Selling Sickness. By Ray Moynihan and Alan Cassels. Vancouver: Greystone Books, 2005. ISBN 1553651316. Hardcover, 272 pages. $32.95.
This book is a must-read if you or your patients are concerned about the way the prescription drug business works. If you have wondered why the cost of medications in our system has gone from half to more than the cost of physician services over a decade, you’ll find some answers here. The writing style is journalistic without being sensational, has well-supported observations, and is an easy read.
There is a strong British Columbia connection since Mr Cassels is a drug policy researcher at the University of Victoria whom many of us have met or heard speak on drug issues. Some of the examples given in the book are very familiar, including references to activities of the Therapeutics Initiative, the work of some BC physicians, and several Pharmacare initiatives. Mr Moynihan is an Australian medical journalist who has written in the Lancet and the New England Journal of Medicine.
The focus is on the myriad avenues through which “big pharma” constantly influences every facet of medication use—marketing, regulation and policy, upward cost pressures, research, guideline development, and the seduction of physicians with money, peer pressure, prestige, and trinkets.
Serious questions are raised that our profession should be asking itself about the reluctance to establish stronger ethical boundaries with the pharmaceutical industry, regulation of financial relationships with sellers, acceptance of financial incentives, and frank conflict of interest. Material is drawn from several countries’ experiences and it reveals the cost of shrinking government support for research and evaluation; it leaves drug development to an industry that aims to fund only what might increase sales.
The chapter titles are descriptive: Selling to Everyone (Cholesterol, the Ads), Working with Celebrities (Menopause and the Public), Making Risks into Medical Conditions (Blood Pressure), Advertising Disease (Premenstrual Dysphoric Disorder), Taming the Watchdogs (IBS and the FDA), and so on.
The information in this book confirmed many things I had suspected. Physicians reading this book should recognize big pharma’s influence on the provision and cost of services and increased testing and office visits. The overlap from consumer advertising in the United States to the Canadian system and the number of patients sent to physicians’ offices specifically to request products they have been “sold” are further evidence of the industry’s sway.
The impact of siphoning billions of dollars away from other service needs, including physician services, and how we as a profession play a role in the uncontrollable rise in pharmaceutical costs are examined.
This is a timely book and I recommend it to anyone concerned about the bigger picture in health care. It makes clear that leaving our fate to the marketplace is risky and expensive and not necessarily a good thing for our patients’ health or our health care system.
—David Blair, MD
This book was recently referred to me by my family physician. I am a 63-year-old man who underwent surgery for colon cancer in October 2003.
After the surgery, I felt ill and somewhat helpless. However, daily visits from my doctor and the surgeon reassured me that my condition was stable and that I would improve daily. Seven days after my operation, I was discharged from the hospital and returned home.
I began chemotherapy a month later. The treatment was supposed to last for 6 months but after the second month I was very sick and had trouble completing normal daily functions. I decided to stop the chemotherapy and, 2 years later, am progressively feeling better. I cannot do many of the things I used to and I fatigue easily, but by pacing myself I can accomplish most activities.
I have no medical background or experience and likely would not have purchased this book without my doctor’s referral. Much of the information in it was of interest to me and to my family and would have been especially helpful soon after my surgery. Sections on staging protocols, nutrition and healthy eating plans, and stress and relaxation were of particular interest.
The section on 5-year survival figures could be unsettling for some readers, particularly during the first 2 years following surgery and treatment. Supplementary information from family physicians to patients specific to their individual cases could provide a reassuring balance.
This book is considerate, comprehensive, informative, and easy for the general public to understand. It is not a book to be tackled in one reading but is more easily digested when used as a reference. It answers questions about how patients may feel during and after their diagnosis and treatment as well as what they may experience in the future. For families and friends of colorectal cancer patients, it offers an understanding of their loved one’s experiences. It is a must-have for those who have endured colorectal cancer.
—John F. Nugent
Physician, do not heal thyself! If you become sick or suffer an injury, it may be difficult for you to make the switch from doctor to patient. But if you file a claim for disability benefits, it’s critical to make that transition since it could impact the benefit amount you receive.
Once you are absent from work due to a disability, it’s important that you seek medical attention from another physician immediately. Not doing so may affect the period of time the insurer will consider your period of disability. Regular care and attendance by a treating physician is contractually required both at the onset of, and during, your disability. A benefit will not be paid for any time that you are not under the required appropriate care.
The following is not considered appropriate care:
• Discussion of your condition with a colleague.
• Treatment from a family member.
• Consultation by telephone.
• Reporting your absence from work to the head of your department (who is a doctor).
• Treatment before your absence from work.
So, as a physician, heal your patients; as a patient, look to an attending physician to heal you as soon as you are absent from work due to a disability.
