We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that (...) physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals. (shrink)

After a 50-page outline of the principles of clinical reasoning, over 60 actual cases are detailed that illustrate (and are keyed to) the principles, presenting case records, analysis, and references to literature. For medical students and interns, and their instructors. Annotation copyright Book Ne.

There is something embarrassing about money. Everybody is seeking it but at the same time they are reluctant to talk about their bank balances and stock holdings. As a society we have so much of it that we can install 7000 saffron curtains all over Central Park, send tourists into outer space, and analyze the gas on the surface of Titan, yet we fail to spend it on millions of poverty-stricken people who die of disease or starvation each year. We (...) do open our pocketbooks sometimes, but only when television images of massive destruction overwhelm our sensibilities. Money often dominates our consciousness and bombards us in the headlines: Our national debt is 7.7 trillion dollars and it's increasing by more than 2 billion dollars a day; corporate executives of Enron walk away with millions while their employees lose their jobs and their pensions; and we had an endless fascination with Martha Stewart, who is worth millions, but went to jail trying to save a few thousand. (shrink)

How do people make difficult decisions in situations involving substantial risk and uncertainty? In this study, we presented a difficult medical decision to three expert physicians in a combined “thinking aloud” and “cross examination” experiment. Verbatim transcripts were analyzed using script analysis to observe the process of constructing and making the decision, and using referring phrase analysis to determine the representation of knowledge of likelihoods. These analyses are compared with a formal decision analysis of the same problem to highlight similarities (...) and differences. The process of making the decision resembles an incremental, sequential‐refinement planning algorithm, where a complex decision is broken into a sequence of choices to be made with a simplified description of the alternatives. This strategy results in certain kinds of relevant information being underweighted in the final decision. Knowledge of likelihood appears to be represented as symbolic descriptions capturing categorical and ordinal relations with “landrhark” likelihoods, only some of which are described numerically. Numerical probabilities, capable of being combined and compared arithmetically, were not observed. These observations suggest an explanation for the heuristics and biases in human decision making under uncertainty in terms of the processes that manipulate symbolic descriptions of likelihoods and construct plans of action for situations involving risk and uncertainty. (shrink)