cal, well-mannered, literate and worldly human beings. Some of us are actually quite charming as well.
own. fusion! I am really fed up with pompSince independence Tanzania ous know-it-alls painting all phys- has been very successful at trainicians with a brush that colours ing physicians and paramedical them as sexual abusers or as im- staff to meet the population's moral and unethical doughheads health care needs. However, with who can't think for themselves or more than 80% of the populaact responsibly. For the most part tion in rural areas and a large we are well-educated, highly ethi- concentration of physicians in the
two medical centres and in nongovernmental organizations the country still has a shortage of trained personnel, especially outside the cities. I have seen aid in the form of money and of human and material resources help to alleviate these problems. Every life saved and every person's suffering that is eliminated or reduced attests to this. Why has all this assistance not made a lasting impact? This question could be asked over and over again in the Third World. In Tanzania a universitytrained physician graduates to work in a district hospital for the equivalent of $30 monthly. There is an on-call allowance for doing extra work, such as a cesarean section in the middle of the night, but it is meagre - the equivalent of $5 to $10 - and often received 6 months late, if at all. Medicine as a career, whether it be as physician, nurse or paramedic, is demanding and requires extraordinary dedication. Is it fair or realistic to expect physicians to put in that extra effort when the salary they receive is not enough to buy food to feed their families? The members of staff at our hospital all have outside jobs in order to meet the normal living expenses of their families. The extra effort they would put into repairing a piece of equipment, changing a patient's dressing or attending a committee meeting is taken up by the activities that are needed for them to survive. Until medical professionals receive a salary that relieves these pressures it is idealistic to expect that foreign aid in any form will always be used effectively to achieve the ends intended. It is a testimony to the spirit of our colleagues in the Third World that our assistance does have an impact. Therefore, I continue to support the idea of sending funds, supplies and trained personnel, because sick people will continue
NOVEMBER 15,1992
CAN MED ASSOC J 1992; 147 (10)
Physicians and the pharmaceutical industry O ver the last several years I have seen increasing correspondence about the reportedly unethical ;relationships physicians have established with the pharmaceutical industry. The recent August 1992 issue of College Notices (no. 26), from the College of Physicians and Surgeons of Ontario, has finally prompted me to put some of my thoughts into writing. Virtually all the correspondence that I have read reflects the underlying (sometimes not very subtle) hypothesis that physicians are mindless idiots who cannot think for themselves and are easily swayed by material incentives into prescribing certain brands of medication to their hapless, un-
suspecting patients. I recently turned 41 years of age. I can dress myself, go to the toilet without assistance and feed myself without spilling things, and I have a very good idea of what is right and what is wrong. I have an extensive educational background, have impressive academic credentials and am well respected by my local and distant peers in the medical community. I have a finely tuned mind that I have been exercising unrelentlessly for most of my life. I resent and am offended that any one person or body of selfprofessed wise people feel that it is their mandate to tell me how to run my life, what is ethical and what is unethical. I am quite capable of making decisions related to these matters completely on my
George Jablonsky, MD, FRCPC Associate professor of medicine University of Western Ontario Director, Coronary Care Unit University Hospital London, Ont.
