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Thursday, March 27, 2008

Physicians (or just folks with MD degrees) and product promotion

The Jarvik-Lipitor ads have disappeared from TV but the larger issue of physicians promoting certain products or services has attracted the interest-among others-of two straight-talking medical bloggers.

Dr, Howard Brody,director of the University of Texas Medical Branch (Galveston) Institute for the Medical Humanities makes his views clear and is quoted in an article in the March 24, 2008 issue of American Medical News. His blog is here.

What is a doctor doing putting money in his or her pocket,shilling for a product?..There is no positive reason for doing such a thing.

Dr. Roy Poses of the blog Health Care Renewal is also makes his views very clear when he states:

I wouldn't do it.

He argues that an endorsement could induce bias in in favor of a product when it is not in the best interest of the patient.

Arthur L. Caplan of the University of Pennsylvania Bioethics Center offers a more morally relativistic position: I might urge someone to think twice about it, but I can understand they may choose to do it.

The AMA "ethical guidelines" offers another tepid general statement saying that physicians are free to promote their services in what form they see fit but do not mislead or deceive.

I can remember a quaint era when physicians did not advertise at all and I seem to have a foggy memory of a time when internists also did not offer cosmetic procedures in their offices,sell vitamins or skin care products, actually attended their sick patients in the hospital after attending them as an outpatient, spent more time treating their patients than treating their chart in an effort to squeeze the best payment by performing the most clever coding and placating the latest pseudo-quality, documentation initiative and did not relegate their patient's care to "mid-level" practitioners or their call to triage nurses or a telephone answering machine and the default strategy of sending everyone to the ER.

Dr.Rich has spoken of a decline in the pride and ethics of physicians and I have echoed that notion. There is much to suggest a loss of pride and ethics but with the continuing straight talk that call our attention to matters that are wrong and things about which we should express outrage from physicians such as Dr. Poses and Dr. Brody you have to be hopeful that if you keep fighting the good fight there is at least a chance of winning.


Anonymous said...

I agree with what you're saying about a drop in ethics and advertising for tonics. It's very sad to see and further erodes our standing in the community.

However, the quaint era you speak of also reimbursed physicians very highly for not selling vitamins, using mid-levels, seeing their patients as inpatients when necessary, and spending less time on the chart.

An argument can be made that many physicians of that era, while caring well for their patients, exhibited poor resource stewardship, and maybe even greed.

The rise of the HMO and cost cutting and 3rd party payers, as well as the increase in regulations have caused PCP's to see a ridiculous amount of volume to keep ahead of overhead.

I am an ER doctor, and have my own problems. But, my uncle was an internist before he retired. In real dollars he made twice as much as my cousin the internist does today.

I think that might be just one reason why we see this slippery slope of medical decay. College kids don't even want to go into medicine... they want an MBA because that's where the money is. They figure they'll give to charity to help people.

james gaulte said...

I agree that much of what I complain about or grieve about is directly indirectly to a significant decrease in physcian(including internist) income.