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Healthy Skepticism Library item: 4961

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Mira AJ, Isely W, McDonnell M, Huch KM, Whittle HM, Nugent TJ, Lack DZ
Readers' Responses to "Physicians on the Take"
MedGenMed 2006 May 12;
http://www.medscape.com/viewarticle/531612?src=mp


Full text:

To the Editor,

I read/heard Dr. Kassirer’s editorial, “Physicians on the Take,1
with
deep concern and full agreement. Immediately, it grabbed my ear and
stirred
my emotions as I waited in anticipation of what he might say. As I
read, I
was anxious, hoping that before the end of his timely article he would
touch
upon the deep-rooted cause(s) of this truly scandalous and frightful
phenomenon! With some disappointment, at the end, I was left yearning
for an
answer, or at least a good theory. I thought that there must be a cause
for
this rather recent, disturbing behavioral change. Otherwise, we may
just
hope that our inner conscience will someday soon prevail to throw off
these
temptations from industry, but raw human nature may prevail — and it
usually does. I say, “Please, Dr. Kassirer, go on; I know you have a
theory
or two, or maybe you just wanted to make those like me think and talk
about
it!”

I have the opinion that this great upheaval in medical care is the
mandated
devaluation of physicians’ services by the government and insurance
companies over the last 20 years or so. It seems that everyone is
afraid to
talk about this like it may be impossible or unthinkable. Increasingly,
physicians are looking for alternate sources of income in the face of
this
and the tremendous inflation of expenses, and they are scrambling in
competition to gain volume, royalties, and even meals! As we are less
able
or unable to afford (or have less time) to go to seminars, for
instance, we
are more easily seduced by a substantial subsidy to give or attend a
biased
seminar. This is the human nature theory.

There is no better way, especially for our patients’ sake, to be paid
for
our services and advice than to be paid reasonably for the professional
services alone, in a free market.

So why does a downtrodden, poor man steal or cheat? It seems
unthinkable,
but in some ways a physician may also!

We must get the free market back or we’re all doomed.

Allan J. Mira, MD
Carlisle, Pennsylvania
miraorthopedics@aol.com

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

Dr. Jerome Kassirer1 has said it exceedingly well.

William Isley, MD
Rochester, Minnesota
isley.william@mayo.edu

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

I read with interest the opinion article, “Physicians on the Take,1
by
Jerome P. Kassirer, MD. This ties in nicely with my favorite topic of
bad-faith peer review. In Dr. Kassirer’s opinion, certain doctors, at
the
behest and usually on the payroll of industry, are rendering opinions
that
profit themselves much more than their patients. In bad-faith peer
review,
certain doctors, also at the behest of and habitually on the payroll of
industry, render opinions that profit themselves and damage the
doctor-victim. In both instances, industry is exerting improper
influence in
medicine. Biased data are being passed off as scientific truth, and
outrageous, biased medical opinions are being passed off as medical
fact.

What we’re seeing here is the politicization of medicine; these doctors
are
no longer practicing medicine but are practicing politics. They have a
constituency that made them successful and to whom they owe everything.
They
are the greatest threat to American medicine today, for only an
independent,
ethical, and unbiased medical community can survive into the future.

Mark F. McDonnell, MD
Houston, Texas
mfmcdonnell@stpsinc.com

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

I completely agree with the opinion of Dr. Kassirer1 of the dangerous
influence of pharmaceutical companies on academic medicine. However,
one of
the problems being faced by faculty in state-sponsored university
programs
is a severe shortfall in funding. Money for small projects for house
officers and fellows, books, and other educational materials, and
funding
for attendance at meetings for trainees are all lacking. There is no
where
else that I am aware of that appeals for assistance other than the
pharmaceutical companies. Faculty will often use speaker’s fees to fund
a
communal “pot” to cover the expenses of the trainees. What other course
of
action would you recommend?

Kim M. Huch, MD
Memphis, Tennessee
kim.huch@va.gov

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

I am an Australian general practitioner and I agree with Dr. Kassirer’s
sentiments.1 I am a member of an international medical organization
that
is committed to the reduction of harm from the misleading promotion of
drugs
— healthy skepticism.

Your readers may be interested to visit the Web site,
http://www.healthyskepticism.org/.

