HMO ‘Gag Clauses’ on Physicians

“Re HMO ‘Gag Clauses’ on Doctors Spur Protest,” April 14:

It is appalling to think that patients do not have free access to experimental procedures or drugs. Although your article focuses on HMOs paying for unproven drugs, no one asked why there is a charge to the patient at all. If the drug does become successful, the drug manufacturer will surely make a profit from future sales. In fact, this cost for development of new drugs is always used to justify the exorbitant prices of pharmaceutical agents.

Doctors should be taken out of the loop of referrals to experimental testing. Their first ethical dilemma is making a referral that will result in a profit to the receiving hospital and physicians and possibly to the drug manufacturer in the future, with no guarantee that the patient will even benefit. Shouldn’t it be the patient who should be compensated for being the guinea pig for these ex- periments?

The second ethical dilemma to a referring physician is that he may be doing more harm than good. What if the experimental procedure actually shortens the patient’s life span, as is now being suggested in bone marrow transplants for breast cancer? Then the physician has violated a basic tenet of medicine, first do no harm.

MARVIN J GORDON MD

Laguna Beach

* Don’t managed-care-imposed “gags” on physicians violate patients’ ethical and legal right to give “informed consent” to treatment?

SAUL HARRISON MD

Pacific Palisades

* Re HMO gag clauses:

“You seniors have got to start reading. You’ve got to start understanding. HMOs are killing health care. If that happens, know who I’ll take care of? Me and my family! I don’t have much time for you.” That was my introduction to a mislabeled “primary caregiver” over a month ago. “Mr. Hippocratic Oath” spat out that welcome, afforded a cursory exam, informed me I had a partially clogged carotid artery and exited, stage left. Last I heard from this white-cloaked carrier of compassion.

Perhaps he’s saddled with the clause but I did the gagging.

PERRY ALLEN

Carlsbad