Friday, April 23, 2010

…AND FOR DESSERT, PERHAPS, CRÊPES SUZETTE?


Let’s say you’re a doctor and you get a note from your local hospital inviting you to a continuing medical education seminar. It’s to be held at a swank restaurant, doctor, and by the way, which entrée do you prefer, poulet a la Montrachet or medaillons de veau en croute? You’d probably go for it, right? Especially if it’s on the house, paid for by Avarice Pharmaceuticals, which also sponsors the evening’s lecturer, the acclaimed chair of the internal medicine department of Majestic University.

While you sip your well-aged Chateau neuf du pape, the professor unrolls an encyclopedic discussion of von Rootpooten’s syndrome, including its treatment with the drug Expensivol, which happens to be manufactured by Avarice Pharmaceuticals. Avarice hasn’t explicitly directed the professor to tout Expensivol, but he hasn’t climbed to the top of the success ladder without constant awareness of which side his bread is buttered on.

A standard style of “continuing medical education,” then, amounts to well-financed, delectable commercials. Matter of fact, this sounds like today’s politics, doesn’t it? Politicians claim not to be influenced by donated campaign contributions, meals, sports tickets, and golf junkets, and in the same way physicians maintain that these meals and other percs don’t influence their prescribing habits. “After all,” one told me, “all the pharmaceutical companies do it, so why would I favor one’s drug over another?”  

The point that’s missed here is the relentless message, no matter who’s paying for dinner: drugs are the answer. For low-tech interventions like healthier diet, higher quality relationships, and, all-in-all, a review of one’s entire life management, there are no sponsors. As a cancer support group facilitator, I’m jealous. I’d love to be wined and dined, but who’s going to do it, competing chair manufacturers?

Fortunately, physicians’ organizations are beginning to recognize third parties' wholesale domination of healthcare. This occurs in many ways in addition to gourmet dinners. When physicians are paid to conduct research and to test drugs, for example, their subsequent medical advice and treatment are often tethered to their patron companies. 

This week the Council of Medical Specialty Societies, which includes the American Academy of Pediatrics, the American College of Cardiology, and eleven other groups, adopted a wide-ranging ethical code. “The public relies on us,” the code states, “to minimize actual and perceived conflicts of interest.” Besides issues involving conflicts of interest, the code covers financial disclosure, independent program development and independent leadership. It prohibits society presidents, CEOs and editors-in-chief of journals from having “direct financial relationships with relevant for-profit companies in the health care sector.”  

The code isn’t law, only voluntary guidelines. But at least it’s the medical profession’s official recognition, at last, that its dominance by industries exclusively tuned to profit, not patient care, is in its twilight days…one hopes.

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