By John Ballard
As I have said before, lasting improvements in the delivery of health care will not come from reform legislation but medical professionals themselves. There is a distinction, however, between medical professionals as health care providers and medical professionals as investor/business types. Although they may be the same individuals, in different roles they are not compensated the same.
PROFESSIONAL COMPENSATION IS NOT THE SAME AS PROFITS. What doctors are
paid is different from what corporations report as profits.
Unfortunately, the corporate view is that professional compensation is
an "expense" (and a drain on profits) but for doctors the same amounts
are how they earn a living.
My two categories of income for doctors overlooked a third income source, subject of an April NY Times article, the professional equivalent of what we in the service industries call "tips."
With little fanfare, a small number of prominent academic scientists have made a decision that was until recently all but unheard of. They decided to stop accepting payments from food, drug and medical device companies.
No longer will they be paid for speaking at meetings or for sitting on advisory boards. They may still work with companies. It is important, they say, for knowledgeable scientists to help companies draw up and interpret studies. But the work will be pro bono.
The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name.
They are part of a group responding to accusations of ethical conflicts inherent in these arrangements, and their decisions repudiate decades of industry influence, says Dr. Jerome P. Kassirer, a professor at the Tufts School of Medicine, who has written a book on conflicts of interest.
Five years ago, �nobody paid any attention to taking money from industry,� he said, adding: �They just took it. In some instances, I think people thought they were suckers if they didn�t.�
Even last year, the Food and Drug Administration decided that it could not altogether ban researchers from its advisory boards who took industry consulting fees.
Now, Dr. Kassirer said, he keeps finding experts who are rejecting the money.
�I don�t think there�s any question that the atmosphere has changed,� Dr. Kassirer said.
He attributes the change to publicity about conflicts and what can be almost a public shaming when researchers� conflicts are published. �Finally, it�s gotten to people,� Dr. Kassirer said.
The article continues with three examples of doctors behaving ethically, one of whom turned down a fifty-thousand dollar offer to be listed as an "adviser" to a drug company. As the writer of the article says, now "when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name...Here are the accounts of three scientists who have lost their asterisks."
I found this link at Glass Hospital because the blogmaster was deeply impressed ten years ago by one of the men listed in the article, Dr. Peter �I used to think I was incorruptible because I took money from EVERY drug company� Libby.
This is not a stampede by legions of doctors and I don't expect it to become one. The examples in the article are high-profile representatives in their fields with a professional sense of balance that goes with that level of leadership. But it is encouraging to see in them a profession recovering a focus on ethics that has for too long been hiding under a bushel. Health care reform is alive and well in America thanks partly to ARRA and partly to the Affordable Care Act, but mostly by a growing awareness among medical professionals that it will be they who ultimately will make the difference.
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