In "Academic Freedom and ED EHR's Down Under: An Update" I wrote about the disputed essay on electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney.
The essay was entitled "A Critical Essay on the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?"
I am happy to report that an updated version of the essay, version 5, is now available from Dr. Patrick's university web site at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 . It can be downloaded from the icon at Item 6.
This is a welcome development.
The essay is now labeled as an Op-Ed (Opinion Editorial).
-- SS
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Tuesday, November 10, 2009
Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development
In "Academic Freedom and ED EHR's Down Under: An Update" I wrote about the disputed essay on electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney.
The essay was entitled "A Critical Essay on the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?"
I am happy to report that an updated version of the essay, version 5, is now available from Dr. Patrick's university web site at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 . It can be downloaded from the icon at Item 6.
This is a welcome development.
The essay is now labeled as an Op-Ed (Opinion Editorial).
-- SS
The Kelo Case Redux Once More: Pfizer Pulls Out and the "Carefully Formulated" Development Plan Collapses
Four years ago we posted (here, here and here) about the controversial US Supreme Court decision in the Kelo case. Most discussion of the case at the time focused on individual property rights vs the power of the government to promote economic development, but the case had an important health care angle.
Briefly, the case centered on the taking of private property, including a house owned by Susette Kelo, by a not-for-profit organization, the New London (Connecticut) Development Corporation (NLDC) given the power of eminent domain by the New London city government. While the ostensible rationale for the taking was economic development, the action appeared to have been at the behest of Pfizer Inc, the world's largest pharmaceutical company, which had built a research and development facility in the city, and wanted a suitably upscale and sanitized environment for its workers.
As we previously posted, the NLDC's leadership had multiple conflicts of interest that involved ties to Pfizer. One board member was a Pfizer vice-president. The board president was married to another Pfizer vice-president. Pfizer wanted the part of New London that included Kelo's house made more attractive to complement its new research facility. The husband of the NLDC president had said, "Pfizer wants a nice place to operate. We don't want to be surrounded by tenements."
Kelo's and other property owners' protest of the taking went all the way to the US Supreme Court. As we posted here, the Court decided against the property owners by a 5-4 vote. Justice John Paul Stevens wrote for the majority that the city's "determination that the area was sufficiently distressed to justify a program of economic rejuvenation is entitled to our deference. The city has carefully formulated an economic development plan that it believes will provide appreciable benefits to the community, including - but by no means limited to - jobs and increased revenues." This majority opinion is important, because the Fifth Amendment to the US Constitution provides "nor shall private property be taken for public use without just compensation." Many had interpreted this provision to mean that eminent domain could only be used to take property for public use, e.g., to build a road or a public school, but not for private purposes, like building upscale waterfront developments.
Two months ago, we posted on how the supposedly "carefully formulated" development plan had fallen apart. The land on which the Kelo house stood had never been developed, and remained a weedy lot.
This week, the (New London) Day reported:
So, the unfortunate Kelo case has become a vivid demonstration how badly government does when it partners with businesses and tries to pick corporate winners and losers. Unfortunately, it seems that much of what passes for US health care policy is such "corporate socialism." As we said before, instead of trying to pick corporate winners and losers, government would do better to act like a combination of an honest policeman on the beat, deterring and punishing dishonest behavior, and in impartial referee, trying to make sure everyone is playing the game honestly. But no doubt government officials used to mingling with the corporate superclass would not be comfortable in the roles of honest cop or impartial referee.
See also comments on the Volokh Conspiracy blog. Hat tip to the PharmaLot blog.
Briefly, the case centered on the taking of private property, including a house owned by Susette Kelo, by a not-for-profit organization, the New London (Connecticut) Development Corporation (NLDC) given the power of eminent domain by the New London city government. While the ostensible rationale for the taking was economic development, the action appeared to have been at the behest of Pfizer Inc, the world's largest pharmaceutical company, which had built a research and development facility in the city, and wanted a suitably upscale and sanitized environment for its workers.
As we previously posted, the NLDC's leadership had multiple conflicts of interest that involved ties to Pfizer. One board member was a Pfizer vice-president. The board president was married to another Pfizer vice-president. Pfizer wanted the part of New London that included Kelo's house made more attractive to complement its new research facility. The husband of the NLDC president had said, "Pfizer wants a nice place to operate. We don't want to be surrounded by tenements."
