Doctors need outside review

Re “Tainted medicine,” Opinion, April 6

The reason that efforts by the medical profession to reform its conflicts of interest have been, as Dr. Jerome P. Kassirer describes them, “superficial” is that physicians are allowed to police themselves, unlike in some other professions. Peer review is a sacred cow in the medical community, but it is in need of some major doctoring.

Consider the police and the airlines, for example, before outside agencies began to police them. And consider their safety records since they have had parts of their functions placed under the direction of independent agencies. Both resisted outside supervision, but their service to the public has improved markedly.

There is no question, as Dr. George Lundberg, former editor of the Journal of the American Medical Assn., said, that “in America, [medicine] has become mostly a business.”

Because of this, conflicts of interest associated with the medical community have proliferated -- at great and continuing cost to medical professionalism -- and to the well-being of patients.

Lee Karr

Venice, Fla.

Kassirer persistently targets financial conflicts while ignoring the many other potential sources of lack of scientific objectivity. Some of these include professional advancement, careerism, ideological or political beliefs, personal (or family) experiences or even religion. Yet there seems to be no widespread call for disclosure of these and other fraught areas of conflict.

Conversely, one might ask if journals and readers should trust a publication on, say, environmental causation of breast cancer, submitted by a researcher whose career has been devoted to finding such a link -- or to a study funded by a foundation devoted to that same cause? No one, it seems, bothers to inquire.

Kassirer uses the withdrawal of the drug Rezulin as an example of supposed pharmaceutical corruption, but he ignores the fact that the drug was a major advance when first introduced. It was, appropriately, later succeeded by two safer drugs once they were approved.

This course of events actually demonstrated that the system worked as it was supposed to. And the expensive new drugs he decries improved on the old -- in fact, newer drugs have been shown to be more effective, in general, than older drugs -- saving money for the healthcare system in the long run.

Gilbert Ross MD

Medical Director

American Council on

Science and Health

New York