COMMENTARY

Response to AMA's Council on Ethical and Judicial Affairs Draft Report on "Ethical Guidance for Physicians and the Profession With Respect to Industry Support for Professional Education in Medicine"

Thomas P. Stossel, MD

Disclosures

June 12, 2008

Benefits of Commerce in Medicine and Medical Education

Prevalent political pronouncements that our healthcare system is "broken" belie the fact that longevity and quality of life have steadily improved since the 1960s when medicine began to become increasingly "commercial." The death rate from cardiovascular disease, for example, the number one killer, has steadily decreased and is currently half of what it was at that time.[8] Because the overall death rate remains 1 per person, this spectacular improvement might have resulted in higher fatalities due to other major diseases, but deaths inflicted by cancer, the number two killer, remained relatively constant as heart disease deaths declined, and, for the last few years, have also decreased.[9] Many factors have contributed to these trends, but economic analyses have concluded that the principal reason for them has been the introduction, and marketing, of new technologies by private companies -- drugs, biologics, devices, and information systems.[10,11,12,13] Publicly funded research, primarily from the National Institutes of Health (NIH), has been essential for medical innovation, but the investments of private companies are the major mechanisms for the development and delivery of useful products on the basis of such innovation to patients.[14,15] Other important examples of value derived from commercial medical technology include medications enabling prolonged symptom-free survival of HIV-infected patients and the introduction of diagnostic methods that render our blood supply increasingly safe.

If the purpose of medical "professionalism" is better patient care, the manifestly positive outcomes of corporate investments in research, development, and promotion -- outcomes ignored by Brennan and colleagues -- contradict The Report's remarkable distortion that corporate support of education somehow renders "the wide array of diagnostic and therapeutic options available today[1]" a threat rather than a boon to patients. Such variety is precisely what providers wishing "to be competent to help and to help with the patient's best interest in mind[1]" should have at their disposal. Brennan and The Report also failed to acknowledge the evidence that many patients frequently do not receive appropriate products, not because of access problems, but because their physicians do not recommend them.[16,17,18] Because a major reason for deficient prescribing is lack of physician awareness, potentially curtailing information transfer by constraining its funding will increase this deficiency. In summary, this context of manifest benefits from commercialism in medicine mandates serious caution before dismantling a system that delivered them.

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