First, do no harm?

For some doctors that may not be the case, at least when money is involved. A new study of thousands of doctors found that just 8 of 10 strongly agreed that they should put patient welfare before their own financial interests. And 4 of 10 did not think they needed to inform their patients about any financial conflicts of interest with pharmaceutical companies.

The study, published this month in the journal BMJ Quality and Safety, included results from a survey of nearly 2,000 doctors in the United States and more than 1,000 in the United Kingdom. The report looked at doctors’ feelings on a broad range of ethical issues.

The results made it clear that a fraction of doctors would at least consider putting money before their patients’ best interests. And some did not think their patients deserved full disclosure. Most of the doctors in the study reported having had accepted gifts or free samples from pharmaceutical companies. The authors found that American doctors were slightly more accepting of potential conflicts of interest than their counterparts in Britain.

“They were more likely to believe that business relationships were appropriate, more likely to report actual business relationships with patients and more likely to receive gifts from pharmaceutical companies,” the authors wrote.

But other recent studies have found that while there is still some coziness between doctors and the drug industry, the ties for the most part are diminishing. A study in the Archives of Internal Medicine in November for example found that growing scrutiny of conflicts of interests between physicians and drug makers has led to a decrease in financial ties between the two.

As evidence the report cited dramatic changes in doctors’ relationships with drug companies since 2004: A 20 percent drop in doctors taking samples, a 60 percent decline in consulting relationships and a more than 50 percent fall in the percentage of doctors taking industry pay to serve on advisory boards. At the same time, a number of large medical groups, like the Institute of Medicine, have advocated tougher restrictions on the links between doctors and drug makers in recent years.

The BMJ report also found that some doctors would rather overlook the incompetence of a colleague than make themselves uncomfortable. Nearly 20 percent of doctors in Britain and about 17 percent of doctors in this country said they had dealt with an “impaired or incompetent” doctor in the last three years.

About 65 percent of American doctors and 70 percent of British doctors surveyed said they had alerted a boss or some other authority figure about the colleague. Among the rest of the doctors who said they did not alert anyone, a sizable proportion said it had something to do with fear. One in three British doctors said they had feared retribution, as did more than 12 percent of American doctors. The authors suggested that the higher rate of reluctance among doctors in Britain might reflect the “unsympathetic treatment of ‘whistleblowers’ that has been widely reported in the British medical press.”

As evidence, they pointed to a recent survey by the British Medical Association, which found that 16 percent of the doctors who had reported on a colleague said that by speaking up they had put their jobs at risk.