On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health [Hardcover]

Jerome P. Kassirer M.D. (Author)

Book Description

ISBN-10: 0195176847 | ISBN-13: 978-0195176841 | Publication Date: October 18, 2004 | Edition: 1

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 expose, 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.

Editorial Reviews

From Publishers Weekly

"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.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From The New England Journal of Medicine

The profession of medicine encompasses a wide variety of ways in which a physician can dedicate his or her life within the traditional areas of clinical practice, research, education, and administration. In this book, Jerome Kassirer, a former editor-in-chief of the Journal, documents, with well-referenced examples, how conflicts of interest, primarily financial in nature, have infiltrated all areas of the profession. The audience for the book is clearly the U.S. public, who, the author writes, "must become involved if we are to change the greed culture that permeates medicine." I agree, in principle, with the author that there are substantial conflicts of interest within the medical profession. However, I question the potential effectiveness of this book as written for the public. The most obvious reason for a physician of Kassirer's stature as a clinician, academician, and former editor to write a book about conflicts of interest in medicine would be to continue his attempts to eliminate or at least decrease a problem that diminishes the profession. But is this book a good way to accomplish that goal? The book wavers between a scholarly work and a sensational expose. For example, the cover features a man wearing a white coat and a neat shirt and tie, with a stethoscope around his neck and a pricey pen and a few crisp $100 bills tucked in his pocket. I was taken aback by the image, which is clearly meant to depict a "fat cat doc" on the take. However, this jarring image is then tempered by the two opening sentences of the first chapter, which declare that most physicians are hard-working and dedicated to their patients and that perhaps even hundreds of thousands of physicians refuse to take any financial gift that might affect their clinical judgment. Then, aside from a few selected exceptions to that supposed rule, the rest of the book is dedicated to stories about physicians tainted by financial self-interest that altered how they cared for patients, how their research was conducted and reported, what they taught, and how they administered medical institutions, with evidence that all of these conflicts of interest led to the detriment of patient care. The final chapter discusses "what can be done," ending with a "possible roadmap" that includes 10 items for immediate implementation that would be possible primarily by legislation. The reader is asked to take a political stand to force the enactment of such legislation. If the reader were to take such action, the author would deserve a medal. However, if the reader's more likely reaction would be to view with distrust all physicians currently practicing in the United States, it would be unfortunate indeed and would undermine the very reason that the book was written. Catherine D. DeAngelis, M.D., M.P.H.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

• Hardcover: 272 pages
• Publisher: Oxford University Press, USA; 1 edition (October 18, 2004)
• Language: English
• ISBN-10: 0195176847
• ISBN-13: 978-0195176841
• Product Dimensions: 9.2 x 6.1 x 0.9 inches
• Shipping Weight: 1.1 pounds
• Average Customer Review: 4.4 out of 5 stars  See all reviews (17 customer reviews)
• Amazon Best Sellers Rank: #812,491 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

40 of 40 people found the following review helpful:

5.0 out of 5 stars We're not as objective as we think we are, April 18, 2005

By 

Martin G. Kistin - See all my reviews
(REAL NAME)   

This review is from: On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health (Hardcover)

Thirty years ago Dr. Kassirer was my chief when I was a medical house officer in Boston. (That will serve as my disclosure of possible conflict of interest although we have had little contact since that time.)
He has been a wildly successful nephorlogist/researcher, clinician and teacher. As editor of the New England Journal of Medicine, he constantly expressed concerns over possible conflict of interest and its influence on published medical literature.
This book is a highly researched and extensively documented look at conflicts of interest and potential conflicts of interest in the medical literature and other closely related areas of medicine. Sometimes there are situations where potential conflict of interest has little or no influence on our decision making. As amply documented in On the Take, there are other times when conflict of interest may impact our decision making to the detriment of our patients. This book examines when and how the harmless potential conflict of interest moves into the realm of a serious, even ethical, dilemma.
Amazingly, these conflicts may extend beyond the published medical literature to consensus papers and clinical guidelines increasingly embraced by the government and major medical societies and these conflicts of interest may even intrude into organizations designed to protect the consumer like the FDA (Food and Drug Administration) and the CDC (Center for Disease Control).
We as physicians minimize the extent to which potential conflicts of interest influence us in our medical practice - a view not widely shared by patients or government regulatory committees.
Dr. Kassirer presents a number of suggestions to improve the situation. Some of these are already being implemented by major medical journals. Others will depend on the integrity of individual practitioners.
This book should be a must-read for medical students - both those planning to do medical research and those who will use the medical research to guide their medical practices.
Martin G. Kistin, M.D.

