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    A Times Editorial

    Physicians won't compromise care for drug loyalty


    © St. Petersburg Times
    published November 30, 2002

    I am writing in response to the article by Kris Hundley regarding a pharmaceutical representative for GlaxoSmithKline PLC who took some local doctors to a waterfront restaurant for dinner recently (Ethics code: They'll drink to that, Nov. 11). The article implies that the Glaxo representative was outside of the code of ethics that was recently signed by Glaxo and many other pharmaceutical companies.

    I am a family practitioner in St. Petersburg and though I have not read the code of ethics, it has been interpreted by many, if not all, of my pharmaceutical representatives as indicating that the pharmaceutical companies are still allowed to provide a "modest meal" as long as there is education presented at the time of that meal. When questioned, apparently the Glaxo spokeswoman indicated that this meeting did meet that description and therefore is not in violation of the company's code of ethics.

    The local sales representative, Tara Kipp, is also my Glaxo representative. Neither Ms. Kipp, nor Glaxo as a company, has solicited my business in an unfair or unethical manner, even before institution of this new code of ethics.

    It is not uncommon for many pharmaceutical companies and their representatives to take physicians to a local restaurant. I, for one, do not feel guilty at all for accepting a meal in exchange for the time that I give to the pharmaceutical company to learn about its product. By the same token, their providing me with a meal or other inexpensive promotional items does not "buy" my favors or loyalty. As a physician, I have enough morals to make appropriate decisions regarding the health and care of my patients. I certainly would not compromise a person's care and give him an inadequate medication because someone purchased a small meal for me. If one puts that in perspective with the medical malpractice crisis, it is not hard to imagine that a physician would be absolutely foolish to compromise his patients' care and risk a lawsuit simply for these small tokens of appreciation and/or advertisement.

    Although I am very young, I would be terribly antiquated in medical knowledge if it were not for the pharmaceutical representatives who have brought me new information, and then provided me with a setting in which to discuss these new medications with colleagues who may have more knowledge and insight into these new products.

    Unfortunately, medicine has become a business rather than a caring profession. As such, there are many distasteful things going on in the health industry, the least of which involves the pharmaceutical representatives "schmoozing" the physicians.

    I recall that several years ago, I was a guest in the St. Petersburg Times' box suite at a Tampa Bay Devil Rays baseball game. I recall the Times group providing me with a modest meal and drinks. I recall enjoying myself at that get-together, but I do not recall leaving that night feeling as though I was obliged to take out a subscription to the paper. Subsequent to that gathering, I have continued to purchase the Times because of its content and method of presentation, but certainly not because of a perceived obligation on my part to repay any favors.

    Gigi C. Lefebvre, M.D., St. Petersburg

    Give doctors a break

    Re: Lobby needs to be broken, letter, Nov. 23.

    The letter writer needs to turn on the big fans and blow the smoke away from his eyes. I'm not a lobbyist for the pharmaceutical industry, so a dinner meeting with a guest speaker on a medical topic to further my education does not lead to the prevention of generic drugs from entering the market, as the letter writer would imply. But now we're not even allowed to bring spouses or guests to the dinner, since the pharmaceutical companies are worried about congressional backlash. Yet congressmen running for office receive millions of dollars in contributions and are not required to pay back funds they don't use. And surely we're not the only profession that receives perks.

    If the phone or electric companies have an increase in their expenses, who pays for it? The consumer does with an increase in the charges to them. But when physicians face an obscene increase in malpractice premiums or the need to comply with absurd regulations which are certain to increase overhead, we are not able to pass along the additional expense to patients because of our contracts with managed care.

    Call your attorney and watch for the bill. Has anyone ever seen a bill from a doctor for a phone call? C'mon, give us a break. An educational dinner with our spouse or guest is the least we deserve.