—Sandie Braid, CEBS
BCMA Benefits Department
Dr Wallace Chung was recently appointed a member of the Order of Canada. Dr Chung graduated in medicine from McGill in 1953. By 1958, he was chief resident in general surgery at Vancouver General Hospital (VGH). He rose to the rank of professor of surgery and became head of the UBC Division of General Surgery and the Division of Vascular Surgery. Professionally, he is perhaps best known for the introduction of innovative techniques in stroke surgery and for the advancement of vascular surgery as an officially recognized specialty in Canada, overseeing its evolvement into a separate surgical division at both VGH and UBC. He led the Department of Surgery at University Hospital for nearly 10 years and did much to enhance its international reputation as an important academic facility.
He is very much involved with the UBC Library, serving on the President’s Library Advisory Council (chair 1993–1997) and, more recently, donating 25000 books and printed materials and 1750 artifacts from an extraordinary private collection. The collection reflects his personal fascination with the CPR and its fleet of steamships. From bedpans to life preservers to pamphlets aimed at new European settlers to a first edition of Captain Cook’s Voyage to the Pacific to an incredible 13-foot model of the Empress of Asia steamship, the collection is an invaluable assortment of tangible history from BC and Western Canada.
Dr Chung’s donation is a generous but unsurprising act from one who strives to promote and preserve Chinese culture in Canada. He was a founding member and past chair of the Vancouver Chinese Cultural Centre; a member of Canadian Multiculturalism Council (playing a role in drafting the Multiculturalism Act), the International Dragon Boat Festival Society, and the BC Heritage Trust’s board of directors; and commissioner of the Vancouver Maritime Museum.
—Stephen W. Chung, MD
The new year is coming and it is time for Docs on the Run to get going again. This training group and run team is open to all physicians and their family members. While the training is designed to prepare participants for taking part in the Vancouver Sun Run or the Victoria Times Colonist Run in late April, the training will get you ready to run in any 5 K or 10 K event.
We have made some improvements this year which we hope will get more people involved after a successful start-up last year. Docs on the Run online training will start in mid-January. The online training will be run by Ms Lynn Kanuka (bronze medalist in the 3000 metre race at the 1984 Olympic Games). During the training, information will be given about nutrition, running shoes, common injuries, and other topics. Lynn will also respond to your questions and give weekly tips.
The training is appropriate for those just starting out through to those who want to learn to run 10 K faster. In addition to the training support, you will receive the Beginning Runner’s Journal and a high-quality running shirt with the Docs on the Run insignia. The registration fee is $95. You can register by calling SportMedBC at 604 730-7225 or, beginning in January, online at www.sportmedbc.com.
The Sun Run or Times Colonist Run registrations will take place in the new year. The Vancouver Sun is also looking for a doctor to feature as one of the people training for the Sun Run, so if you are willing to be featured in this way please send an e-mail to Docsontherun@bcma.bc.ca.
We know many docs do the Sun Run or Times Colonist Run every year. Let’s make a real effort to come out in force as the Docs on the Run team this year. Once again a CME dinner event will be held the night before the runs in both Vancouver and Victoria.
—Ron Wilson, MD
Sexual Medicine in Primary Care by Dr William L. Maurice was recently awarded the SSTAR Health Professional Book Award for 2005. The selection committee called it “a superb text for medical school use, or for graduate programs in health-related programs such as clinical psychology, nursing, and social work. It is already having a most significant impact in reaching out to an audience in need of sex therapy information. It is thorough, well written, and fills a great need in the field. It is already being used extensively in teaching and is quickly becoming a classic reference in sex therapists’ offices.”
Dr Maurice is a psychiatrist who has subspecialized in the area of sexual medicine since joining the UBC Department of Psychiatry in 1970. He was co-director of the Sexual Medicine Unit at Shaughnessy Hospital and head of the Division of Sexual Medicine in the UBC Department of Psychiatry. He has been president of both the Canadian Sex Research Forum and the Society for Sex Therapy and Research (SSTAR). Since retiring from UBC in 2004, he has been the director of the Sexual Medicine Consultation Clinic at the Vancouver Community Mental Health Service.
Providence Health Care has received the 2005 International Spirit at Work Award, presented annually by the Association for Spirit at Work (ASAW) to recognize organizations that have implemented spiritual practices, policies, or programs in the workplace.
In making the award, the ASAW said Providence was the first example they had seen of an organization that used spiritual principles and practices to support staff while undergoing major restructuring. Providence was also acknowledged for the many spiritual development opportunities provided to staff members of all faiths.
Over the past 4 years, the International Spirit at Work Award has been given to 23 companies ranging from the Body Shop to the Times of India and to the Australia and New Zealand Banking Group Ltd.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org