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What Happened to Ethics?

Binghamton, N.Y.

I am writing this letter after much thought and anguish. The last straw was the recent news reported in the New York Times that a senior scientist was found to have sold his laboratory's CSF samples to a drug company for profit.

Hippocrates must be turning in his grave over the state of affairs of medicine in all specialties. I am sure there are honest physicians, but many appear to be in the silent majority.

Physicians are doing procedures with no regard for indication, treatments are recommended without adequate consideration of alternatives, and the lecture circuit is getting crowded by people who call themselves "experts." In psychiatry, I encounter such problems as overmedication, inadequate time for evaluation, quick med checks with no regard for outcome, and administration of ECT on even the most demented elderly with the hope it will keep them well. A new option—the vagus nerve stimulation system—and another one expected to be approved soon—transcranial magnetic stimulation—will probably be overused as well.

Where is the limit? What happened to medical ethics and the Hippocratic Oath? I am sure I will encounter the wrath of my colleagues as I raise these questions, but I am willing to accept the consequences. Having resigned from managed care panels and Medicare, I am free as a bird doing the work I enjoy, albeit with meager remuneration since fees figured on a sliding-scale basis have been declining along with the economy.

There are many reasons for the trends I described, and the most important is the financial crunch created by managed care organizations and physicians who want to make the most money in the least amount of time. Procedures come in handy to boost income. The patient's psyche gets scant attention, and sometimes patients are advised to seek therapy elsewhere. This is a sad situation, but I have hope it can be rectified if enough physicians speak up.

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