This was going to be a post about science-based medicine and the law. Really. I still might write it, maybe even tonight. But before I could get started, I cleared my comment spam. Among the usual expected unsavoury entities hawking the usual unsavoury wares, I found two recent spam comments from professionals who really should know better.
I think the law bloggers handle this better than we on the medical side do. There are plenty of social media evangelists in both fields who can be found online treating new technology as an end and not a means, promoting the ideal of “saying anything” over “saying something,” and generally clogging the ‘tubes with tweets, blog posts, and comments that barely even try to masquerade as anything beyond marketing. At least there are some lawyers out there willing to call “shenanigans” when they see them.
I have yet to see a physician call out his/her colleagues for scammy/scummy behaviour online. Not like some of the blawgs do. Take Ken and Patrick at Popehat, for instance. They’re brutal, and rightfully so. As another blawger, Eric Turkewitz, puts it: “when you outsource your marketing, you outsource your ethics“.
I am no luminary in the medical profession. Given that I blog pseudonymously, you can’t even be sure that I am a medical student. I claim no special authority to make pronouncements on medical ethics. I don’t need to. The following statement should speak for itself:
If you are a medical professional, comment-spamming blogs is not an acceptable marketing tactic. If you find yourself keeping company with SEO hucksters and vendors of penis-enlargement pills, you’ve made a wrong turn somewhere.Your online obligations don’t end at HIPAA.
Dr. Michelle Scott Tucker of Castle Hill Pediatrics, Carrollton, TX: you wanted search engine visibility. You got it.
These marketing shenanigans are undignified, unethical, and reflect incredibly poorly on the medical profession. I will not be associated with them. If you have a medical blog yourself, I hope you’ll join me. Make it clear to other physicians that indiscriminate spamming is no way to promote a practice. Call them out. Someone has to show them the error of their ways.
I will take another page from Popehat’s book and make the following offer to anyone called out for comment spam at this site:
“I will scrub this post of data identifying [you] and [your practice] on two conditions. First condition, [you] must make a sincere apology for [writing spam comments yourself, or] outsourcing [your] reputation and ethics […]. Second condition, [you] must provide emails or other documentation identifying the marketeer [you] hired who produced the comment spam and proving their responsibility for this, so that we can alter the post to call them out by name.”
My email is in the upper right-hand corner. You know how to reach me.
I’ve alluded to AMSA’s… interesting choices regarding who they will and will not take money from (or at least, who they will claim not to take money from). Here’s the long-promised photographic evidence: the swag I collected from conference exhibitors.
What you’ll find below the cut includes:
- A pamphlet, a bag, and some pens from Medical Protective, a professional liability insurance company owned by Berkshire Hathaway.
- A Merck Manual (yes, that Merck… the one that makes all these ”pharms” of which AMSA claims to be ”free”).
- Materials from various academies of quackery (as seen earlier).
- A pen, a magnet, and some other swag from the FDA.
- Application forms for various forms of insurance/consumer credit provided by or through AMSA.
- Some stuff from banks.
- Swag NOS.
[My efforts at live-blogging/tweeting have been foiled by the fact that this conference occurs two levels below ground where there is no connectivity of any sort. I guess this means the hotel has me on tape delay…]
The first talk of the morning was by a second-year medical student (Shahram Ahari, UC Davis)who spent some time as a sales rep for Eli Lilly after graduating from Rutgers. He went into sales because he thought it would be an opportunity to connect with clinicians at an intellectual level and discuss the science. Because that’s what a private-sector sales job is all about. Needless to say, he was somewhat disillusioned, especially upon finding that most of his salesforce colleagues weren’t scientists, but… salespeople. Go figure.
The presentation wasn’t irrationally hostile to pharm companies, though I might have caught the suggestion at the end that physicians have an “obligation” to vote the interests of their patients. He explained the many ways in which pharm sales people use the same techniques employed by salespeople in any industry: appeals to emotion backed up by data about the client that is never overtly mentioned.
