So this is a little off the usual path for my online articles but I feel very strongly about the topic and want to run a few things by you. If you follow along it will be apparent that this is an issue that affects all patients. And we will all be patients sooner or later.
What do you believe my motivation is when writing for AOPA? And do you trust me? Would you believe my muse is inspired by a simple goal; I gain immense satisfaction knowing that even if I influence one fellow pilot to address their health, my time has been well spent. And as for trust? I certainly tell no lies and do my utmost to research and justify any position I take, but medicine is not an exact science and there are areas of dispute. I assure those of you who are not in the medical field, the AME's and other pilot physicians who read my scribblings are quick to take issue with me about opinions where they differ from me. Polite and constructive debate leads to deeper thought, more experimentation and ultimately, the truth will out. But being inexact, even when the answer is not clear, is a very different proposition than being deliberately deceitful and as a doctor surely you want to trust me as much as you would the ATC vectoring you onto an ILS in IMC? Without trust there is no progress. And that trust is slowly being eroded by misguided people.
I was born and trained as a surgeon and pilot in the United Kingdom, a country with a proud medical and aviation history. The Spitfire and Comet, Harrier and Concorde and many other innovations in flight. Penicillin and much modern orthopaedic and colorectal surgery, CAT scanners and vaccines and many other medical innovations. But over the past few decades, lethargy among pilots and physicians saw ill-conceived central government policies destroy the spirit and drive that inspires innovation in both these fields. Whether user fees or grant restrictions, fewer airfields and higher taxes the effect is the same, bureaucracy impeding humans soaring literally, and metaphorically.
I moved to the USA 26 years ago, drawn by American derring-do and shudder each time I see the American eagle lose the thermal. As aviators you know what I am talking about - user fees and taxes, burdensome regulatory processes and other moves eroding our freedom to fly. Unfortunately there are similar, although rather more subtle issues chipping away at the desire to drive medical innovation - I am attuned to this particular frequency because the wish to shift the medical paradigm was what brought me here in the first place.
For instance, a tax was imposed on medical device companies on top of our already very high corporate taxes. This levy comes off revenue once a company achieves a certain level of sales and as such is very punitive to early-stage medical startups. This has led to many companies moving to my old country where corporate taxes are capped at a very low level and investment enterprise schemes are drawing capital offshore. The British have seen the error of their ways and are moving to reduce barriers to human endeavor. Recently, Congressman Paulsen led a move to have this tax repealed and I for one am in favor of it.
But a more insidious and foul-tasting law came into effect and it disgusts me; the "Sunshine Act." Here is the central premise; if a physician earns money from activities other than looking after patients, that should be a matter of public record because fees from lecturing about a technology one has helped develop, royalties from an invention or other such earnings might lead to a conflict of interest that could lead a doctor to inappropriately treat a patient.
What about this for a conflict of interest? As a surgeon I tell people they need to have an operation and I get paid for performing the procedure. Is that not a conflict? Of course it is a potential conflict but any doctor who is evil enough to do an unnecessary operation will, if caught, be subject to the full weight of the law and will doubtless be sued into a corner. And rightfully so. But to paint all of us as sick-minded individuals lacking a moral compass is heinous. I have invented technologies and received payment for doing so. I would proudly tell my patients of the small contribution I had made to medical practice and would, of course, use my technologies where appropriate. But to avoid the perception of wrong-doing, any royalties due to me or any inventor at their host institution could be paid to a charity or educational fund.
"Pharmaphobia" by Dr. Tom Stossel is a recent book that addresses this topic and is well worth a read. If the current witch-hunt ethos is not turned around, we will see American physicians throw their hands up in despair, cease their proud heritage of innovation and our healthcare system will decline. As an example, we would not have insulin today had it not been for a collaboration between basic scientists, clinicians and the Eli Lilly company of Indianapolis.
I am proud to be an American, I am proud to be a pilot, I am proud to be a doctor. Please trust me - my intentions are sincere and so are those of the vast majority of my colleagues.
