Today, we have association guidelines from device makers and drug manufacturers. And yet we have national headlines such as those raised in a whistle-blower lawsuit last month alleging that medical-device maker Medtronic Inc. improperly paid millions of dollars to more than a dozen doctors around the United States, prompting them to perform unnecessary spinal surgeries and otherwise affecting their judgment.
Today, we have codes of conduct from medical societies. And yet we have more headlines made by articles such as that in the January 25 Journal of the American Medical Association decrying the practices of free gifts, consulting relationships and other practices that have become standard in modern medicine in this country.
The authors of the JAMA article warn, "More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts."
Whether the medical establishment on its own can ever succeed in reining in the excesses associated with medical marketing is questionable. It may not be the Wild West out there, but it's not a stretch to imagine that more stringent government regulation may be in the offing.
I don't pretend to have a solution to this, but there is one thing I'd like to see. There is one party in the equation that is being kept in the dark: the patient. Most patients, to be honest, are probably just as happy to be in the dark on this, but for those few who might be interested, let's get it out in the open. If you're consulting, on a speaker's bureau, receiving research support, or any financial support from a medical supplier, let's hear it. This is information you routinely share with your colleagues any time you present at a meeting or publish an article. Not, in other words, any violation of your privacy. You don't have to hang it up next to your sheepskin. If you hand out any "welcome to the practice" material to patients, slip your standard financial disclosure in there. If medicine as a whole adopted the practice, it would not only add to more open atmosphere around this issue, it might just make further regulation unnecessary.