Money's corrupting influence on medicine

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BOOK REVIEW

 

Money's corrupting influence on medicine

 

By Charles Stein, Globe Staff  |  October 10, 2004

 

Fears that money has an undue influence on the practice of medicine are

not new. In the 12th century, the Jewish philosopher Maimonides wrote an

oath for physicians that included this admonition: ''Do not allow thirst

for profit, ambition for renown and admiration to interfere with my

profession. "

 

Nine centuries later, the situation has not improved. Money -- mainly

drug company money -- flows into every nook and cranny of the medical

world. It pays for clinical trials, medical education, and academic

research. It gets handed out to doctors as gifts, free meals, consulting

fees, and payments for speaking.

 

In Jerome P. Kassirer's book, ''On the Take, " money is handed out in

medicine as freely as bribes in Third World countries.

 

''The time has come to ask whether all of the money floating around

medicine has created a pattern of corruption, " writes Kassirer, a former

editor of the New England Journal of Medicine and a current faculty

member at Tufts University School of Medicine.

 

Many of the examples Kassirer cites have been noted before. Nonetheless,

Kassirer's reporting on the sheer volume of money and the huge number of

people and institutions that receive it makes a powerful impression.

 

Consider the following examples:

 

The American Academy of Pediatrics distributes a guide to breast-feeding

for new mothers. The 2002 cover featured the name and logo of Ross

Products, the maker of Similac, the most popular brand of infant

formula.

 

During the 1990s Kassirer found it increasingly difficult to find

writers for the New England Journal of Medicine who had not taken money

from drug companies. Another publication, the Annals of Internal

Medicine, ran an editorial on HIV infection by a writer who consulted

for 14 different companies and took grant money from nine firms, some of

which had products in the AIDS field.

 

A Canadian doctor doing drug research found that the drug in question

had a side effect that was potentially dangerous to the children she was

treating. When she published her findings, the drug company, Apotex,

dropped her from the study. Her hospital refused to back her up because

it was negotiating to get a multimillion dollar gift from Apotex.

 

For Kassirer, the problem comes down to trust. How can you trust your

doctor or your hospital, if they are on the take?

 

Kassirer's book would have been stronger if we got to hear more of the

voices of the doctors on the front lines. Do they acknowledge that their

integrity is being compromised? Has the drug company money contributed

anything to medicine or is it a blight on the field?

 

Kassirer concludes with a long list of recommendations for removing the

taint money has brought to medicine. In some cases, he is in favor of

better disclosure of conflicts of interests. In others cases, he says

doctors have to just say no -- to such things as gifts and participation

in company-sponsored speaker's bureaus.

The recommendations make sense, but you have to wonder whether they are

realistic. If drug companies spend $2 billion a year on physician

education, who is going to fill that vacuum if the drug money

disappears? Government? The doctors themselves?

 

© Copyright 2004 The New York Times Company