From Publishers Weekly
"Some physicians become known as whores." This is strong language in Kassirer's mostly temperate but tough look at how big business is corrupting medicine—but according to Kassirer, one doctor's wife used the word "whore" to describe her husband's accepting high fees to promote medical products. Such personal anecdotes distinguish Kassirer's look at the conversion of America's health-care system into a commercial enterprise. Kassirer, former editor-in-chief of the prestigious New England Journal of Medicine, notes the range of conflicts of interest between profit-centered business and people-centered medicine, such as the drug industry's huge expenditures (in the billions) for courting doctors to use their products, for recruiting physicians to tout their drugs or, more slyly, to present seemingly objective medical discussions that, on closer examination, do favor the company's product over others. Kassirer also covers the abuses of both fee-for-service (which can lead doctors to perform unnecessary but lucrative tests and procedures) and HMOs (which reward doctors for keeping costs down). The author calls for more scrutiny of the health-care industry by Congress and a "sustained public outcry against inappropriate practices"; the banning of industry gifts to medical personnel; and—difficult to imagine—disclosure to patients by doctors of financial incentives they are receiving.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
From The New England Journal of Medicine
The profession of medicine encompasses a wide variety of ways in which a physician can dedicate his or her life within the traditional areas of clinical practice, research, education, and administration. In this book, Jerome Kassirer, a former editor-in-chief of the Journal, documents, with well-referenced examples, how conflicts of interest, primarily financial in nature, have infiltrated all areas of the profession. The audience for the book is clearly the U.S. public, who, the author writes, "must become involved if we are to change the greed culture that permeates medicine." I agree, in principle, with the author that there are substantial conflicts of interest within the medical profession. However, I question the potential effectiveness of this book as written for the public. The most obvious reason for a physician of Kassirer's stature as a clinician, academician, and former editor to write a book about conflicts of interest in medicine would be to continue his attempts to eliminate or at least decrease a problem that diminishes the profession. But is this book a good way to accomplish that goal? The book wavers between a scholarly work and a sensational expose. For example, the cover features a man wearing a white coat and a neat shirt and tie, with a stethoscope around his neck and a pricey pen and a few crisp $100 bills tucked in his pocket. I was taken aback by the image, which is clearly meant to depict a "fat cat doc" on the take. However, this jarring image is then tempered by the two opening sentences of the first chapter, which declare that most physicians are hard-working and dedicated to their patients and that perhaps even hundreds of thousands of physicians refuse to take any financial gift that might affect their clinical judgment. Then, aside from a few selected exceptions to that supposed rule, the rest of the book is dedicated to stories about physicians tainted by financial self-interest that altered how they cared for patients, how their research was conducted and reported, what they taught, and how they administered medical institutions, with evidence that all of these conflicts of interest led to the detriment of patient care. The final chapter discusses "what can be done," ending with a "possible roadmap" that includes 10 items for immediate implementation that would be possible primarily by legislation. The reader is asked to take a political stand to force the enactment of such legislation. If the reader were to take such action, the author would deserve a medal. However, if the reader's more likely reaction would be to view with distrust all physicians currently practicing in the United States, it would be unfortunate indeed and would undermine the very reason that the book was written. Catherine D. DeAngelis, M.D., M.P.H.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
"A surprisingly bare-knuckled book by one of the last editors-in-chief at the New England Journal of Medicine."--Mother Jones"A temperate but tough look at how big business is corrupting medicine."--Publishers Weekly"Kassirer's quiet fury is palpable as he watches his beloved medical profession being corrupted by businesses willing to do whatever it takes to get their drugs prescribed."--American Scientist"From this book's title to its final words...Jerome P. Kassirer slams his fellow physicians.... 'It shouldn't have to be patients' responsibilities to protect themselves against the medical profession,' Kassirer writes. Bravo to that."--Tom Graham, Washington Post Book World"Documents with well-referenced examples, how conflicts of interest, primarily financial in nature, have infiltrated all areas of the profession."--New England Journal of Medicine"Kassirer...has taken on the daunting task of documenting the varied and ingenious ways in which his fellow physicians have managed to accept money and gifts from pharmaceutical companies without calling the practice 'bribery'.... One virtue of this fine book, at least as a muckraking exhibit, is that its author, a physician of the old school, has been around long enough to see a lot of unraked muck.... You have to admire Kassirer's willingness to call a spade a spade."--American Prospect"An important and thought-provoking analysis of the extensive conflicts of interest that pervade the relationship between pharmaceutical companies and the medical profession. This book is a wake-up call for physicians, policy-makers, and the public." --Senator Edward M. Kennedy"On the Take should be required reading for anyone concerned about the future of medicine in this country. Kassirer has shined a much-needed spotlight on the dark underbelly of physicians' financial dealings with industry. He argues compellingly that the corrupting influence of money is now so entrenched that the medical profession alone may not be able to save itself from rank commercialism. Public outrage at the unconscionable practices documented in this book may be our only hope of redirecting the medical profession away from overweening self-interest and back towards its moral purpose--protecting patients' interests. If readers of this book are not outraged at what they learn, hope for a future of beneficent medicine may indeed be lost."--Jordan J. Cohen, M.D., President, Association of American Medical Colleges"On the Take describes the web of financial interests that entangles many doctors and threatens their objectivity and professionalism. Equally bad, financial conflicts of interest can undermine public trust in doctors. In this book, Dr. Jerome P. Kassirer diagnoses the malady as systemic, widespread, and insidious. Dr. Kassirer's powerful account will make it hard for anyone to deny that a serious problem exists and demands attention. On the Take deserves to be read by everyone who has a stake in the future integrity of medicine and health care."--Harvey V. Fineberg, President, The Institute of Medicine of the National Academy of Sciences"Dr. Jerome Kassirer authoritatively describes the emerging immersion of the practice of medicine into the activities of the pharmaceutical and medical device world. As medicine itself has become a big business, the duties of the physician to the patient are in danger of being compromised and subverted. Personal vignettes from the author's experience lend credibility to many of the dangers described. The observations are disturbing and the implications profound." --Joseph B. Martin, M.D., Ph.D., Dean of the Faculty of Medicine, Harvard University"This important book provides a thoughtful, well-documented, and ultimately devastating exposé of the pervasive relationships between health care corporations, researchers and practicing physicians. Every patient should be familiar with the conflicts of interest that affect the care they receive, and this book explains those conflicts with often frightening clarity. The time has come for full disclosure." --Dr. John W. Rowe, M.D., Chairman and CEO, Aetna, Inc."On the Take paints a disturbing portrait of a medical system twisted by unseen and pernicious conflicts of interest. Dr. Jerome Kassirer writes with the authority of a leader in medicine, with the candor of an advocate who pulls no punches, and with the common sense of a citizen who can smell when something is just not right. I highly recommend this book." --U.S. Representative Henry A. Waxman, California Book Description
An eminent physician exposes rampant corruption and conflict of interest in America's healthcare system
About the Author
Jerome P. Kassirer is Distinguished Professor at Tufts University School of Medicine and Adjunct Professor of Medicine at Yale University School of Medicine. Editor-in-Chief of New England Journal of Medicine for more than 8 years, he has been honored by membership in the Institute of Medicine and the American Academy of Arts and Sciences, and has been referred to as the "Conscience of American Medicine." He lives in Wellesley, Massachusetts.