73 of 78 people found the following review helpful:

5.0 out of 5 stars essential reading, January 25, 2005

By 

Paul Gahlinger, MD, PhD (Salt Lake City) - See all my reviews

This review is from: On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health (Hardcover)

I rarely write reviews, but in this case feel obligated to point out what a tremendous service Dr. Kassirer has provided. As a physician, I have always been concerned about the influence of gifts and outright payments to doctors and researchers in promoting pharmaceuticals and other healthcare. However, I had no idea how extensive and pervasive it is. Dr. Kassirer has done an outstanding job in giving us a picture of the truth. This is a very well written book. I strongly recommend that all medical students and physicians read it, and suggest that everyone interested in healthcare do so.

As a minor point: Dr. Kassirer does not address the same influence which is present in alternative and complementary medicine--whose practitioners often benefit from the negative press of scientific (allopathic) medicine. In fact, it is just as bad or even worse in those types of care.

Finally, I must point out that I have never met Dr. Kassirer and have no financial inducement to write this :-)

Paul Gahlinger, MD, PhD

60 of 65 people found the following review helpful:

5.0 out of 5 stars Big Pharma Out of Control, January 19, 2005

By 

Joel M. Kauffman (Berwyn, PA United States) - See all my reviews
(REAL NAME)   

This review is from: On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health (Hardcover)

Fact-dense, well referenced, yet balanced in tone and easy to read, this book is the best exposé I have ever read on the financial conflicts of the medical profession caused by the efforts of Big Pharma, which for this review will include device and test manufacturers as well as drug makers. From pens and pads to cruises and fake consulting arrangements, Big Pharma has caused financial conflicts in many physicians and others "on the take". Many of the consulting deals are to give talks, ostensibly based on good medical science, that promote a product. Much of this is shown to occur at Continuing Medical Education courses sponsored by Big Pharma in which gifts are freely dispensed, reprints of journal articles favorable to products are handed out, and financial ties of the "consultants" giving talks are minimized or concealed.

Academic researchers are tainted as well. By being encouraged by their universities to obtain grants with overhead from Big Pharma, they must do research that helps in product development. Agreements may delay, prevent or pollute the publication of results. When a product possibility from a government (usually NIH) grant is seen, federal legislation passed 20 years ago allows the researcher to patent discoveries, form a company, and do clinical trials on his own potential product. While this may have led to valuable results, the potential for bias at every step due to financial conflict is clearly laid out.

Journals fare little better, even the prominent JAMA, NEJM and Annals of Internal Medicine. Papers that may have been ghost-written by Big Pharma on clinical trials with selectively favorable results are published [see Joel M. Kauffman, Bias in Recent Papers on Diets and Drugs in Peer-Reviewed Medical Journals, J. Am. Physicians & Surgeons, 9(1), 11-14 (2004)]. Editors and peer-reviewers may have ties to Big Pharma. Editorials and comments in medical journals may be written by authors with financial conflicts of interest. Revealing such conflicts is mostly on the honor system at present.

Clinical guidelines for physicians are promulgated by committees whose members often have close ties to Big Pharma. The products included in formularies of HMOs, Medicare and other insurers, the only products that will be paid for, are influenced by Big Pharma, whose general lobbying efforts are already legendary.

Dr. Kassirer gives many specific examples of financial conflicts. Far from quitting with the devastating description of how bad things are, he goes on to make specific suggestions for reform, while being very realistic about their success without federal action for certain conflicts. He lists many desirable changes, such as no gifts from Big Pharma at all, boycotting meetings sponsored by Big Pharma, disclosure mandated for all financial ties, and selection of journal editors, officers of medical societies and leaders of medical schools who have no financial conflicts. He did not seem to indicate the degree of influence of Big Pharma on the FDA.

Trying not to alienate most of the medical profession, Dr. Kassirer wrote that most MDs are basically ethical and went into the profession for non-financial as well as financial reasons. Reductions in income with increased work loads due to inadequate compensation from HMOs and Medicare is one of the reasons so many MDs have looked outside normal practice for income.
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He dropped a few hints that most major classes of drugs are more beneficial than they actually are [see Joel M. Kauffman, "Drugging Cardiovascular Disease", J. Am. Physicians & Surgeons, 9(4), 98-99 (2004)], and that alternative practices are not worth much [see Joel M. Kauffman, "Alternative Medicine: Watching the Watchdogs at Quackwatch", Website Review, J. Scientific Exploration 16(2), 312-337 (2002)].
This is a very minor blemish on one of the great exposés of all time, the "Unsafe at Any Speed" of the medical madness in the USA today.
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Daniel Haley's "Politics in Healing" describes the squashing of alternatives.
Charles T. McGee's "Heart Frauds" exposes the mythology behind so much medical advice.
H. Gilbert Welch's "Should I Be Tested for Cancer?" gives the evidence for the harm in excessive testing.
John Anderson's "Overdosed America" reveals the extent of perverted clinical drug trials.
Merrill Goozner's "The $800 Million Pill" give the lie to Big Pharma's claim that high prices are needed for the discovery of breakthrough drugs, as does...
Marcia Angell's "The Truth About the Drug Companies", which also suggests how the perversion of drug trials can be halted.