Kelo's and other property owners' protest of the taking went all the way to the US Supreme Court. As we posted here, the Court decided against the property owners by a 5-4 vote. Justice John Paul Stevens wrote for the majority that the city's "determination that the area was sufficiently distressed to justify a program of economic rejuvenation is entitled to our deference. The city has carefully formulated an economic development plan that it believes will provide appreciable benefits to the community, including - but by no means limited to - jobs and increased revenues." This majority opinion is important, because the Fifth Amendment to the US Constitution provides "nor shall private property be taken for public use without just compensation." Many had interpreted this provision to mean that eminent domain could only be used to take property for public use, e.g., to build a road or a public school, but not for private purposes, like building upscale waterfront developments.
Two months ago, we posted on how the supposedly "carefully formulated" development plan had fallen apart. The land on which the Kelo house stood had never been developed, and remained a weedy lot.
This week, the (New London) Day reported:
Eight years after opening its state-of-the-art global research-and-development headquarters in New London, Pfizer Inc. announced Monday it will close the nearly $300 million complex within the next two years and consolidate local operations into its Groton campus.Why did Pfizer decide to close the facility?
Pfizer earlier this year said nearly 20,000 jobs would be cut as a result of its merger with the New Jersey-based Wyeth. The company said Monday that about 15 percent of its overall R&D work force would be cut as part of that downsizing.The result apparently will be the complete dissolution of the "carefully formulated" development plan.
The announced closing of the New London site came as a blow to a city that had counted on Pfizer to help revive its fortunes.
The loss of Pfizer as a keystone business in New London could put in further jeopardy the Fort Trumbull development that started in conjunction with Pfizer's move into the city but has left little but flattened buildings and eminent-domain angst in its wake.
So, the unfortunate Kelo case has become a vivid demonstration how badly government does when it partners with businesses and tries to pick corporate winners and losers. Unfortunately, it seems that much of what passes for US health care policy is such "corporate socialism." As we said before, instead of trying to pick corporate winners and losers, government would do better to act like a combination of an honest policeman on the beat, deterring and punishing dishonest behavior, and in impartial referee, trying to make sure everyone is playing the game honestly. But no doubt government officials used to mingling with the corporate superclass would not be comfortable in the roles of honest cop or impartial referee.
See also comments on the Volokh Conspiracy blog. Hat tip to the PharmaLot blog.
The Kelo Case Redux Once More: Pfizer Pulls Out and the "Carefully Formulated" Development Plan Collapses
Four years ago we posted (here, here and here) about the controversial US Supreme Court decision in the Kelo case. Most discussion of the case at the time focused on individual property rights vs the power of the government to promote economic development, but the case had an important health care angle.
Briefly, the case centered on the taking of private property, including a house owned by Susette Kelo, by a not-for-profit organization, the New London (Connecticut) Development Corporation (NLDC) given the power of eminent domain by the New London city government. While the ostensible rationale for the taking was economic development, the action appeared to have been at the behest of Pfizer Inc, the world's largest pharmaceutical company, which had built a research and development facility in the city, and wanted a suitably upscale and sanitized environment for its workers.
As we previously posted, the NLDC's leadership had multiple conflicts of interest that involved ties to Pfizer. One board member was a Pfizer vice-president. The board president was married to another Pfizer vice-president. Pfizer wanted the part of New London that included Kelo's house made more attractive to complement its new research facility. The husband of the NLDC president had said, "Pfizer wants a nice place to operate. We don't want to be surrounded by tenements."
Kelo's and other property owners' protest of the taking went all the way to the US Supreme Court. As we posted here, the Court decided against the property owners by a 5-4 vote. Justice John Paul Stevens wrote for the majority that the city's "determination that the area was sufficiently distressed to justify a program of economic rejuvenation is entitled to our deference. The city has carefully formulated an economic development plan that it believes will provide appreciable benefits to the community, including - but by no means limited to - jobs and increased revenues." This majority opinion is important, because the Fifth Amendment to the US Constitution provides "nor shall private property be taken for public use without just compensation." Many had interpreted this provision to mean that eminent domain could only be used to take property for public use, e.g., to build a road or a public school, but not for private purposes, like building upscale waterfront developments.