Administrative blunders in Third World medicine J am writing in response to Dr. Michael C. Cross's letter in the Oct. 15, 1991, issue of
CMAJ(145: 920-921). As a Canadian physician working in a rural district of Tanzania I agree with Cross about the positive impact that practising medicine in Third World countries has on one's professional and personal life: it gives a 'filter through which the essentials of life take on a new definition. Tanzania is called a "least developed" country by the United Nations, a designation that places it among the poorest countries of the world; thus, the conditions mentioned by Cross (and even worse ones) exist. In my 2 years here I have seen our district hospital (100 beds serving a population of 100 000) run out of basic medicine and equipment such as acetylsalicylic acid, intravenous infusions, gauze and films for radiography. We have referred patients to the city for basic treatment just because we have no plaster of Paris for a cast or no bottles to collect blood for a trans-
1415
own. fusion! I am really fed up with pompSince independence Tanzania ous know-it-alls painting all phys- has been very successful at trainicians with a brush that colours ing physicians and paramedical them as sexual abusers or as im- staff to meet the population's moral and unethical doughheads health care needs. However, with who can't think for themselves or more than 80% of the populaact responsibly. For the most part tion in rural areas and a large we are well-educated, highly ethi- concentration of physicians in the
two medical centres and in nongovernmental organizations the country still has a shortage of trained personnel, especially outside the cities. I have seen aid in the form of money and of human and material resources help to alleviate these problems. Every life saved and every person's suffering that is eliminated or reduced attests to this. Why has all this assistance not made a lasting impact? This question could be asked over and over again in the Third World. In Tanzania a universitytrained physician graduates to work in a district hospital for the equivalent of $30 monthly. There is an on-call allowance for doing extra work, such as a cesarean section in the middle of the night, but it is meagre - the equivalent of $5 to $10 - and often received 6 months late, if at all. Medicine as a career, whether it be as physician, nurse or paramedic, is demanding and requires extraordinary dedication. Is it fair or realistic to expect physicians to put in that extra effort when the salary they receive is not enough to buy food to feed their families? The members of staff at our hospital all have outside jobs in order to meet the normal living expenses of their families. The extra effort they would put into repairing a piece of equipment, changing a patient's dressing or attending a committee meeting is taken up by the activities that are needed for them to survive. Until medical professionals receive a salary that relieves these pressures it is idealistic to expect that foreign aid in any form will always be used effectively to achieve the ends intended. It is a testimony to the spirit of our colleagues in the Third World that our assistance does have an impact. Therefore, I continue to support the idea of sending funds, supplies and trained personnel, because sick people will continue
NOVEMBER 15,1992
CAN MED ASSOC J 1992; 147 (10)
Physicians and the pharmaceutical industry O ver the last several years I have seen increasing correspondence about the reportedly unethical ;relationships physicians have established with the pharmaceutical industry. The recent August 1992 issue of College Notices (no. 26), from the College of Physicians and Surgeons of Ontario, has finally prompted me to put some of my thoughts into writing. Virtually all the correspondence that I have read reflects the underlying (sometimes not very subtle) hypothesis that physicians are mindless idiots who cannot think for themselves and are easily swayed by material incentives into prescribing certain brands of medication to their hapless, un-
suspecting patients. I recently turned 41 years of age. I can dress myself, go to the toilet without assistance and feed myself without spilling things, and I have a very good idea of what is right and what is wrong. I have an extensive educational background, have impressive academic credentials and am well respected by my local and distant peers in the medical community. I have a finely tuned mind that I have been exercising unrelentlessly for most of my life. I resent and am offended that any one person or body of selfprofessed wise people feel that it is their mandate to tell me how to run my life, what is ethical and what is unethical. I am quite capable of making decisions related to these matters completely on my
George Jablonsky, MD, FRCPC Associate professor of medicine University of Western Ontario Director, Coronary Care Unit University Hospital London, Ont.
Administrative blunders in Third World medicine J am writing in response to Dr. Michael C. Cross's letter in the Oct. 15, 1991, issue of
CMAJ(145: 920-921). As a Canadian physician working in a rural district of Tanzania I agree with Cross about the positive impact that practising medicine in Third World countries has on one's professional and personal life: it gives a 'filter through which the essentials of life take on a new definition. Tanzania is called a "least developed" country by the United Nations, a designation that places it among the poorest countries of the world; thus, the conditions mentioned by Cross (and even worse ones) exist. In my 2 years here I have seen our district hospital (100 beds serving a population of 100 000) run out of basic medicine and equipment such as acetylsalicylic acid, intravenous infusions, gauze and films for radiography. We have referred patients to the city for basic treatment just because we have no plaster of Paris for a cast or no bottles to collect blood for a trans-
1415
