دانلود کتاب On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health

The recent financial meltdown illustrates yet again how capitalism is vulnerable to exploitation and serious instability because of greed. Our health care system is a particularly egregious example of this problem. A major reason why costs are spiralling is rather obvious if one pays attention: drug companies, medical technology companies, insurance companies, hospitals, and some (not all) doctors and researchers are simply making too much money! They get away with it because a shell game has been set up in which the costs are largely hidden in Medicare/Medicaid and insurance premiums, with insurance premiums in turn hidden as “employer benefits.” But rest assured that you and I (the public) are paying for all of this through increased taxes, reduced incomes, and higher costs of products and services. After all, where else but the public does money ultimately come from?

All of this is context for this book by Dr. Jerome Kassirer, a highly respected doctor who was Chief Editor of the New England Journal of Medicine for over 8 years. Kassirer particularly focuses on how drug companies (and medical technology companies) use every method they can to try to influence doctors to use and promote their products, thus imposing greatly increased cost on the public, often with little or no health benefit, and often at increased risk to the public due to unnecessary or inappropriate research participation, testing, and treatment. Big pharma especially spends a huge amount of money pushing drugs (more than $30,000/year per doctor!) because their resulting boost in profit is even higher, and they employ methods which are rountinely unethical and sometimes illegal.

Many (not all) doctors collude in this ruse because they naively and wrongly believe that their judgment is not being adversely affected (countless anthropological and psychological studies on gift exchange refute this), and some are motivated outright by greed because they make a lot of money in the process. As one might expect, this corruption extends not just to individual doctors, but also to hospitals, research institutions, and medical professional organizations, among others. When the medical profession is “on the take” in this way, not only does cost and risk to the public go up, but a vital bond based on trust is also broken, to the detriment of everyone.

Kassirer’s solution is tight governmental regulation with a high level of transparency. This solution is not only appropriate, but it’s also pretty much the only viable option we have, since we can already see that the medical profession isn’t going to adequately regulate itself, and drug companies will certainly continue to do whatever they can get away with. Of course, as with capitalism in general, the problem is that these various participants in the lucrative health care system are wealthy special interests, and they will do whatever they can to resist regulation which goes against their financial interest. Kassirer is aware of this and he recommends that the public apply pressure to help implement such regulation, but I worry that it won’t happen, at least not until we reach the point of extreme crisis (we’re certainly getting there). Time will tell, and suppose I should try to be optimistic …

Meanwhile, for anyone who wants to learn more about this disturbing situation (to put it mildly), I can certainly recommend this book. Kassirer is eminently qualified to write it, his tone is measured and balanced, and he provides plenty of detailed data and examples to back up his assertions (the details are actually more than I needed, but I can see that he had to provide them).