The discussion was focused almost entirely on the prescriber-marketing interface; I was hoping for some evaluation of the appropriate nature of researcher-industry relationships, which is where (in my view) the controversy is much hotter. Nonetheless, it was an entertaining talk that explained the psychological basis behind all sorts of marketing techniques such as giving away free stuff…
Oh, right! Free stuff! AMSA might claim to be pharm-free, but a quick visit through their exhibition hall revealed a whole host of characters whose money AMSA was more than happy to accept in exchange for a booth. Some of these groups are more savoury than others.
Details to come… truly extraordinary.
For immediate release:
February 22, 2011
Washington, D.C. – The American Medical Association (AMA) announced late last night that it wholeheartedly supports the pro-union protest activities of certain physicians from the University of Wisconsin School of Medicine’s Department of Family Medicine.
Pro-union demonstrators — notably public school teachers — have flooded the state capital, Madison, to voice their displeasure with proposed cuts to pay, benefits, and collective bargaining ability. Meanwhile, a group of idealistic, enterprising physicians have set up shop to aid the protesters in their efforts. Given that these protests have been, fortunately, free from the violence wracking demonstrators in other parts of the world, these inspiring doctors have been using their special expertise for the benefit of the local protester community by writing the “sick notes” that will allow these teachers to keep their pay and jobs after having skipped work to attend the demonstrations.
They are, in short, ”providing real doctor’s notes for people who miss work.”
As has been captured in many of the videos of the protests, these heroic physicians have been able to assess their new ”patients” in mere seconds, doubtlessly utilizing the speed-H&P skills learned by practicing medicine under the AMA-supported system of RVU-based payment.
While some commentators have accused these doctors of ”stealing,” ”lying,” ”falling short of the public’s ethical expectations,” and ”demeaning the doctor-patient relationship,” the AMA would like to commend the work of these courageous physicians, who truly represent the best of American medicine and the future of primary care in this country. They truly are a shining example of what the AMA thinks that medical practice should be.
In addition to showcasing the near-lightspeed pace at which the AMA believes outpatient medicine should be practiced, these doctors — from unlicensed resident to grizzled veteran of community practice alike — exemplify the values that will need to become more commonplace if primary care in the United States is to be revitalized.
In 2007, the AMA’s Initiative to Transform Medical Education (ITME) released its Recommendations for Change in the System of Medical Education, concluding that the current shortage of primary care physicians in the United States is due to a cohort of medical students who are insufficiently altruistic, unwilling to be advocates for social justice issues, and too fixated on problem-solving and intellectual pursuits to be the effective community organizers that primary-care physicians ought to be.
In the view of the AMA, the model of ”primary-care-physician-as-community-organizer-for-social-justice” must replace the model of ”primary-care-physician-as-healer-and-problem-solver” for there to be a future for primary care in this country, especially given the reluctance of the federal government to increase physician payment under the AMA-supported RVU system.
As the voice of America’s doctors, and as the champions of primary care’s bright future as social justice advocacy, we are thrilled to see these Wisconsin physicians living up to the ideals espoused in the ITME recommendations, if not the Hippocratic Oath. The future of primary care is not in practicing medicine; it is in political agitation. These family practitioners are pioneering the way forward for their specialty. They are organizing for their community, and they are advocating for their patients’ sense of social justice, entirely unbound by the conventional problem-solving, clinical-assessment mentality that persists among primary care physicians at their own peril.
The American Medical Association stands with these brave primary care practitioners, and urges them to continue to practice primary care medicine in the best way possible. Only by following in their example can family physicians, outpatient internists, and pediatricians ”win the future” for their specialties in this environment of harsh RVU economics.
In case you haven’t realized by now, this is not an AMA press release. It is a satire/parody of the AMA’s positions on medical education and physician supply in the context of the primary care shortage. Use of the AMA name is protected fair use. For more disclaimers, see my ”About” page.