A Budding Emergencist
Thursday, August 03, 2006
  Dr. DeAngleis, JAMA Ed-in-chief
Cross-posted from Kevin's post about JAMA's "No Free Lunch" editor-in-chief

My prediction: Dr. DeAngleis will be good for JAMA, and for the AMA. Our top journals being direct to doctor advertisement has got to stop, or at least be recognized.

Why? Because trust is an issue. People's trust in doctors, hand-patters nonwithstanding, depends on their judgement. A doctor acts as a judge in medical matters, weighing evidence and coming to a ruling regarding the perpetrator and the treatment. What if we allowed real judges to accept money from the prison-industrial complex, or even influence in the form of studies that showed that perps who go through CCA's or Wackenhut's "rehabilitation" end up being model citizens? Or what if we did an end run and allowed these co's to influence lawmakers (no, no, no, not in our fair country...) to mandate prison sentences, effectively tying judges' hands (since guilt is determined by juries in criminal, and, dare I say it, medical malpractice cases) by removing judicial (and by allegorical extension, doctors') discretion?

Don't think it hasn't happened to medicine. Quick, what is standard of care for hyperlipidemia? Depression? Non-resectable breast cancer? Hypertension? Urinary retention? Alzheimer's? Upper respiratory tract infection? Come ON! These medical standards were defined by ghost written articles in top journals, subsequently flogged by drug reps over free eggplant parmesean, and finally begged for by patients after watching Bob Dole waltz his way into Viagra-enabled ecstasy.

In addition, medical journals, which target a very small and relatively wealthy population, often restrict advertising (NEJM) to pharmaceutical companies and drug-device manufacturers. Thus, the existence and publication of the journal itself depends on drug advertising. Going back to our metaphor, how would you like to see a leading criminal law journal restrict its advertising to CCA and Wackenhut?
 
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Emergency medicine, from the beginning of a new doctor's career.

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Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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