Lecture Notes (cont.)

As noted, I am posting some more lecture notes, picking up where I left off in Chapter 2 of The Cheating Culture --

1. In our contemporary society with its resurgent bottom-line, laissez faire ideology, wealth is equated with virtue. And inequalities of wealth are seen as good because they motivate people to work harder (or cut corners) to acquire that wealth.

2. Whereas corporate executives of the 1950s were more concerned with their employees and being good citizens themselves, by the 1980s this "social contract" was seriously eroded.

(a) Pay equity went out the window -- an extreme example of which is: the highest paid CEO in 1968 was the chairman of GM who made (a paltry) $795,000; in 1988, Michael Eisner of Walt Disney Corp. made $40.1 million; and by 1998, Eisner pulled in $575.6 million! (The Wall Street Journal article I handed out confirms this extreme wage separation -- that as of 2005 the average CEO pay was 369 times as much as the average worker, and that is down from over 400 times around 2000.)

D. Callahan goes on to point out how a large scale change in values has made it easier to rationalize such greed and its attendant "cheating culture." (see last paragraph, p. 46 over to p. 47)

E. Finally, in this chapter he turns his attention to doctors and the "business" of medicine.

1. Notes that many doctors have gotten involved in multi-level marketing schemes -- selling nutritional supplements despite lack of evidence to back up health claims. And they have resisted efforts by the AMA to restrict such practices.

2. Or, they are in bed (so to speak) with the powerful pharmaceutical industry.

(a) For example: Drug companies encouraged doctors to prescribe neurontin (designed to treat epilepsy), for other purposes. Although the FDA does not allow the drug companies themselves to do this, it does regulate doctors. Obviously a way to boost sales, and doctors get a big "kick-back."

3. Doctors are now under greater bottom-line pressures, either to pay off huge debts and establish an office, or increasingly these days, working for a managed care organization such as an HMO. Pressure to see more patients and cut costs. Certainly could use some cost cutting, but not at the expense of what is the appropriate or best medical care.

4. There are also big gaps between star physicians such as cardiologists, neurosurgeons, etc. and young general practitioners just starting out.

F. Callahan concludes with an overall assessment of whether this "leaner and meaner" system focused squarely on the bottom line (not necessarily the best medical care) has been as good as conventional wisdom holds. (Clearly not, when it comes to the increased pressure to cheat.) (See last two paragraphs, p. 62)



That's all for now. This brings us up to Chapter 3: Whatever It Takes.