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On the Take: How Medicine's Complicity with Big Business Can Endanger Your Healthby Jerome P. Kassirer
Synopses & Reviews
We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of the New England Journal of Medicine reveals in this shocking exposé, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today.
In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust.
Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals.
"'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. Agent, Theresa Park at Sanford J. Greenburger Assoc." Publishers Weekly (Copyright 2004 Reed Business Information, Inc.)
"A suprisingly bare-knuckled book by one of the last editors-in-chief at the New England Journal of Medicine." Mother Jones
"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
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.
Table of Contents
1 Free gifts, free meals, free education, special deals 1
2 Money-warped behavior 25
3 Conflicts of interest: financial and otherwise 50
4 Influenced by gifts?: not I! 63
5 Your doctor's tainted information 79
6 Our obliging professional organizations 103
7 Can you trust your doctor? 131
8 Can we trust our researchers? 154
9 How did it happen? 170
10 What can be done? 192
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