Editorial: To find out what society thinks of you, ask 'real people' who do not know you

Two brothers (they were about 35 years old at the time) frequently entertained my cousin Phil and I when we were kids. They may have been distant cousins of ours. It might seem strange not to know whether someone is a relative, but you would have to understand that my family was enormous.

Maybe I'm exaggerating slightly, but when someone in my family got married or passed away, half of New Jersey would show up, and the first hour would be spent being reminded of who is a first cousin, second cousin, second cousin twice removed, etc.

To this day, I am pretty sure that just about any ophthalmologist in the United States with an Irish last name is probably at least a second cousin. And because two of my sisters married Italians and another two married Germans, I am also probably distantly related to most Italian-American and German-American ophthalmologists.

Always joking around and having fun, the brothers also had unusual professions, being funeral directors (morticians, undertakers, or whatever you want to call them). They really enjoyed starting up conversations with strangers in bars. At the ages of 12 and 13, Phil and I weren't supposed to be in bars, but we were tall for our ages and didn't order alcohol so we were invited in by the brothers and tolerated.

The brothers then would introduce into the conversation that they recently had buried a family member, and that the funeral arrangements had proven to be quite expensive. That would invariably result in tirades from the other bar patrons about greedy, unscrupulous funeral directors who prey upon grieving family members by making them feel guilty if they did not purchase the most expensive casket, nicest flowers, etc.

The drinks no doubt encouraged people to express themselves, and often with colorful vocabularies that we boys found most entertaining and educational (but not in a way our parents would have appreciated). For fun, the brothers would facilitate the discussion, egging on everyone to share anecdotes about egregious gouging by the human vultures that comprise the funeral industry.

Remembering those alcohol-infused focus groups, I sometimes try to benefit from the extreme candor and truthfulness of people who don't realize they are speaking to someone who practices the profession they are commenting upon.

For example, on airplanes and in other venues over the years, my conversation partners have shared with me that professors are boring, out-of-touch, and in love with the sound of their own voices; academic physicians talk a good game but are mostly clinically incompetent (otherwise they would be out in private practice); and refractive surgeons are unscrupulous, unethical, and always talking people into having surgery so they can make more money.

In almost every instance, I am fairly sure those opinions would not have been offered if the person knew they were describing me. But those conversations are always interesting and let me inquire about the basis for those opinions.

To me, the bottom line is that if you want to know what society thinks of your profession, don't go to your professional society meeting, but ask "real people" who do not know who you are. Alternatively, read what they read.

Yesterday, I read an article about medical researchers in a business periodical.¹ The article is based upon a study from Duke University showing that the "honor system" by which medical authors of papers about cardiac stents are supposed to disclose financial conflicts generally is not working; 83% of papers failed to disclose if any of the authors were paid consultants and 71% of the papers did not reveal who funded the research.

Journal editors defend themselves by saying that they cannot investigate each author to see if he or she has honestly complied with the journal's disclosure policy. "I'm not a cop. I'm not the FBI," said the editor-in-chief of the Journal of the American Medical Association.

Nor does Ophthalmology Times engage the services of private investigators to investigate the authors of our articles to verify the accuracy of any disclosures or confirm the appropriateness of any claim to be free of relevant financial interest.

The article in BusinessWeek paints an ugly picture and implies that there is corruption among biomedical researchers-at least those involved with cardiac stents. If business people really think this way about us, my prediction is that our profession will continue to loose respect from society and it will not be long before additional legislation designed to punish corrupt physicians becomes reality.

By Peter J. McDonnell, MD director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278
Phone: 443/287-1511
Fax: 443/287-1514
E-mail: pmcdonn1@jhmi.edu

Reference

1. What the doctors aren't disclosing: a new study shows how authors of medical journal articles flout rules on revealing conflicts of interest. BusinessWeek. May 15, 2008. http:// http://www.businessweek.com/magazine/content/08_21/b4085032659726.htm?chan=autos_executive+health+--+lifestyle+subindex+page_health+news/