Two months ago, we posted on how the supposedly "carefully formulated" development plan had fallen apart. The land on which the Kelo house stood had never been developed, and remained a weedy lot.
This week, the (New London) Day reported:
Eight years after opening its state-of-the-art global research-and-development headquarters in New London, Pfizer Inc. announced Monday it will close the nearly $300 million complex within the next two years and consolidate local operations into its Groton campus.
Why did Pfizer decide to close the facility?
Pfizer earlier this year said nearly 20,000 jobs would be cut as a result of its merger with the New Jersey-based Wyeth. The company said Monday that about 15 percent of its overall R&D work force would be cut as part of that downsizing.
The result apparently will be the complete dissolution of the "carefully formulated" development plan.
The announced closing of the New London site came as a blow to a city that had counted on Pfizer to help revive its fortunes.
The loss of Pfizer as a keystone business in New London could put in further jeopardy the Fort Trumbull development that started in conjunction with Pfizer's move into the city but has left little but flattened buildings and eminent-domain angst in its wake.
So, the unfortunate Kelo case has become a vivid demonstration how badly government does when it partners with businesses and tries to pick corporate winners and losers. Unfortunately, it seems that much of what passes for US health care policy is such "corporate socialism." As we said before, instead of trying to pick corporate winners and losers, government would do better to act like a combination of an honest policeman on the beat, deterring and punishing dishonest behavior, and in impartial referee, trying to make sure everyone is playing the game honestly. But no doubt government officials used to mingling with the corporate superclass would not be comfortable in the roles of honest cop or impartial referee.
Health IT Personnel: Want To Bone Up On Technology? Try This
An interesting article appeared in an IT journal that merits brief mention with respect to electronic health records:
"Want to bone up on wireless tech? Try ham radio"
Computerworld, October 29, 2009
I find it interesting in that in no interaction that I recall with IT personnel, my amateur radio background and the deep understanding of technology it imparted seemed of interest or value to them.
Key point in the article:
I would extend this to many other IT-dependent areas.
Unfortunately, many IT personnel - and many so called physician directors of information systems - seem to be "appliance operators", a term hams use to describe people who can push buttons but lack a depth of understanding of what goes on "inside the box". Also expressed in ham radio terms, I have found most IT personnel in hospitals to be at the "CB operator" level of technological understanding, where "computer" equates to "cybernetic miracle," and computerization equates automatically to "improvement."
Breaker, breaker, big buddy!
For IT personnel, studying and then securing a ham radio license and experimenting might give them the technical skills they need to be more fully in control of their systems, rather than the systems being in control of them.
This physician-informaticist diagnosing and treating ailments in an electronic patient, the classic Ten Tec Corsair II amateur radio transceiver.
Such expertise could also help ameliorate the problems noted on this site regarding healthcare IT.
-- SS
(Amateur radio, extra class)
"Want to bone up on wireless tech? Try ham radio"
Computerworld, October 29, 2009
I find it interesting in that in no interaction that I recall with IT personnel, my amateur radio background and the deep understanding of technology it imparted seemed of interest or value to them.
Key point in the article:
"For IT professionals, ham radio can foster skills that are translatable into real-world wireless and wired networking applications."
I would extend this to many other IT-dependent areas.
Unfortunately, many IT personnel - and many so called physician directors of information systems - seem to be "appliance operators", a term hams use to describe people who can push buttons but lack a depth of understanding of what goes on "inside the box". Also expressed in ham radio terms, I have found most IT personnel in hospitals to be at the "CB operator" level of technological understanding, where "computer" equates to "cybernetic miracle," and computerization equates automatically to "improvement."
Breaker, breaker, big buddy!For IT personnel, studying and then securing a ham radio license and experimenting might give them the technical skills they need to be more fully in control of their systems, rather than the systems being in control of them.
This physician-informaticist diagnosing and treating ailments in an electronic patient, the classic Ten Tec Corsair II amateur radio transceiver.Such expertise could also help ameliorate the problems noted on this site regarding healthcare IT.
-- SS
(Amateur radio, extra class)
Health IT Personnel: Want To Bone Up On Technology? Try This
An interesting article appeared in an IT journal that merits brief mention with respect to electronic health records:
"Want to bone up on wireless tech? Try ham radio"
Computerworld, October 29, 2009
I find it interesting in that in no interaction that I recall with IT personnel, my amateur radio background and the deep understanding of technology it imparted seemed of interest or value to them.