    David Lubin, M.D., Tampa

    Elder care is high priorit

    The report was released in Boston. But Florida residents might like to know that the H. Lee Moffitt Cancer Center and Research Institute implemented in 1994 a Senior Adult Oncology Program to provide comprehensive care to older individuals with cancer, the second most common cause of death for older individuals. (The first is cardiovascular disease, but its importance as cause of death is declining; it is possible that in the near future cancer will be No. 1.) This program stemmed from the awareness of the special needs of the older population and from the desire to identify and serve these needs

    The impact of this program has been dramatic. The National Cancer Institute and the National Institute of Aging have funded eight grants for a total of $25-million to establish other geriatric programs at comprehensive cancer centers around the country to deepen and amplify elder care, based in part on the Moffitt experience.

    The other important aspect that should be highlighted for the management of older individuals is the need for coordination of care. More than 50 percent of the patients older than 65 in the United States don't have a primary care physician, even though they visit multispecialty clinics. The lack of a primary care provider has two unwanted effects:

    Neglect of social issues such as difficulty with transportation, home caregiving, food preparation -- all of which may interfere with the management of existing disease.

    Redundancy of diagnostic and therapeutic intervention, which increases cost and discomfort while creating a high risk of drug interactions. These may cause allergic reactions, suppression of the bone marrow, delirium coma and even death.

    I believe having a primary-care provider able to coordinate the care of older individuals and to resolve those issues that interfere with health care delivery, should be contemporary medicine's highest priority.

    Lodovico Balducci, M.D., program leader, Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa

    Terri has suffered enough

    Re: Judge: Schiavo can't recover, Nov. 23.

    After much deliberation, Judge George Greer ordered the feeding tube that has kept Terri Schiavo alive for 12 years be removed. Terri is then expected to expire from dehydration within two weeks. Can we begin to imagine the crushing grief that Terri's family will have to endure as their daughter dies that prolonged death?

    What kind of society do we live in when we can sanction prolonging death yet deny the medical profession that has kept Terri artificially alive with science and technology the right to use that same science and technology to end her life and her suffering?

    It seems to me, if the judge has the right to end Terri's life, then he should also have the right to order a single humane injection. Terri Schiavo has suffered enough, her family has suffered enough.

    Roberta McElwain, Seminole

    Calling Judge Kevorkia

    And what happens to the next handicapped person whom someone gets tired of caring for? Judge Greer has opened the door to legalized murder under certain circumstances. I'm sure Dr. Kevorkian wishes he were the judge in his case

    What has our court system come to when we will allow this absurdity and no one will step in and put a stop to it? God help us all.

    Sue Hill, Largo

    JFK triumphed over adversit

    The point to be made about JFK's tenure is not that he was willing to suffer physical problems as the price of "wielding great power," but that he had a unique talent for communication and leadership. Nor, in such circumstance, is it surprising that he felt obligated to exercise such talent in pursuit of appropriate causes, despite any personal discomforts such pursuits might engender. Being a realist as well as an idealist, he was also cognizant that "a fully informed electorate," (an oxymoron if ever there was one) would surely have considered him "disabled" and disallowed opportunity for such pursuit

    In similar context one thinks of cyclist Lance Armstrong, suffering post-cancer sequelae of weakness, weight loss and a trauma, which could not always be ameliorated because of the drug-testing policies associated with competitive cycling. Despite such constraints, and defying the predictions of naysayers, in what was widely perceived as a futile gesture of magnanimity, the U.S. Postal Service agreed to make Armstrong a team member. The rest, (Tour de France, times three,) is history.

    All of which suggests that perhaps we would do well to forgo speculations as to their devious motivational promptings and more accurately describe subsequent "overachievers" in time-honored fashion as exemplars of the triumph of spirit over adversity.

    Ben Tutoli, St. Petersburg

    Shocking antichoice politic

    It wasn't very long before the new antichoice leadership in Congress flexed its muscle. In their first legislative measure since Nov. 5, in the dead of night, the House killed a bill that would have made it difficult for perpetrators of clinic violence to evade fines by claiming bankruptcy

    This may be a harbinger of things to come in this increasingly antichoice environment in the White House and Congress.

    Ruth J. Anderson, Homosassa

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