As a lifelong hypochondriac, I've always been comforted by the Hippocratic oath. What an excellent idea, having doctors pledge to put patients first. So I was less than thrilled to learn that doctors are under increasing pressure—from state legislatures, industry, and other groups—to break that oath by withholding key pieces of information from their patients. "We are very concerned about special interests attempting to influence our practices," says Valerie Arkoosh, president of the National Physicians Alliance (NPA). "We've seen state legislatures overreaching a lot with regard to doctor-patient relationship." Here are five things that—depending on where you live—your doctor could be keeping from you:
- Fracking chemicals might be making you sick. Many of the chemicals that oil and gas companies are pumping into the ground (and groundwater) during the hydrofracking process are known carcinogens or neurotoxicants. Pennsylvania recently passed a law requiring companies to disclose the ingredients of proprietary fracking fluids to doctors who can show that a patient may have been exposed, so long as the doc signs a nondisclosure agreement. State officials say the info can be shared with patients, but the law itself contains no such guarantee. "How are you supposed to treat a patient if you can't say why you're treating them?" Arkoosh asks. "I wouldn't know how to do that."
- Your fetus has a serious anomaly. Fourteen states forbid parents from suing doctors who withheld information that might have caused them to seek an abortion. Proponents argue that these laws protect the rights of disabled people. As Nancy Barto, a Republican state senator who championed such a law in Arizona, put it on her blog, "Wrongful life/wrongful birth lawsuits implicitly endorse the view that the life of a disabled child is worth less than the life of a healthy child."
- The gun in your house may get you shot. Pediatricians routinely ask parents whether they own guns, since research shows that gun owners and their families are almost twice as likely to be murdered and 17 times more likely to commit suicide with a gun. But in Florida, the Firearm Owners' Privacy Act—introduced by conservative legislators and signed into law by Gov. Rick Scott in 2011—forbids doctors from asking patients whether they own guns. A federal judge has since ruled most of "Docs vs. Glocks" unconstitutional, but Scott aims to appeal the decision. Dr. Jerome Paulson, a pediatrician at the Children's National Medical Center's Child Health Advocacy Institute in Washington, DC, calls the move "absolutely absurd." Since the connection between guns and injury is clear, he says, "as health professionals, it's our job to share that information with patients."
- There's a cheaper and safer drug than the one I prescribed for you. It's no secret that pharmaceutical companies push new drugs on doctors. But now they employ data-mining to do so. For a licensing fee, industry marketers can access the American Medical Association's database of physicians, which allows sales reps to track down precisely which drugs a doctor is prescribing. "That's how reps get incentivized—they know what drugs to pitch to what physicians," Arkoosh says. "Those drugs are always the most expensive drugs. And we don't have a full understanding of the safety profile of these drugs. Vioxx is exhibit A." (In 2004, Merck pulled its blockbuster anti-arthritis drug after a study revealed that Vioxx increased patients' risk of heart attack and stroke; the company has paid out billions of dollars to settle the resulting lawsuits. Cheap alternative: ibuprofen.) The good news is that Obamacare requires doctors to disclose in a public database any gift worth more than $10 that they receive from pharma reps. Until next year, when the provision kicks in, the NPA counsels doctors to opt out of the AMA database.
- Alternative vaccination schedules can sicken your kid. In his popular 2007 tome, The Vaccine Book: Making the Right Decision for Your Child, pediatrician Robert "Dr. Bob" Sears (son of the best-selling author Dr. William Sears) encourages parents who are skittish about shots to reconsider the vaccination schedule recommended by the Centers for Disease Control and Prevention to decrease the likelihood of a bad reaction. Parents should consider getting "fewer shots at each infant checkup and spreading the shots out over more time," he suggests on AskDrSears.com, the online arm of his family's pediatric advice franchise. Online parent forums are full of posts touting pediatricians amenable to the Sears vaccine schedule. But Dr. Mary Fallat, chair of the American Academy of Pediatrics' bioethics committee, says doctors have an ethical duty to warn parents that delaying vaccines will leave kids exposed to disease. If enough of them adopt the Sears schedule, it could weaken our herd immunity to catastrophic diseases like whooping cough. The kicker? A 2010 study in Pediatrics showed that adopting an alternative schedule doesn't affect children's long-term outcomes.