Key point in the article:
"Want to bone up on wireless tech? Try ham radio"
Computerworld, October 29, 2009
I find it interesting in that in no interaction that I recall with IT personnel, my amateur radio background and the deep understanding of technology it imparted seemed of interest or value to them.
Key point in the article:
"For IT professionals, ham radio can foster skills that are translatable into real-world wireless and wired networking applications."
I would extend this to many other IT-dependent areas.
Unfortunately, many IT personnel - and many so called physician directors of information systems - seem to be "appliance operators", a term hams use to describe people who can push buttons but lack a depth of understanding of what goes on "inside the box". Also expressed in ham radio terms, I have found most IT personnel in hospitals to be at the "CB operator" level of technological understanding, where "computer" equates to "cybernetic miracle," and computerization equates automatically to "improvement."
Breaker, breaker, big buddy!For IT personnel, studying and then securing a ham radio license and experimenting might give them the technical skills they need to be more fully in control of their systems, rather than the systems being in control of them.
This physician-informaticist diagnosing and treating ailments in an electronic patient, the classic Ten Tec Corsair II amateur radio transceiver.Such expertise could also help ameliorate the problems noted on this site regarding healthcare IT.
-- SS
(Amateur radio, extra class)
Monday, November 9, 2009
Paging (and Paying) "Dr Coca-Cola"
A few weeks ago, the Los Angeles Times Booster Shots blog announced that "Dr. Coca-Cola will see you now," noting opposition to the recently revealed alliance between the Coca-Cola Company and the American Academy of Family Physicians:
Dr Henley was not moved:
Nonetheless, criticism of the deal has continued. A Kansas City Star editorial said:
The editorial did not buy Dr Henley's assurances:
Meanwhile, family physician and AAFP member Dr Howard Brody noted on his Hooked: Ethics, Medicine and Pharma blog how AAFP leaders continued to obfuscate:
Some AAFP members went beyond criticism, as reported by the AP:
Nonetheless, as Dr Brody later posted,
So here we have the latest variant on institutional conflicts of interest affecting medical associations. We have noted (e.g., here) how professional societies have blithely accepted substantial funding from corporations which sell products physicians may prescribe for or implant in patients. This raises concerns that professional societies have become drug and device marketers. This conflicts with physicians' prime directive, to put the interests of individual patients ahead of their own, and hence to base decisions on which drugs to prescribe, tests to order, and procedures to do on maximizing benefits and minimizing harms for individual patients, not maximizing financial gain for physicians, or their organizations.
Family physicians are a respected source not only of decisions about tests and treatments, but about diet. Having the main family physician organization humming "things go better with Coke" suggests that professional advice could be co-opted by marketing. As Dr Brody noted above, the issue is not whether the product is good or bad, but is whether physicians are giving each patient the best possible advice.
One question implied by the "Dr Coca-Cola" story is why the leadership of the AAFP seems so oblivious to the conflict of interest issues it raises. As Dr Brody wrote:
I appreciate Dr Brody's depression, but note that this is not the first time that AAFP leadership has seemed tone deaf to the issue of the organization's institutional conflict of interest. In 2005, we posted how the AAFP had banned the "No Free Lunch" organization, which opposes most pharmaceutical marketing to physicians, from appearing in the exhibit hall of its annual meeting. The exhibit hall was otherwise populated by lavish exhibits by pharmaceutical and other health care corporation marketers.
The abstract for a 2006 article in Family Medicine [Standridge JB. Of doctor conventions and drug companies. Fam Med 2006; 38(7):518-20. Link here] began:
The current web-site for the AAFP Foundation boasts of its corporate partners, which include many of the biggest pharmaceutical and biotechnology companies (at the "Pinnacle" level, Amgen, AstraZeneca, Lilly, Purdue Pharma.
So adding Coca-Cola to the list of corporate sponsors does not seem like such a big step. In fact, being "Dr Coca-Cola" does not seem intrinsically more questionable than being "Dr Amgen," "Dr AstraZeneca," etc.
