Letters to the Editor - Jan. 17, 2005

Limits in MICRA tort reform felt mostly by lawyers -- not patients - Physicians have good reason to be leery of industry-sponsored CME - Keep specialty hospital moratorium until indigent are adequately served

Limits in MICRA tort reform felt mostly by lawyers -- not patients

I want to thank AMNews Senior Reporter Tanya Albert for the very well-written article "MICRAscope"(Article, Nov. 8, 2004). The recently published RAND report on California's experience with tort reform (MICRA) does have "something for everyone" on all sides of this issue.

One observation from my study of the RAND report: If you omit the jury verdicts in the seven highest awards as "outlier" cases (that is, omit the top 3% of the cases, ranging from $4.7 million to $31.3 million), the conclusions of the study would change significantly. Rather than characterizing MICRA as penalizing "seniors, stay-at-home moms and children," the data clearly point out that the major savings occur in the area of attorney fees.

The "little secret" of MICRA is not that it forces a significant limit on the awards of deserving, injured patients, but rather that it limits the amount of money received by the law firms representing those patients. Based on my calculations, the average net capped award received by 97% of the patients reported was reduced by only 7.5%, and in most cases even less than that. Over 80% of the savings of those cases occurred as a result of fee limits.

In simple terms: The party who suffers most under MICRA is the plaintiff's attorney, not the plaintiff.

MICRA's limits on unreasonable awards made by "juries gone wild" hurt the attorneys who encourage them, not the patients and families who need help.

--Curtis E. Harris, MD, Ada, Okla.

Editor's note: Dr. Harris is also a lawyer and teaches a course on law and medicine at Oklahoma City University School of Law.

Physicians have good reason to be leery of industry-sponsored CME

Regarding "Voluntary self-regulation of CME sponsorship debated" (Ethics Forum, Dec. 6, 2004): Thank you for that much-needed and thoughtful debate. After nine years of practicing internal medicine and much reflection on the subject, my position has evolved to that of Ethics Forum commentator Arnold S. Relman, MD.

The pharmaceutical industry is in the business of making money, and physicians delude ourselves to think that we can be informed and discriminating consumers of the drug industry.

Recently I attended a local CME event that left me with an uneasy feeling of questioning one of the speaker's motivations. He was a noted specialist from a nearby medical school. He gave what appeared to be an objective discussion of competing drugs A and B. I had to go to a prescribing book afterwards to find out that the event was sponsored by the maker of drug A.

The problem was that the speaker omitted the discussion of the additional therapeutic effect of drug B that made it the better prescribing choice.

As much as I tried to give him the benefit of doubt, the questions kept coming. By appearing even-handed, did he convince himself that he was being objective, or was it a smokescreen to deceive his unsuspecting audience?

Did he make conscious choices to compromise himself for self-gains? I recognized the bias this time, but how much am I missing?

Unfortunately, drug industry-sponsored CMEs lead me to ask such distasteful questions and leave me little confidence in any speaker's perceived self-objectiveness as the sole safeguard against bias for busy practitioners.

I wholeheartedly agree with Dr. Relman and appreciate his wisdom.

Voluntary self-regulation is as flawed as the human beings who hold this responsibility, and we do our profession a disservice by being beholden to the purse strings of the pharmaceutical companies.

Since it doesn't appear that drug industry-sponsored CMEs are on their way out any time soon, I appeal to my esteemed colleagues who speak at these education seminars to be as forthcoming as possible to retain their own credibility and self-respect.

With regard to my own responsibilities, I've been increasingly questioning my rationalizations for participating in these CMEs. They have been easy and free opportunities for keeping up with the latest developments.

I thought I could pick and choose what these CMEs had to offer without compromising my professional integrity, but I might not be picking up all of the subtle biases.

At the least, I will be making even greater efforts to be more discriminating when choosing material for CME, and, ultimately, I know I have the power to reject easy and free CMEs sponsored by the drug industry.

--Aeria Chang, MD, La Jolla, Calif.

Keep specialty hospital moratorium until indigent are adequately served

Regarding "AMA: Don't extend moratorium on specialty hospitals" (Article, Dec. 27, 2004): The moratorium on specialty hospitals should remain in place until the specialty hospitals provide the same (or similar) amount of care to the indigent as do the public hospitals.

The public hospitals have been providing this care; however, the specialty hospitals, for the most part "cherry-pick" those areas of medicine that are profitable.

This issue of "improving medical care," "innovative thinking," "improving quality of care," blah, blah, blah, is nothing more than a smoke-screen for innovative thinking in revenue generation.

Many specialty hospitals do not maintain full-function EDs and "refer" to the public hospitals, cherry-pick the money areas (surgery) and do not accept for care patients who have little or no financial resources.

Do the indigent get admitted to these institutions for this "innovative medicine" or "improved quality"? I suspect we all know the answer. When the playing field is leveled, then the AMA should support removing the ban.

--Frederick E. Harlass, MD, El Paso, Texas