Will centrifugal forces destroy the medical profession?

Article Abstract:

The rate of expansion of medical knowledge and the degree of specialization that is required to remain current in one's medical specialty have led to considerable partitioning among physicians. Often there is little to bind one subspecialty or specialty to another. This has also led to battles of territory or jurisdiction where the same procedure or treatment or where competing therapies are practiced by different types of physicians. There is a growing sense of despair, particularly in older physicians, concerning the future of medicine and the medical profession. In addition, the growing involvement of nonphysicians such as legislators, review bodies, administrators, and accountants adds to the sense of loss of physician control and direction. Considerable improvements provided by technological advances in instrumentation and genetic engineering that have greatly changed the practice of medicine. Concomitantly there have been major sociologic changes that have allowed many physicians to move from members of the middle class to more extravagant lifestyles. Modern medicine has increasingly become entrepreneurial and now more resembles a trade rather than a profession. The degree of funding and the friendliness of legislatures toward the medical profession have also decreased. Increased cohesiveness within the profession could allow it to exert a stronger influence on legislation. The profession must find a better way of protecting its autonomy while offering a more collegial environment that also presents an image to the outside world that its own house is in order.

Social aspects, Medicine, Practice, Medical practice, Communication in medicine, Medical communication, column

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Physicians' conflicts of interest; the limitations of disclosure

Article Abstract:

Conflicts of interest between a physician's personal financial interest and the best interest of his patients is becoming an important issue in US health policy. There is nothing particularly new about such professional conflicts, and some should be accepted because to totally eliminate them could cause harm to some patients. Several states now require full disclosure of physicians' financial interests, including interests in medical facilities. By way of example, consider the investment of an internist in an imaging center, a facility that includes expensive but useful devices such as CAT scanners and magnetic resonance imagers. The physician will benefit financially from the center's success, and suffer financially if it is a failure, but it may never have been built without physician participation. To what extent should this form of investment be tolerated, considering the risks of over-use by the physician for personal gain? This article considers the use of disclosure policies for lawyers and governmental officials as a model for health professionals. Disclosure may help in dealing with the problem of physicians' self-interest, but by itself it is insufficient, and may place some patients at a disadvantage. It is possible that physicians may, by simple disclosure of financial participation, limit their legal liability rather than protect their patients from abuse. Financial disclosure coupled with a high ethical standard of conduct could produce useful and practical guidelines which would ensure proper conduct by medical professionals.

Interpretation and construction, Physician and patient, Physician-patient relations, Medical ethics

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An orally active iron chelator

Article Abstract:

The iron-chelating drug deferiprone appears to be effective in reducing excessive body iron but the drug has drawbacks. Iron overload is toxic to the body and is common in patients with thalassemia major, a disorder of hemoglobin metabolism commonly treated by regular blood transfusions. Another iron-chelating drug called deferoxamine has improved the prognosis of this disease considerably, but it must be injected like insulin. A 1995 study found that deferiprone, which can be taken orally, is effective in lowering iron levels. However, the drug has side effects, and patients must take one or two grams of the drug three times a day. Ten percent of the patients were not totally compliant with the treatment. The effective drug dose is so high that the drug itself may damage the very organs it is meant to protect. Longer studies of more patients are needed before this drug can replace deferoxamine.

Health aspects, Care and treatment, Editorial, Iron in the body, Iron (Nutrient), Chelating agents, Thalassemia

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