"Physicians on the Take" or, Disciplines Heal Thyselves ...

The Medscape webcast video editorial (March 20, 2006) featured a scathing critique of the close relationships between conventional medical doctors and industry from Jerome Kassirer, MD, former editor of the New England Journal of Medicine. Kassirer begins his statement this way: "In my view, relations between physicians and industry have become scandalous." He decries activities "that benefit shareholders but do not benefit patients." The editorial is titled, simply: "Physicians on the Take."

Jerome Kassirer, MD

The editorial is a poweful indictment. Kassirer speaks of physicians signing ghost-written articles, promoting off-label uses of drugs, stumping for devices, creating "marketing materials disguised as educational information" and receiving "large sums" to be part of speakers bureaus. Kassirer sees this culture impacting the next generation of medical students who are "being seduced everyday by lunches, dinners and gifts" from industry representatives.

Are physicians able to maintain their independence of mind and of practice despite the gifts? Kassirer is blunt: "All evidence from psychological studies suggests that this is naive." The response from organized medicine is portrayed as "feeble." He urges professional organizations and academic medicine leaders to "reverse the troublesome trend" or likely see patients increasingly lose trust in their doctor's opinions.

Comment: CAM advocates tend to celebrate such strong outing of the shadow side of what is so often mis-represented as the best health care the world has to offer. What's good for the goose is good, as may be said, for the gander who lives in a glass house ...

Witness the commendable, strong position taken by a group of leaders of chiropractic against certain billing, advertising and patient management practices of some of their colleagues. They view this behavior,

of natural product endorsements by Andrew Weil, MD, Phil McGraw, MD, and Larry King . We can find good value in significant self-policing work insdie each discipline. Kassirer could have been talking to any of the disciplines, though these have fewer zeros after the numbers.

In my work between disciplines with the National Education Dialogue to Advance Integrated Health Care, a project of the Integrated Healthcare Policy Consortium, many of us are acutely aware of the way the shadow of power and economic interests quietly enter, restraining pure exchange. Finally, when things are going well, the elephant in the room is noted. Some of us call this bringing "the rest of the family" into the dialogue. We are all accustomed to presenting our favorable self-definitions. Yet the process of integration typically brings to the table the issues of the whole family -- the principled as well as the sleazy. The "other" has been acculturated to see the shadow that one may be denying.

In credentialing an individual, we can select for those consciously admitting the self-work that is needed within their own discipline. Yet the success of the broader integration process may rest on the active, humbling engagement of each discipline in the hard work Kassirer asks of conventional medicine.  Disciplines, heal thyselves!

That said, the Integrator Blog News & Reports has sponsors. I confess that in speaking of supplement sales in professional offices I wondered at the response the comment might produce from a natural products company which is currently considering sponsorship. Please let me know if you think that IBN&R sponsorship is negatively influencing the content offfered here.

An additional note: I sent this write-up and comments to Lou Sportelli, DC, president of IBN&R sponsor NCMIC. Lou had sent me the link to the Medscape editorial. He responded,

Lou Sportelli, Pres of IBN&R Sponsor NCMIC

in part: "I like the ending, the question asking if the Integrator is influenced by sponsorship. There is nothing pure and everything can be seen in the worst light. But having asked the question, the fact that some group sponsors the Integrator does not necessarily lead to favorable or unfavorable treatment. While there should be a presumption of innocence, there are groups that historically have had activities that would cause a high degree of suspicion. I commend Dr. Kassirer for his strength and his courage. We must do what is right, because it is right, when no one is looking."