Nonetheless, one would think that the latest round of criticism would make the top leaders of this august professional society less comfortable about the organization's financial relationships with pharmaceutical, biotechnology, and now beverage corporations. I fear, though, that they may live too much in the sort of bubble that now protects top executives of most large health care organizations to really question their corporate ties. After all, according to the most recent (2007, covering 6/2007-5/2008) US Internal Revenue Service form 990 filed by the AAFP (via Guidestar), its leaders get sufficient compensation to put them into such a bubble. For example, Dr "Coca-Cola" Hensley received $441,027 regular compensation and $108,930 in benefits and deferred compensation, compared with a median compensation for family physicians in 2008 reported as $159,000 from one survey. Presumably "voluntary" officers got five- and six-figure "expense accounts and other allowances," maxing out at $195,648 for then President Dr James B King. It may be hard for leaders who are so comfortably recompensed by the organization to become uncomfortable about the financial relationships that make the largesse they receive seem less of a burden for members who may not be so well-paid. The leaders' comfort with the current arrangement, however, makes their organization more liable to be viewed as a drug, device, and now beverage marketer rather than a defender of physicians' professionalism. Maybe the leaders should accept more austere compensation, perhaps similar to what working family doctors get paid, as the price they need to pay to remove questions about their organization's real commitment to professionalism.
[in] a sharply worded letter sent Wednesday to Dr. Douglas E. Henley, the academy’s chief executive.
'We urge the AAFP to regain its credibility by rejecting the deal with Coca-Cola,' the letter stated. 'If the AAFP declines to do that, we urge your organization to reassert its support for the public health (and its own independence) by supporting a warning label on caloric sugar-sweetened beverages and a federal tax on soft drinks to support health promotion or health insurance programs.'
The letter was signed by 22 doctors, nutritionists and health advocates,
Dr Henley was not moved:
Henley told Food Navigator-USA.com that the academy was aware of the letter. But he stood by the partnership with Coke.
'We will move forward with this commitment together by providing educational materials on sweeteners and how to maintain a healthy, active lifestyle while still enjoying many of the foods and beverages consumers love,' he said in a statement.
Nonetheless, criticism of the deal has continued. A Kansas City Star editorial said:
the Leawood-based American Academy of Family Physicians has set a poor example when it comes to resisting the lure of the soft drink industry.
The academy has accepted a grant from Coca-Cola, reportedly in the neighborhood of $500,000. It will use the money for educational materials about drinks and sweeteners for its consumer Web site, FamilyDoctor.org. Leftover funds will go into the academy’s general budget.
In return, Coca-Cola gets what? Legitimacy, for one thing. Consumers are less likely to consider a product unhealthy if it’s listed as a partner with a leading physicians’ alliance.
In a more shameful scenario, the soft drink manufacturer would succeed in muting the message that the academy puts out to its consumers.
The editorial did not buy Dr Henley's assurances:
Academy leaders say they won’t allow the hefty corporate grant to compromise the organization’s integrity.
'We have total editorial control, as we always have, of FamilyDoctor.org,' said Executive Vice President Douglas Henley.
Henley added, 'I would hope folks won’t rush to judgment but hold us to the content we’re going to put on FamilyDoctor.org.'
But consumers accessing that information will soon be informed that information about soft drinks is being sponsored in part by Coca-Cola, 'a proud partner of FamilyDoctor.org.'
That’s a mixed message, regardless of the content.
Meanwhile, family physician and AAFP member Dr Howard Brody noted on his Hooked: Ethics, Medicine and Pharma blog how AAFP leaders continued to obfuscate:
AAFP President Dr. Lori Heim: obesity is more complex and that 'there's no one evil out there.'
Why does the question of whether it's a good idea for AAFP to take money from Coke so quickly segue into the question of whether Coke is 'evil'? (For our blogger colleague who likes logical fallacies, Roy Poses, this sounds like "straw man." [It sure does - Editor]) Why does it have to be: either they are evil or else it's just fine for us to take their money? What cannot it simply be that they have different interests--they are trying to make a buck selling beverages (some of which I enjoy drinking myself, I am pleased to report, if they don't have calories in them) while AAFP is trying to protect the public interest through credible health education? What part of conflict of interest don't you understand?
