From Publishers Weekly
"Some physicians become known as whores." This is strong language in Kassirer's mostly temperate but tough look at how big business is corrupting medicine—but according to Kassirer, one doctor's wife used the word "whore" to describe her husband's accepting high fees to promote medical products. Such personal anecdotes distinguish Kassirer's look at the conversion of America's health-care system into a commercial enterprise. Kassirer, former editor-in-chief of the prestigious New England Journal of Medicine, notes the range of conflicts of interest between profit-centered business and people-centered medicine, such as the drug industry's huge expenditures (in the billions) for courting doctors to use their products, for recruiting physicians to tout their drugs or, more slyly, to present seemingly objective medical discussions that, on closer examination, do favor the company's product over others. Kassirer also covers the abuses of both fee-for-service (which can lead doctors to perform unnecessary but lucrative tests and procedures) and HMOs (which reward doctors for keeping costs down). The author calls for more scrutiny of the health-care industry by Congress and a "sustained public outcry against inappropriate practices"; the banning of industry gifts to medical personnel; and—difficult to imagine—disclosure to patients by doctors of financial incentives they are receiving. Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From the New England Journal of Medicine, December 2, 2004
The profession of medicine encompasses a wide variety of ways in which a physician can dedicate his or her life within the traditional areas of clinical practice, research, education, and administration. In this book, Jerome Kassirer, a former editor-in-chief of the Journal, documents, with well-referenced examples, how conflicts of interest, primarily financial in nature, have infiltrated all areas of the profession. The audience for the book is clearly the U.S. public, who, the author writes, "must become involved if we are to change the greed culture that permeates medicine." I agree, in principle, with the author that there are substantial conflicts of interest within the medical profession. However, I question the potential effectiveness of this book as written for the public. The most obvious reason for a physician of Kassirer's stature as a clinician, academician, and former editor to write a book about conflicts of interest in medicine would be to continue his attempts to eliminate or at least decrease a problem that diminishes the profession. But is this book a good way to accomplish that goal? The book wavers between a scholarly work and a sensational expose. For example, the cover features a man wearing a white coat and a neat shirt and tie, with a stethoscope around his neck and a pricey pen and a few crisp $100 bills tucked in his pocket. I was taken aback by the image, which is clearly meant to depict a "fat cat doc" on the take. However, this jarring image is then tempered by the two opening sentences of the first chapter, which declare that most physicians are hard-working and dedicated to their patients and that perhaps even hundreds of thousands of physicians refuse to take any financial gift that might affect their clinical judgment. Then, aside from a few selected exceptions to that supposed rule, the rest of the book is dedicated to stories about physicians tainted by financial self-interest that altered how they cared for patients, how their research was conducted and reported, what they taught, and how they administered medical institutions, with evidence that all of these conflicts of interest led to the detriment of patient care. The final chapter discusses "what can be done," ending with a "possible roadmap" that includes 10 items for immediate implementation that would be possible primarily by legislation. The reader is asked to take a political stand to force the enactment of such legislation. If the reader were to take such action, the author would deserve a medal. However, if the reader's more likely reaction would be to view with distrust all physicians currently practicing in the United States, it would be unfortunate indeed and would undermine the very reason that the book was written. Catherine D. DeAngelis, M.D., M.P.H.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Mother Jones
"A suprisingly bare-knuckled book by one of the last editors-in-chief at the New England Journal of Medicine."

Book Description
We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals.

FROM THE PUBLISHER

"In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Under-scored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them." A diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors.

FROM THE CRITICS

Tom Graham - The Washington Post

Kassirer takes the cynical view; in fact, he's all but resigned to having the government police his colleagues' ethical behavior. "It shouldn't have to be patients' responsibilities to protect themselves against the medical profession," Kassirer writes. Bravo to that.

Publishers Weekly