The overriding commercial interest of the drug firms is underlined by the ungodly amount of money (billions of dollars per year) that they spend on promotion of their products, primarily attempting to influence the physician, who unfortunately is rather easy prey. There are very few doctors who have not accepted some gift or service from the drug industry. I still have the black bag given to me as a third-year medical student, and I have attended a number of symposia sponsored by a drug company. The drug industry currently spends more on promotion and advertising each year than it does on research! According to Pills, Profits, and Politics, the amount is also more than the total spent on all educational activities conducted by all the medical schools in the United States to train medical students.
It would be unfair to suggest that the pharmaceutical industry has not contributed to society. But this has been the by-product, not the goal. And there have been cases in which the public good has been ignored. One need only to mention the thalidomide disaster or the DES calamity to recognize that the record is variegated and that commercial interests can have unfortunate consequences. Drug companies have marketed products that they knew might be dangerous or ineffective or both merely to turn a profit.
Medical practice as it has been known in this country for the last thirty years or so is changing. The doctor-patient relationship used to be the fulcrum, but it is losing ground to economic and business interests. The American public has a right and an obligation to know what kind of system is evolving.
For those people interested in pursuing the issue, I recommend the following books:
Ainsworth, T. H., M.D., Live or Die (Macmillan, 1983). Written by a physician who looks at the problem from the vantage point of having been both a practitioner and a hospital medical director, this book is particularly poignant in its appeal for physicians to recognize what is happening to the profession and to reexert their leadership.
Silverman, Milton, et al., Pills, Profits, and Politics (University of California Press, 1974). This book gives an overall view of the pharmaceutical industry, and it makes for interesting reading. I’m confident it will arouse some unexpected emotions. Although it was written over ten years ago, it is still strikingly relevant.
Starr, Paul, The Social Transformation of American Medicine (Basic Books, 1982). This book provides an impressive overview of the history of medicine in America and gives one a realistic comprehension of how the current situation has developed.
Wohl, Stanley, M.D., The Medical Industrial Complex (Harmony Books, 1984). This readable, concise book discusses the issues with few embellishments.
This is a work of fiction. Names, characters, places, and incidents are either the product of the author’s Imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events or locales is entirely coincidental.
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Robin Cook, Mindbend
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