Hey! Randy

Doctors for Dollars

Posted by heyrandy on February 27, 2012

On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, Jerome Kassirer, 2005

Are you getting unbiased medical advice from your doctor? Probably not. The author, a medical doctor and former editor of the New England Journal of Medicine, should know. He was once part of the system. He spoke at various functions while being paid by a drug manufacture to do so. He said it did not influence his practice decisions, and he never mentioned any of the company’s products. When he refused a company request to do so, the speaking engagement stopped.

The big pharmaceutical companies spend millions on promotion. They seek to get knowledge of their products out to the ones who count: medical doctors. The doctors are the ones who write prescriptions. The influence is usually indirect. Free meals, symposia at nice resorts, lecture fees, research grants, cash. It is that bad. It is also petty. It is no secret that medical conferences have displays by drug and device companies. There is nothing wrong with this. What is really sad is how doctors mob the displays that give away the best trinkets. It is not unusual for the doctors to behave unseemly if the tee shirts are not dispensed fast enough. The Healers: a special caste.

Kassirer show that there is untoward influence in almost every area of medicine. The crushing debt of a medical education makes most young M.D.s easy prey. A free lunch while you listen to a sales pitch? “I have to eat lunch anyway,” is the usual excuse.

It is not just the drug companies that are a problem. Sometimes it is the doctors themselves. You need a x-ray? You may be referred  to a place partly owned by your doctor. What is the point of having all that expensive imaging equipment if it is not used? Often the doctors are willing to do what the patients want. Patients come in demanding this or that, so the doctors give it to them. It is too easy not to argue that it is unnecessary and a waste of resources, especially when you are getting paid to do the unnecessary.

Kassirer give some solutions. They are what you expect: transparency, honesty, integrity. He is naïve. There is too much at stake. There are too many dollars that will go to someone else. We have the system we have because we all benefit from it. At least we think we do. 

The system will not soon change. The costs of becoming a doctor, of developing drugs, and hospitalization are not about to go down. The book  was written before the passage of Obamacare, so there will be change: the doctors will all be subject to government review of all their actions. This does not bode well for a system is such a bad state. 

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