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BOOK REVIEW

Money's corrupting influence on medicine

Fears that money has an undue influence on the practice of medicine are not new. In the 12th century, the Jewish philosopher Maimonides wrote an oath for physicians that included this admonition: ''Do not allow thirst for profit, ambition for renown and admiration to interfere with my profession."

Nine centuries later, the situation has not improved. Money -- mainly drug company money -- flows into every nook and cranny of the medical world. It pays for clinical trials, medical education, and academic research. It gets handed out to doctors as gifts, free meals, consulting fees, and payments for speaking.

In Jerome P. Kassirer's book, ''On the Take," money is handed out in medicine as freely as bribes in Third World countries.

''The time has come to ask whether all of the money floating around medicine has created a pattern of corruption," writes Kassirer, a former editor of the New England Journal of Medicine and a current faculty member at Tufts University School of Medicine.

Many of the examples Kassirer cites have been noted before. Nonetheless, Kassirer's reporting on the sheer volume of money and the huge number of people and institutions that receive it makes a powerful impression.

Consider the following examples:

The American Academy of Pediatrics distributes a guide to breast-feeding for new mothers. The 2002 cover featured the name and logo of Ross Products, the maker of Similac, the most popular brand of infant formula.

During the 1990s Kassirer found it increasingly difficult to find writers for the New England Journal of Medicine who had not taken money from drug companies. Another publication, the Annals of Internal Medicine, ran an editorial on HIV infection by a writer who consulted for 14 different companies and took grant money from nine firms, some of which had products in the AIDS field.

A Canadian doctor doing drug research found that the drug in question had a side effect that was potentially dangerous to the children she was treating. When she published her findings, the drug company, Apotex, dropped her from the study. Her hospital refused to back her up because it was negotiating to get a multimillion dollar gift from Apotex.

For Kassirer, the problem comes down to trust. How can you trust your doctor or your hospital, if they are on the take?

Kassirer's book would have been stronger if we got to hear more of the voices of the doctors on the front lines. Do they acknowledge that their integrity is being compromised? Has the drug company money contributed anything to medicine or is it a blight on the field?

Kassirer concludes with a long list of recommendations for removing the taint money has brought to medicine. In some cases, he is in favor of better disclosure of conflicts of interests. In others cases, he says doctors have to just say no -- to such things as gifts and participation in company-sponsored speaker's bureaus. The recommendations make sense, but you have to wonder whether they are realistic. If drug companies spend $2 billion a year on physician education, who is going to fill that vacuum if the drug money disappears? Government? The doctors themselves?

Charles Stein is a Globe columnist. He can be reached at stein@globe.com.

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