy solutions, from outright bans on conflicting interests to disclosure mandates, yet their comparative effectiveness is poorly understood. By constructing a decision task for human subjects and providing advice in various scenarios, this Article reports new experiments testing alternative policy mechanisms. Prior research has shown that disclosure mandates can be deleterious if they make advisors more biased, but this paper contextualizes those findings. It turns out that disclosures may be valuable in settings where relative expertise is low, but deleterious where relative expertise is high. By also disaggregating the data, one finds that disclosures of conflicting interests may hurt laypersons in the majority of situations where the conflicted advice is not actually biased. Thus, the evidence suggests that, if they are to be at all effective, disclosure mandates should be narrowly tailored. Most importantly, the evidence shows that a disclosure mandate improves layperson performance when unbiased advisors are also available. Yet laypersons appear to be poor judges of their need for unbiased advice, so market mechanisms may be ineffective for provisioning unbiased advice. In the end, the presence of an unbiased advisor is the strongest determinant of layperson performance, and thus policymakers must develop ways of aligning the interests of advisors and laypersons. Pay-for-performance, blinding of experts, and mandatory or subsidized second-opinion policies are likely to be helpful in aligning these interests.

Summary. This piece argues that, while considerable attention has been paid to financial conflicts of interest involving the pharmaceutical industry, conflicts involving the food and soda industries have been neglected. Such conflicts call for urgent attention from both scholars and policymakers.