Some AAFP members went beyond criticism, as reported by the AP:
Dr. William Walker, public health officer for Contra Costa County near San Francisco, likened the alliance with ads decades ago in which physicians said mild cigarettes are safe,
Walker has been a member of the academy for 25 years but quit last week. He said 20 other doctors who work with his local medical practice also quit because of the Coke deal.
Nonetheless, as Dr Brody later posted,
Sadly, if the responses to this news report from AAFP leadership are accurate, the AAFP still does not get it. '[AAFP CEO Dr. Douglas] Henley said the academy regrets the resignations and hopes other members will not 'rush to judgment' before seeing the new content." News flash: we don't need to see the content to know there's something rotten in Denmark. The deal itself raises concerns about the credibility of anything AAFP posts about diet and obesity from now on.
So here we have the latest variant on institutional conflicts of interest affecting medical associations. We have noted (e.g., here) how professional societies have blithely accepted substantial funding from corporations which sell products physicians may prescribe for or implant in patients. This raises concerns that professional societies have become drug and device marketers. This conflicts with physicians' prime directive, to put the interests of individual patients ahead of their own, and hence to base decisions on which drugs to prescribe, tests to order, and procedures to do on maximizing benefits and minimizing harms for individual patients, not maximizing financial gain for physicians, or their organizations.
Family physicians are a respected source not only of decisions about tests and treatments, but about diet. Having the main family physician organization humming "things go better with Coke" suggests that professional advice could be co-opted by marketing. As Dr Brody noted above, the issue is not whether the product is good or bad, but is whether physicians are giving each patient the best possible advice.
One question implied by the "Dr Coca-Cola" story is why the leadership of the AAFP seems so oblivious to the conflict of interest issues it raises. As Dr Brody wrote:
What's even more depressing is that with the whole world telling them that they mishandled this affair, the AAFP still seems to think that the problem is someone else's.
I appreciate Dr Brody's depression, but note that this is not the first time that AAFP leadership has seemed tone deaf to the issue of the organization's institutional conflict of interest. In 2005, we posted how the AAFP had banned the "No Free Lunch" organization, which opposes most pharmaceutical marketing to physicians, from appearing in the exhibit hall of its annual meeting. The exhibit hall was otherwise populated by lavish exhibits by pharmaceutical and other health care corporation marketers.
The abstract for a 2006 article in Family Medicine [Standridge JB. Of doctor conventions and drug companies. Fam Med 2006; 38(7):518-20. Link here] began:
Pharmaceutical companies provide the majority of financial support for staging the American Academy of Family Physicians (AAFP) Annual Scientific Assembly. In return they are allowed to dominate the physical and mental environment.
The current web-site for the AAFP Foundation boasts of its corporate partners, which include many of the biggest pharmaceutical and biotechnology companies (at the "Pinnacle" level, Amgen, AstraZeneca, Lilly, Purdue Pharma.
So adding Coca-Cola to the list of corporate sponsors does not seem like such a big step. In fact, being "Dr Coca-Cola" does not seem intrinsically more questionable than being "Dr Amgen," "Dr AstraZeneca," etc.
Nonetheless, one would think that the latest round of criticism would make the top leaders of this august professional society less comfortable about the organization's financial relationships with pharmaceutical, biotechnology, and now beverage corporations. I fear, though, that they may live too much in the sort of bubble that now protects top executives of most large health care organizations to really question their corporate ties. After all, according to the most recent (2007, covering 6/2007-5/2008) US Internal Revenue Service form 990 filed by the AAFP (via Guidestar), its leaders get sufficient compensation to put them into such a bubble. For example, Dr "Coca-Cola" Hensley received $441,027 regular compensation and $108,930 in benefits and deferred compensation, compared with a median compensation for family physicians in 2008 reported as $159,000 from one survey. Presumably "voluntary" officers got five- and six-figure "expense accounts and other allowances," maxing out at $195,648 for then President Dr James B King. It may be hard for leaders who are so comfortably recompensed by the organization to become uncomfortable about the financial relationships that make the largesse they receive seem less of a burden for members who may not be so well-paid. The leaders' comfort with the current arrangement, however, makes their organization more liable to be viewed as a drug, device, and now beverage marketer rather than a defender of physicians' professionalism. Maybe the leaders should accept more austere compensation, perhaps similar to what working family doctors get paid, as the price they need to pay to remove questions about their organization's real commitment to professionalism.
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