Ordinary Doctors Research Articles

Disease Mongering: One of the Hidden Consequences

I found Moynihan and Henry's article on disease mongering [ 1] interesting, especially because I have previously suggested that the medical profession might consider being more proactive concerning various problematic areas in their interactions with the pharmaceutical industry by exercising their considerable power and improving the scientific quality of research [ 2]. There is a strong tendency for doctors to be trusting and accepting of the good intentions and honesty of others. It takes a substantial amount of evidence for doctors to adopt the contrary posture of distrust. Perhaps the profession is, understandably, at that point with pharmaceutical companies. A significant hidden area related to disease mongering is the inevitable increase in doctors' medico-legal insurance costs. The pharmaceutical industry has generally been quite successful in getting doctors to shoulder the blame for the negative consequences of drug treatment. They are quick to inform the profession (and patients, by covert direct-to-consumer advertising) of any evidence favourable to the promotion of their drug, but slow to update the product information, or inform doctors, about side effects, complications, or drug interactions [ 3]. It is dishonest to actively promote supposed advantages (to patients) whilst consciously failing to look for, or alert doctors to, the disadvantages. Furthermore, inducing patients to visit doctors and pressure them into colluding with drug company advertising is a subtle form of bullying. Medical insurers tend to accept full responsibility on behalf of doctors without much attempt to bring others into legal actions, especially drug companies. Since both patients and doctors are being fed misinformation, it may be that a greater part of the responsibility for difficulties should be apportioned to drug companies. Perhaps both doctors and drug companies need to be reminded that only doctors are able to sign prescriptions and take the primary responsibility for the consequences. It may be time for medical organizations and authorities to impose conditions and demand more information from pharmaceutical companies if they are going to agree to sign the script. As but one of many possible examples, how many doctors realise that drug toxicity data are rarely made available and that much of the data presented to regulatory authorities are not available to ordinary doctors? I suggest that those in the profession who are in a position to influence such matters should give serious consideration to these and other similar questions and exercise their power.

APA Disaster Team, Members on Scene Mobilize Quickly

APA Disaster Team, Members on Scene Mobilize Quickly

Bringing ordinary doctors into the genetics party

Bringing ordinary doctors into the genetics party

An Ethical Debate: Commentary: Too blunt an instrument?

Many ordinary family doctors reading this distressing account will feel a surge of relief that our uneasiness in this quintessential lose-lose situation is being aired at last. I am grateful for the candour of the writer, who knows how rarely the outcome of these interventions seems adequate. The stories of our adult patients remind us repeatedly of the disturbing prevalence and the damaging legacy of the sexual abuse of children. We are obliged to do all we can to protect children from this kind of damage, and to this end there is an incontrovertible requirement for doctors to work in close cooperation with other agencies. However, serious abuse of a child demands two responses from society: physical and …

New broom at the top? An interview with Anders Milton, the chairman of the World Medical Association's Council

The week long annual assembly of the World Medical Association opens in Bali next week. The WMA has been through long years of internal conflict associated with the continuing membership of the South African Medical Association and wrangles over finance, and the question that observers of the assembly must address is: has the WMA finally turned a corner, or are there still questions over its relevance to ordinary doctors? Douglas Carnall talked to Anders Milton, the chairman of its council, about the work of the WMA and his vision of its future. Dr Milton was born and brought up in Sweden and studied for a degree in economics before turning to medicine. He was appointed to the staff of the University Hospital at Uppsala as a nephrologist on completing his PhD. Four years ago he gave up his clinical work to became the full time secretary general of the Swedish Medical Association. He was elected chairman of the council of the WMA in April of this year. DC: Why do doctors need the WMA? AM: Doctors are all members of one of the classic professions. A profession is defined by two qualities: firstly, it defines its own area of work, and, secondly it has it own ethics. Medicine has had its own ethical guidelines since the time of Hippocrates, the basic rule being that you should not harm your patients--do good and not bad. However, during the second world war some doctors in some countries engaged in “scientific” research on or pure torture of both civilians in concentration camps and prisoners of war. After the second world war it was felt that this should not happen again, and a number of medical associations decided to form a world body that would define and promulgate medical ethics throughout the world, while …

Electoral reform of GMSC

EDITOR,—As a member of the General Medical Services Committee of many years' standing who may have to answer to an electorate of ordinary general practitioners, J David Watts has one view of the need for changes in the method of election to the committee.1 I, as one of those ordinary doctors, have another view.2 It is perhaps understandable that they differ considerably. I am grateful to Watts, however, for telling us why Leicestershire's motion at the BMA's annual representative meeting last year was deliberately placed low on the order paper. What Watts seems …

A dialogue between practitioners of alternative (traditional) medicine and modern (western) medicine in Norway

This paper tells about a ‘dialogue group’, consisting of alternative and modern health practitioners, that was started in Norway in 1989, how it works and what has been achieved up to now. WHO has strongly advocated promotion of cooperation between traditional and modern health practitioners. In Botswana, where one of the general practitioners in the group has practiced, ‘United Health Committees’ have been established aiming at creating a dialogue between the different types of health professionals. In industrialized countries little seems to have been done so far. Many patients in Norway, as in many other countries, consult ordinary doctors as well as alternative practitioners. In Norway, members of these two professions almost never meet, other than as opponents. They receive information about each other mostly through discontented patients who have been unsuccessfully treated by the other part. In this way practitioners get an insufficient and biased report of one another's practices, as well as an unrealistic and distorted picture. If patients know that both parts respect one another, then most of them dare to tell that they use both types of practitioners. Otherwise many patients conceal this.

Chiropraktyk en homeopatie: 'n Voorbeeld van die legitimering van 'n newe-struktuur / Chiropractic and homeopathy: An example of the legitimization of a peripheral structure

The gradual establishment and expansion of chiropractic and homeopathy as alternative medical services in South Africa, may serve as illustrative material for various sociological theories. One issue of special interest is the legitimization of these medical services as a peripheral structure in the existing medical system. Evidence was provided by a nation-wide survey (N = 2 206) undertaken during 1983 by the Opinion Survey Centre of the Human Sciences Research Council. Of the respondents, 61,1% received their first information about alternative medical services by means of personal communication, in comparison with 9,3% who mentioned mass media. Asked about the reasons why they consulted alternative practitioners, the majority stated that they were ‘desperate’ or ‘in despair’. Patients of alternative practitioners also appreciate their personal attention and hold their efficiency in high esteem. A considerable proportion of respondents who had often and regularly consulted ordinary doctors to no avail o...

A Tale of Two Islands

To the Editor.— Once upon a time all was well on the islands of the common language, and the medical schools taught everything. A few students tarried in hospitals for a while, but most became ordinary doctors. Some had a hard time at first, but most were happy because they were not poor and they were loved. It was easy to get a doctor for ordinary sick people because there was one with a black bag at every corner. Some wanted to become learned. So they worked in the outpatient clinic at the hospital for many years for free. But they were still ordinary doctors They read heavy books and clever journals and tried for hard examinations. Some became little chiefs and were allowed to take care of patients in two beds at the hospital for free. A few became big chiefs and took care of many patients at the