We teach medical students, residents and fellows evidence-based medicine to lay the groundwork for rational prescribing and good clinical judgment. But should we stop our rheumatology fellows from interacting with pharmaceutical companies as part of this foundation? It is not surprising that pharmaceutical companies can influence physician prescribing through gifts. At least, it should not…
The Case You’re working in a busy rheumatology practice with wait times of two to three months for new outpatient consultations. A hospital administrator requests that his daughter see you right away. All but one of your urgent appointment slots for the week is already filled, and there are several patients on a waitlist; these…
Eight years ago, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs embarked on a comprehensive review of the AMA Code of Medical Ethics. What emerged after years of hard effort, intensive feedback and thoughtful revisions was a modernized version of the guide, which the AMA House of Delegates voted to adopt in…
In 2014, the American College of Rheumatology (ACR) was one of 25 healthcare associations invited to participate in an initiative by the American Medical Association (AMA) to reduce the public health epidemic posed by the abuse of prescription opioids.1 The AMA initiative is based on the belief that physicians are professionally obligated to participate in…
Case A 17-year-old girl returns to the rheumatology clinic for scheduled follow-up for systemic lupus erythematosus (SLE). She is accompanied by her mother and father. She has a history of autoimmune cytopenias and Class III lupus nephritis. She has responded well to treatment with mycophenolate mofetil and hydroxychloroquine and was successfully weaned off of prednisone…
Ethical issues that arise in the average rheumatology practice and in clinical research are often straightforward. The AMA Code of Medical Ethics and the Office Practice and Procedures Manual offer useful information.1 In research, the Protocol and Investigators Agreement spells out who you can enroll and how the trial must be conducted. But still—even when…
The boy who could not walk: S.L. is a previously healthy 10-year-old boy who has not walked for three months. Physical examination reveals swollen wrists, knees, ankles and several toes. There is reduced hip range of motion and flexion contractures of both knees. He can stand with assistance, but is unable to take a single…
NEW YORK (Reuters Health)—Authors should agree to share deidentified patient data as a condition for publication of a clinical trial report, according to a proposal from the International Committee of Medical Journal Editors (ICMJE). “Our patients generously and selflessly volunteer to participate in clinical trials on the promise that the knowledge gained will be used…
Over the course of a month, you diagnose systemic sclerosis in two newly evaluated patients. Their responses to the news could not be more different. Patient 1 is a previously healthy 55-year-old man who is an avid bicyclist and skier. He presents with a several-month history of rapidly progressive skin tightening extending to the proximal…
Receipt of an unsolicited communication that a sweepstakes award has been won may con some people (especially, but not limited to, those underprivileged or undereducated as to legalities), but can’t fool all of the people all of the time. The names of the organizations and products involved are often marketing tool inventions, which imply special…