The courts and commercialised medicineby Helen SpringNews Weekly
, November 4, 2000
Medicine's 2000-year-old Hippocratic tradition - codified in the Medical Code of Ethics - may be on the wane, but economic rationalism could deliver the coup de grace.
The first directive in this code is "First do no harm - Primum non nocere".
Second comes: "Listen to the story, 'ere yet ye construct the history." That is, the facts before the conclusions. Only by listening to the patient can we discover the nature and origin of the affliction. The doctor is then able to understand and help the patient find the remedy.
Now, it seems, listening to the patient is discouraged by insidious propaganda and the veiled promotion of medication to dull the symptoms.
In America, the medical profession is failing in its duty of care to patients. Many doctors have become hirelings of managed care. Many are becoming cosy with pharmaceutical firms. The fight to defend patients has been left to lawyers. Class actions are on the increase.
For example, following successful litigation against the tobacco industry, lawyer Richard Scruggs filed a suit against Aetna, one of the largest managed care businesses in America. Other high profile lawyers are also suing managed care companies (Fortune, November 8, 1999).
In one widely-reported action, lawyers claimed that "Attention Deficit Hyperactivity Disorder" (ADHD) is an invented syndrome designed to fuel the sale of psycho-stimulant drugs." (The Australian, September 26, 2000). According to The Bulletin (October 24, 2000), "two class actions have been brought against Novartis, the manufacturer of Ritalin, the American Psychiatric Association and CHADD, a parents' support group, alleging fraud and conspiracy in the over-promotion of ADHD and Ritalin."Conflicts of interest?
As such legal actions demonstrate, patients need to be aware of potential conflicts of interest in medicine. They also need to watch closely politics in medicine, because politics may influence the treatment patients receive.
Take, for example, a recent situation: three medical organisations - the Australian Medical Association, the National Association of Practising Psychiatrists (NAPP) and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) united to defend a small group of vulnerable patients, victims of a Medicare anomaly (Item 319) - reported previously in News Weekly - which restricts access to intensive psychotherapy.
It is now believed that the RANZCP has withdrawn from collaborating with the other two bodies.
Although apparently only of esoteric interest (to the patients, their families and the doctors who treat them) the issue has wider ramifications. The outcome is being watched closely by medical and other interested parties because it has great symbolic significance.
Leaving such a small group of patients undefended would signal that the road to American-style market-driven medicine is wide open.
If this is the case, then Australians may follow Americans and turn to lawyers. Will Item 319 be the first such Australian class action?