There are a lot of things wrong with the American health care system, and there are plenty of villains. The LHSFNA is doing its best to report and highlight the problems.

Now, a nationally recognized and highly respected source has leant his weight to the cause. Dr. Jerome P. Kassirer, former editor-in-chief of the influential New England Journal of Medicine, has written a book called On the Take, the story of “how medicine’s complicity with big business can endanger your health.”

“Here’s an example,” says LHSFNA Executive Director Joseph C. Fowler. “It used to be that doctors assessed your health problem and, if necessary, drew on their knowledge of available drugs to prescribe a remedy. Now, drug companies are by-passing your doctor with direct-to-consumer advertising designed to get you to assess yourself and ask for their drugs. Plus, they are aggressively promoting their drugs, not only with boatloads of free samples for your doctor to ‘try out’ on you, but also with free pizza for the doctor’s staff to warm him or her up to their sales pitch. The pressure is on the doctor to sort through the hype and ensure the right treatment for you.”

“Is this anyway to practice medicine?” Kassirer might write. His 250-page book documents a host of ways that patient care decisions are increasingly influenced by the profit needs of corporations and the compensation interests of doctors. He writes:

I believe that the great majority of physicians are high-minded and principled, and that most of them intentionally avoid any kind of entanglements with industry. Their dedication to their work, their willingness to sacrifice time with their families for their patients’ bedside, and their efforts to improve themselves and the system of care make many of them truly heroic. Nonetheless, serious conflicts of interest are widespread, and with the growth of industry marketing, they continue to increase. Whether intentionally or not, too many physicians have become marketing whores, mere tools of industry’s promotional efforts. Others have engaged in pseudoscientific studies and published biased articles and educational materials that foster industry goals over patient goals. My beef is with those who exploit their professional status for personal gain in schemes that are counterproductive to patients’ best interests and the profession’s venerable goal of curing and caring for the sick. Clinical advice, like votes, should never be bought.

In his last chapter, “What Can Be Done?,” Kassirer acknowledges the difficulty in reforming a system that has been backsliding for two decades. Yet, he advances a specific, ten-point roadmap to begin remolding the business of medicine, and he outlines seven additional points that need further analysis and debate. He challenges the public and the leaders of professional associations to take up the battle.

The book, which is available for $18.48 at Amazon, has drawn positive reviews from most quarters. If you want to understand the relationship between business and medicine, this is a good place to start.

[Steve Clark]