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There are many who are in positions of power in the field of medicine. Most individuals acquit themselves admirably while other "luminaries" use their power and prestige to influence thought based on self-interest and hidden agenda. When this occurs truth and patient care are the ones who are short-changed. The straightforward remedy to this challenge is the application of the "Sunshine Principle", which continues to be a reasonable and effective check on such abuse. In the field of spine care abuse of positions of authority due to hidden agendas has has adversely influenced the early introduction of Computed Tomographic (CT) scanning; the use of CT scans (instead of myelograms) to diagnose lateral spinal stenosis and the use of self-administered traction devices in non-invasive treatment and prevention programs. Because of these conflicts of interest, lateral spinal stenosis (a totally treatable condition), has continued to remain the single most common etiology of the "failed back surgery syndrome." Hidden agendas play an important role in influencing medical care in general. The worst examples involve outright fraud. There are few areas of greater medical concern than the treatment of cancer in general and the treatment of cancer of the breast in particular. A highly visible research study supporting bone-marrow transplantation associated with high-dose chemotherapy was found, after investigation, to be fraudulent. The investigator admitted committing a serious breach of scientific honesty and integrity (Grady D: Breast Cancer Researcher Admits Falsifying Data N.Y. Times, February 5, 2000). Because of these fraudulent data many patients battled their third party pairs for this treatment. Significant unwarranted cost to the health care system and personal risk for the patient have been the result of this unfortunate situation. Conflicts of interest in health care abound. Catherine DeAngeles, the Editor of the Journal of the American Medical Association (JAMA) has published a thoughtful editorial on this subject. Because "peer reviewed" medical journals such as JAMA are now taken as "gospel" in regard to "evidence-based medical practice the avoidance of author conflicts of interest by prior full-disclosure of conflicts of interest has assumed great importance. Not all medical journals have instituted such policies and significant abuse remains today. Unless abuse is egregious and thus comes to the attention of the media many exploitive acts do not then typically come before the eye of the medical community or the public at large. When the patient is returned to the "driver's seat" in health care the inherent higher level of vigilance exerted by the patients themselves and patient advocacy groups should greatly assist in reducing the incidence and prevalence of hidden agendas in the health care field. |
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