Letters to the Editor - Nov. 6, 2006

Practice-based sales risk reducing physicians to cosmetics salespeople - Prison research can't meet standard of "freely given informed consent" - End Medicare hypocrisy by making it mandatory for those now in charge - Medicaid capitation fails patients

Practice-based sales risk reducing physicians to cosmetics salespeople

Regarding "Office-based sales hinge on patient's best interests" (Column, Oct. 2): I read with interest this commentary by Michael H. Gold, MD, of Nashville, Tenn.

As a practicing dermatologist, I am concerned about the office-based sales of some of my colleagues. A walk through many cosmetically-oriented offices or a quick perusal of their Web sites will reveal that some physicians are selling much more than health-related products, and much of what is sold has questionable evidence of effectiveness. While most cosmeceutical products are physiologically harmless, they do cause harm to the pocketbooks of our patients and to the reputation of our specialty.

The sale of these products in a physician's office implies a clinical or scientific rationale for their use. Obviously there is a financial incentive to take advantage of that perception.

While my current practice has no office-based sales, I do recognize a potential need for certain physician-supplied products. These sales should be limited to those products that have demonstrated clinical merit and that are not easily obtained elsewhere. To do otherwise is to unethically use our position as physicians to inappropriately market products to patients.

Dr. Gold describes us, in part, as "skin care professionals." To me, this puts us in the same category as aestheticians and department store sales representatives. The sales of makeup, age-defying cosmeceuticals, and particularly eyeliners turn patients into clients and physicians into salespeople. We must think long and hard about how this influences the public perception of our specialty and, more importantly, always consider what is best for our patients.

--Daniel D. Bennett, MD, Temple, Texas

Prison research can't meet standard of "freely given informed consent"

Regarding "IOM panel wants prisoners to be available for research" (AMNews, Sept. 18): This is a demonstration of the ethical failure of physicians to understand the phrase "freely given informed consent," which is the first tenet of the Nuremberg Code of Medical Ethics.

Having been the dermatological consultant to the inmates at San Quentin Prison from 1955-1960, I can attest to the fact that incarceration in a prison means that the proposed inmate volunteer subject for use in drug trials is an oxymoron.

The use of prisoners throughout the history of American medicine has revealed only abuse and the threat of harm or death in many cases.

I would ask the "experts" at the Institute of Medicine to spend two to three days in a prison of their choosing and they will realize that no prisoner is free in any sense of the word.

--Michael J. Franzblau, MD, San Francisco

End Medicare hypocrisy by making it mandatory for those now in charge

Congress and the White House have repeatedly failed to correct problems with the Medicare program because they have no real stake in the program. They are covered by their own exclusive medical plan.

The AMA should pioneer a people's initiative to require all senators and House representatives, as well as the White House, to live under the Medicare program.

Forcing them to live under Medicare program's benefits, prescription drug programs and regulations will give them a stake in making it a program that works and preserves access. The hypocrisy of our government forcing us to live under one set of rules, while the ruling class lives with an entirely different set of rules, must come to an end. This is the only way we can make our legislators and executive branch officials truly accountable to the laws they create and force the population to live under.

--Benjamin T. Hu, MD, Coupeville, Wash.

Medicaid capitation fails patients

Regarding "Georgia doctors take on Medicaid HMOs over slow pay" (Article, Sept. 11): It is interesting that Georgia doctors are feeling they are getting slow pay. I am not concerned about the slow pay as much as I am the slow care. I have had patients come in on Medicaid (I don't take Medicaid) that have documented cartilage tears on MRI that the gatekeepers who are getting some sort of capitation agreements are not allowing to get surgery. I take care of these kids through my own private foundation and get their operations done. Basically the state governments are handing off and washing their hands of this situation by paying capitated amounts. I really don't think they could care less if anything is getting done or not.

--Peter F. Holmes, MD, San Antonio

Vote refines AMA stance on health reform
The AMA House of Delegates rejected attempts to rescind support of a U.S. House health reform bill and any new government-sponsored health insurance plan during the 2009 Interim Meeting.
Story - AMA House - Slideshow