Yours sincerely,

Hilary M. Whittle, MBBS (Adel), DipRACOG, FRACGP
Adelaide, South Australia
hilsmw@gmail.com

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

As a patient, I am moved by Dr. Kassirer’s call for physician
incorruptibility.1 However, my enthusiasm is tempered by nearly 30
years
of experience working for and with the medical profession in organized
medicine and medical marketing.

Renunciation of pharmaceutical largesse would require revolutionary
change
of a profession that is chronically dependent on it, organizationally
and
individually. Its professional organizations and media, including the
leading online and off-line journals, rely on pharmaceutical industry
support. Rank-and-file physician backlash is evident against
renunciation,
which would result in higher professional dues, journal subscriptions,
and
CME costs. Physicians faced with reduced reimbursement and demands for
ever
greater expenditures on CME and recertification are reluctant to give
up one
of the few perquisites of their profession, the occasional subsidy from
the
pharmaceutical industry.

Many physicians resent the charge that they are corrupted by the
industry. I
submit that the pharmaceutical industry is far from the most powerful
of the
myriad forces brought to bear upon the physician’s ethical compass.
Virtually every decision about procedures, referrals, and reimbursement
poses ethical dilemmas between financial gain and patient welfare. In
many
cases, prescribing a drug benefits the patient more than performing a
procedure, but has the opposite financial consequences for the
provider. In
some cases, eg, leuprolide (Lupron) vs prostatectomy, such conflicts
are
existential financial threats that are far more powerful than the
inducements of pharmaceutical sirens. Prudent patients must always
supplement trust with a diversity of opinions to guard against
ethically
challenged professionals in matters across the ethical spectrum, and
are
perhaps the best protection against a moral pandemic.

As doctors of medicine, physicians depend on medicine to practice. The
pharmaceutical industry also depends heavily on physicians. The
long-standing symbiotic relationship between doctors of medicine and
manufacturers of medicine has regrettably deteriorated to the point
that
respected physicians, such as Dr. Kassirer, are moved to seek the
equivalent
of a divorce.

As in many divorces, the dependents of the parties are at greatest
risk. A
viable, innovative industry, appropriately supportive of the
profession, is
perhaps the single best hope for patients struggling with unconquered
diseases, such as cancer, and frightening new horsemen of the
apocalypse,
such as bird flu. The pharmaceutical industry is working to reform
itself. I
would encourage opinion leaders, such as Dr. Kassirer, to work with the
industry to repair the relationship rather than renounce it.

Terence J. Nugent
Wood Dale, Illinois
t-nugent@mmslists.com

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

——————————————————————————————————————
——

To the Editor,

In my opinion this is a naive view.1 I would prefer to see physicians
being paid large sums to market and develop industry products than to
lose
them from clinical medicine due to shrinking fees, loss of income, and
autonomy. For example, 10 years ago my aging uncle was operated on for
a
vascular problem by a brilliant surgeon in Boston, Massachusetts. This
brilliant surgeon, who had a young family and brutal hours along with a
modest salary, soon left medicine to become a venture capitalist.

I would prefer to see industry court physicians and surgeons assist in
the
development of excellent products, to pay them handsomely to join
speaker’s
bureaus, and to send them to the corners of the Earth to ensure that
the
products are properly used. I think that we should thank industry for
underwriting research and physician income in this way.

I believe that physicians are basically ethical, and as long as the
products
that they help develop and market are excellent, I have no problem with
industry financing. I think that it is a good thing that they are
motivated
to use new top-of-the-line products, and I don’t think that that
significantly increases the cost of medicine. I think that the use of
these
excellent products increases the possibility of successful treatment,
therefore decreasing costs in medicine. I also believe that physicians
would
only enter into this agreement if they knew that the products were
excellent. This is one more insurance that patients are getting the
best
care. I also think that there is a built-in quality control if the
competition remains high, and all companies are given equal access to
this
type of practice.

As reimbursement declines and pressure on physicians to produce at
higher
and higher levels continues, we should be grateful to industry for
motivating these brilliant people to remain in medicine rather than to
leave
for other areas of employment that appreciate their brilliance and
performance, and we should be grateful for whatever funds are absorbed
into
research for product development. Just compare the salary of the most
brilliant surgeon to that of the dullest insurance executive and my
point
will be made.

Sincerely,

Dorothea Z. Lack, PhD
San Francisco, California
dlack7@aol.com

Reference

Kassirer J. Physicians on the take. MedGenMed. 2006;8(1). Available at:
http://www.medscape.com/viewarticle/524994 Accessed March 20, 2006.

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909