Friday, October 15, 2010

Commerce and self interest in medicine

A Guided Tour of Modern Medicine’s Underbelly is a NY Times  book review by Dr. Abigail Zuger of  the book WHITE COAT, BLACK HAT: Adventures on the Dark Side of Medicine. By Dr. Carl Elliott.

"A physician who specializes in philosophy and ethics, Dr. Elliott hails from that quiet zone of medicine where much of the job involves thinking about, talking about and doling out medications. Hence his primary focus is on the ever-evolving relationship between the high art of medicine and the big business of drugs.

"Doctors get pens and trinkets, football tickets, junkets to beach resorts. Less visible are the large sums handed over in “I’m going to make you a star” projects to groom them as trusted faces and voices in the service of some drug. Education and advertisement merge in these elaborate ventures, as the paid professor travels the country, lecturing about disease and, incidentally, the treatment thereof.

"These “key opinion leaders” are bad enough, but who would ever imagine that the curricula vitae of many academic physicians (those on a medical school faculty) are packed with journal articles actually written by ghostwriters sponsored by pharmaceutical companies?

"“Nobody expects American politicians to write their own speeches anymore,” Dr. Elliott reminds us, “and nobody expects celebrities to write their own memoirs.” Apparently doctors have now joined the ranks of the charismatic talking heads, mouthing the words of others.

"And just as “professor” generally describes someone who writes his or her own sentences, “ethicist” generally describes someone who dwells (or at least works) on an unusually high moral plane. But Dr. Elliott also takes a brief and very informative excursion into the world of the medical ethicists. Once they were highly principled, underpaid gadflies, trying to sort out medical decision making. Now they are part of a booming industry, and, speaking of industry, their ties to the pharmaceutical industry are many and complex. Many companies now hire their own ethicists. But who guards those guards?
"What a world, what a world, as the melting witch said in “The Wizard of Oz.” But there is one small consolation: at least Dr. Elliott didn’t have to call his book “White Coat, Black Heart.” Now that would have been depressing. The bottom line is that much of what he describes is simply the big business of medicine as we have allowed it to take shape. His bad actors are mostly just that: actors caught up in a script not of their own devising. They all come home in the evening, take off their black hats and hang up their white coats, just regular working stiffs out to make a buck. "


michael webster said...

Isn't this just another example of regulatory capture?

Anonymous said...

Dr. Elliott gets a high-intensity grilling in this frank interview.