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http://www.ama-assn.org/sci-pubs/amnews/amn_02/edlt1118.htm

Regarding "Medical school applications: A disconcerting drop" (Editorial, Oct. 21): Your editorial cites the opinion of "experts" regarding "the fading attraction of medicine" for young people in our society. Those reasons are said to include "concern about the status of medicine, loss of physician autonomy in the managed care era, government regulation and litigation woes."

Nowhere, however, is a syllable addressed to a major factor in the decline of interest of young people in medicine, namely, the devastating role played by physicians in the demise of American medicine.

Ironically, the letter to the editor that followed immediately on the editorial page is headlined "Reflections on a lawsuit, expert testimony and the 'plaintiff whore' " (Letters, Oct. 21). But it is not only in the matter of medical expert testimony that physicians have proven to be whores.

It is in university medical centers, where, all too often, heads of departments are interested almost exclusively in lucre, political chicanery and advancement of their own careers (rather than in matters academic, such as training residents in the rudiments of a discipline) or in certain specialties in which the dominant order of the day is to convince patients that physiologic changes, such as aging, are a disease. It is in research laboratories, where plagiarism, pilfering the work of others, doctoring data, and skill at grantsmanship that borders on fraud are all too common. It is in collaboration with managed care organizations for the purpose of excluding colleagues from participation, freely and fairly, to the detriment ultimately of patients. And it is in turf wars, where the struggle has nothing whatever to do with the needs of patients, but with the pocketbooks of physicians.

Until the medical profession faces, squarely and unflinchingly, the reality of its own contribution to the progressive deterioration of what was once a noble, learned profession -- and until the AMA shows greater leadership in addressing these issues -- there not only will be "a disconcerting drop" in applications to medical schools, but also a plummet beyond redemption of a profession.

--A. Bernard Ackerman, MD New York

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