Medical devices: Primum non nocere or Pecunia primum?
That medical device companies have an equal, if not stronger, interest in making money than they do in helping the sick and injured— that pecunia primum (“first make money”) is more important than primum non nocere (“first do no harm”)—will come as no surprise to most readers of this journal. Those who defend device companies might look at this fact and explain, “no money, no mission”— ie, the primary goal of the companies is, in fact, to help people, but if they fail to make a profit, they will be unable to achieve that goal. Others might point out that it is not as if the officers of medical device companies sit in smoke-filled rooms plotting to maximise profits, while shouting “the patient be damned.” Rather it is a matter of “goal displacement” where proximate goals—efficient production, making deadlines, meeting sales targets—become more important than the larger goal of helping those who may benefit from a medical device. No one person is responsible for the harm done to thousands by medical devices. The guilt is diffuse and shared by many, none of whom fully understands their contribution to the problem. Engineers design, managers manage, marketers market, lawyers defend, each simply doing what they are paid to do; none seeing their work as part of a conspiracy of harm.
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