Letters to the Editor - Nov. 13, 2006

Despite rules, "in-office dispensing is a form of implicit coercion" - Crackdown on detailer visits a joke given what academic researchers get - HHS chief Q&A article left physician with more questions than answers

Despite rules, "in-office dispensing is a form of implicit coercion"

Regarding "Office-based sales hinge on the patient's best interests" (Column, Oct. 2): Office-based dispensing to patients is wrong, and its widespread practice does not alter an inherent conflict of interest.

As physicians, we are afforded unique and special privileges in society. We are trusted always to consider our patients' needs first regardless of any financial interests. Dispensing products at a double or triple markup is suspect, especially given the lack of rigorous evidence-based studies demonstrating superiority against over-the-counter products.

Ethics Forum commentator Michael H. Gold, MD, of Nashville, Tenn., notes that the American Medical Association's Code of Ethics permits sales of health-related products when the patient is not coerced. However, our relationships with patients are not equal. In-office dispensing is a form of implicit coercion, given the position we enjoy in society.

Patients assume that a product must be superior, given its placement in our offices. The exploitation of this assumption for financial gain is a blatant violation of our duty to act in the best interests of our patients. We were all physicians before we were business owners.

In an age of managed care and declining reimbursements, financial pressures have led to a creative interpretation of ethical practices. If we continue to behave in this manner, and if we continue to permit midlevel practitioners to see our patients with minimal to no oversight, then I fear that our profession will suffer irreparable harm. In the end, however, patients will suffer most.

--Peter A. Klein, MD, Stony Brook, N.Y.

Crackdown on detailer visits a joke given what academic researchers get

Regarding "Some medical schools say no to drug reps' free lunch" (Article, Oct. 9): The new policy at Stanford is laughable. The real culprits causing bias in medicine are the academic physicians who receive substantial compensation, airfare, hotels, etc. to research and promote medications. Their bias permeates the medical literature and amplifies it like a PCR does DNA.

I challenge the academic medical centers to release the compensation that their staff receive from the pharmaceutical industry, both directly or indirectly. The results probably would be staggering.

--Andre Ettinger, MD, Pasadena, Calif.

HHS chief Q&A article left physician with more questions than answers

Regarding "HHS chief: Get ready for quality reporting" (Article, Oct. 2): So let me get this straight: Health and Human Services Secretary Michael Leavitt's plan entails physicians identifying, designing and implementing our own quality measures. What does he think we do every day, strive for mediocrity?

Then, in an odd answer to a question that is very close to my heart, will physicians who take care of sick noncompliant patients (mostly because they cannot afford their medicine) be penalized, he states, "We're pioneering." It sounds to me like he does not have a clue about how to proceed.

There are just two things I would like to know:

What is going to happen to the patients whose doctors lose the value-based competition?

If he thinks that we are doing such a miserable job of taking care of our patients to begin with, how can he entrust us with such an important task?

None of this is going to matter anyway. If listening to the medical students I teach is indicative of a growing trend, there will be no primary care physicians to do this mandated and uncompensated work.

--Dean Raffaelli, DO, Chicago

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