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In
the news ...
The
uneasy, unbreakable link of money, medicine
Even after centuries of earnest oaths and laws, the debate
about whether money compromises medicine remains
unresolved, observes Dr. Eli Adashi. The problem might not
be truly intractable, he said, but recent reforms will
likely make little progress or difference.
"This is one of those things we have to appreciate as
being with us for a long time," said Adashi, former dean
of medicine and biological sciences at Brown University.
"It will probably be with us forever. It's probably not
entirely fixable unless one really made a concerted effort
driven by consensus to do so, but that doesn't exist. I
think it's a useful exercise to call it as it is."
Those who worry physicians will be compromised by money --
and certainly not everyone does -- have sought to prevent
it for centuries, Adashi writes. Physician's oaths dating
back hundreds of years in Spain, India, Japan all decry
greed (and in one case, miserliness). Nevertheless,
in different countries and to different extents medicine and money remain entangled
not only in how physicians make a living, but also in
the debt their education creates, in their
entrepreneurship, or by the other stakeholders in
their industry, be they insurers or drug companies.
Even in the relatively laissez faire United States,
reforms over the last few decades have sought to lessen
potential challenges, Adashi notes. The "Stark Laws"
attempted to curb physician referrals of patients to
businesses they own. The Affordable Care Act took on the
matter of disclosure of industry payments to physicians.
The Affordable Care Act also encourages a transition from
"fee-for-volume" payment, in which doctors are paid more
for doing more procedures (as fast as possible), to
"fee-for-value," in which their incentive is to produce a
quality result at minimal cost.
But even that latter reform, Adashi writes, may not prove
decisive.
"Whether or not a momentous alteration of the economic
ground rules on this scale will in effect change hearts
and minds remains doubtful," he concludes. "More than
likely, money and medicine will remain indivisible and
irreconcilable for some time to come. Few expect
otherwise."
Brown University.
AMA Journal of Ethics
The corporate sponsored creation of
disease
Psychotropic drug prescriptions:
Therapeutic advances or fads? Painkillers, Drug
Addiction. Diagnostic and Statistical Manual of Mental
Disorder
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