Prescription drug abuse and the physician gatekeeper

Opioid painkillers such as Vicodin (hydrocodone) and OxyContin (oxycodone) are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, e.g., Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal […]

Dilemmas of cash-based practice

I write in response to a recent post on KevinMD and the comments that followed. A primary care physician named Ashley Maltz discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: she prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled […]

Medical professionalism vs commercialism

The history of American medicine is the story of the rise and fall of a professional guild. In the 19th and early 20th Centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice. Even more important, medical ethics put the patient first, above considerations of personal gain […]

Parenting medical disruptors

Popularized telemedicine — that is, teleconferencing with a physician over one’s smartphone — worries many critics because it assumes patients can be evaluated without a physical exam. The critics are right that those with a financial interest in “disrupting” health care typically minimize the trade-offs. Convenience and lower cost are trumpeted, while risks of misdiagnosis […]

NEJM and the pharmascolds

The New England Journal of Medicine (NEJM) called the question: Has criticism of the pharmaceutical industry, and of physician relationships with that industry, gone too far? Are self-righteous “pharmascolds” blocking the kind of essential collaboration that brought streptomycin and other lifesaving treatments to market? The editorial by Dr. Jeffrey Drazen and the lengthy three–part […]

Medical ethics are healthier than business ethics

Compared to most others in society, physicians endorse, and are held to, higher ethical standards. (To illustrate, here are ethical codes from the AMA and the World Medical Association.) High standards apply to professionals in other fields as well, especially fiduciaries such as attorneys, accountants, schoolteachers, and judges. But standards of medical ethics may be […]