What drives your ethical behavior in the workplace?
By Maggie McMullen and Erik Burns, MA, MBA, EdD
“Protected Values” are “where you are willing to pay the price to uphold the value...to withstand the temptation to give-in,” says economist Alexander Wagner in his November 2016 TedTalk What Really Motivates People to be Honest in the Workplace. These are the values that will drive your ethical behavior.1 But, protected values are different for every individual.
Roots of the Opioid Epidemic
A contemporary example within our own industry is the opiate epidemic facing this country—probably the biggest public health crisis in U.S. history.
Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic,
provides an eloquent, yet chilling synopsis chronicling the rise of the opioid epidemic and the ramifications of compromising one’s values and ethics.
It’s a story of a massive shift in the pain management movement: opportunistic heroin growers from the villages of Xalisco, Mexico, delivering black tar heroin like pizza; greedy physicians; the explosion of pill mills; and criminal misbranding of a highly addictive narcotic as a simple solution to chronic pain.
It all started with a 1980 letter by Hershel Jick, M.D., and Jane Porter to the New England Journal of Medicine
In this letter, Jick and Porter suggested Addiction Rare in Patients Treated with Narcotics
. Somehow, this one paragraph letter was cited by industry colleagues as a “clear study” which was later called “an extensive study” and eventually “a landmark study.”3
This single paragraph laid the foundation for a medical movement in pain management. In an interview, Nathaniel Katz, a pain specialist in Boston, told Quinones, "The paragraph gives you relief from your inner conflict. It's like drinking from the breast. All of a sudden the comfort washes over you."4
This lone paragraph provided the erroneous data suggesting narcotics were not addictive, and it fueled the marketing and selling practices of Oxycontin, which flooded the U.S. market.
Prescriptions for chronic pain rose from 670,000 in 1997 to 6.2 million in 2002.5
With this rise in prescriptions came a just as alarming rise in heroin abuse. According to a government survey of heroin users (373,000 in 2007 to 620,000 in 2011), 80 percent had used prescription pain killers first.5
According to a 2014 report from the Centers for Disease Control, “Since 2000, the rate of deaths from drug overdoses has increased 137 percent, including a 200 percent increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).”6
On December 31, 2017, Eric Anderson, M.D. (former president of the New Hampshire Academy of Family Physicians)
wrote a review of Dreamland,
where he boldly states, “This might be a good place to pause and sort all this out because this is a most complicated and ugly story that starts with academic stupidity, continues with medical profession incompetence and individual physician greed.”4
Ben Goldacre, a physician and epidemiologist, is a huge proponent of information sharing so patients and physicians can make vitally important decisions based on all
the information. He states that publication bias (publication of research results depends not just on the quality of the research but also on the hypothesis tested, and the significance and direction of effects detected1
) is “undoubtedly the single biggest ethical problem facing medicine today….We cannot make decisions in the absence of information”.
So, ask yourself, “Am I behaving ethically? Am I living by and standing by my ‘protected values’?”
How different would the last two to three decades have been if all the information on the truly addictive nature of new opiates had been properly shared with patients, physicians, and family members, and all contributors had lived by their protected values and behaved ethically?
Ethics and values are varied and impacted by a variety of factors, such as culture, belief systems, experience, gender, and others. However, what may be helpful is identifying a starting place to even understand and articulate your known (and unknown) personal values. There are multiple ways to identify your value set (self-help books, life coaches, career counselors, coffee with friends, and feedback from mentors). However, if you are looking for a place to start, below is an exercise to get you on the right path.
- Think of two people you greatly admire, one from a professional perspective and one personally.
- Identify the traits that make you admire them. Be specific about what it is that makes them special to you. Don’t be shy; the more, the better!
Step 3-Connect and Reflect:
- For the traits you identified, how have they played a role in your personal and professional development? Reflect on how these admired traits have surfaced in your life’s experiences. Consider why you are drawn to these traits and their importance to you.
- Identify those values that most resonate with you and your preferred belief system, if one applies. Select those that you most identify with and feel passionate about. Be sure to reference any that you are not sure of. Ensuring that your definition is in line with overall meaning is key to staying aligned and informed.
- For Step 2, you should have listed a number of traits. We challenge you to select four to six traits that you are most passionate about. Which of these are you drawn to the most? These will likely help you round out your list. Remember, honesty is key!
Step 5-Prioritize and Document:
- Once your four to six values are identified, prioritize those that you want to focus on the most, and perhaps identify when they are strongest (and weakest).
- When complete, write them down, and post them where they can be seen, consulted, and reflected upon.
Values and ethics are not always easy to identify and adhere to. However, being aware of your values is a key component. Your thoughtfulness on this subject will go a long way in helping you keep yourself in check when tough decisions arise.
1 What really motivates people to be honest in business. TED website. Posted November 2016. Accessed January 5, 2018.
2 Porter J, Jick H. Addiction Rare in Patients Treated with Narcotics. New England Journal of Medicine. 1980;302(2):123.
3 Zhang S. The One-Paragraph Letter from 1980 that Fueled the Opioid Crisis. The Atlantic. June 2, 2017. Accessed January 5, 2018.
4 Anderson E. Book Review: Dreamland. MedPage Today. December 31, 2017. Accessed January 5, 2018.
5Quinones S, Dreamland: The True Tale of America’s Opiate Epidemic. New York: Bloomsbury Press; 2015.
6 Morbidity and Mortality Weekly Report webpage. Centers for Disease Control and Prevention website. Accessed January 5, 2018.
Maggie Mullen is business development manager at Lovelace Biomedical. Erik Burns, MA, MBA, EdD, is division chair and assistant dean of Outreach and Professional Development at the University of Wisconsin-Madison, School of Pharmacy.