Having recently been selected to introduce a new emphysema drug into Northern California (the other practice centers are in the Bay Area, Los Angeles, and San Diego), I attended an investigator’s meeting as well as a practice meeting in the Research Triangle area in North Carolina. Although I have communicated with several firms from Research Triangle Park, I never knew why they had chosen that name.

The Research Triangle has three universities at its apices: Duke University in Durham, North Carolina University in Chapel Hill, and North Carolina State University in Raleigh. Eight other colleges are scattered throughout the Triangle. The Triangle was established in 1959 on 6,900 acres of North Carolina pinelands to create an economic focus and provide jobs for university graduates who had been leaving the state for jobs elsewhere. Today, more than a hundred research organizations employ nearly 40,000 people in various pharmaceutical, biotechnology, telecom, and healthcare firms.

In 1924, James Buchanan Duke created Duke University when he donated a large share of his father’s tobacco fortune to a small Methodist college founded in 1859. This institution was renamed for the family, and although built by tobacco, it is tobacco free. Tobacco money, ironically, allows Duke to research into how cigarette chemicals insidiously damage developing brains. Duke’s Primate Center has the largest colony of endangered primates and Duke boasts 30,000 mice in its Transgenic Mouse Facility. The cost of regulations was epitomized when one professor imported 38 frogs for research which turned out to be on the Endangered Species List. This unwitting violation cost the school $50,000 per frog. These costs eventually were passed on to the students in the form of increases in tuition.

I looked for the cemetery Zig Ziglar described as being on a rolling hill near a freeway over which a huge billboard announces: “Marlboro Country.” I now understand the tobacco attorneys had the promotional ad moved to another site.

The practice seminar (“When Bad Things Happen to Good Doctors”) was depressing as we heard doctor after doctor describe the atrocities they had experienced. One allergist was prosecuted for overcharging $1.00 on his allergy shots. He asked HCFA how he was to know that the medicare intermediary was paying him a dollar too much on that particular RBRVS when Medicare paid him the allowable charge irrespective of the billing charge on all the other items? He was told that it was ultimately his responsibility and therefore, he was guilty of Medicare Fraud. Fighting this charge–unsuccessfully–cost him more than $50,000. Another doctor lost his license without a hearing or notification as to why. A sting operation was set up where a long-time patient called the doctor and asked for help. The doctor went to the patient, and while he was giving emergency care, police officers sprung from a closet and arrested and jailed him. A judge gave the doctor a 28-year prison term for practicing without a license. This, thankfully, was reversed on appeal. What one judge ruled was so egregious as to warrant 28 years in prison, another judge felt it was just an ambush without merit. Is it an accolade for an US Attorney to number the doctors he’s made into felons? One is batting a perfect record: 20 felons in twenty tries.

Two Washington, D.C. Bureaucrats who attended this meeting mentioned that the AMA was so far to the left of center that it was no longer representative of the practicing physician. “As far as we’re concerned,” one stated, “the AMA is just a trade organization, like the American Grapegrowers Association.” It was pointed out that when the AMA participated in developing the National Physician Data Bank, this was the second national data bank in the country–the first one was the FBI. It took another four years for the third national data bank to be developed. It was for sex offenders. How did doctors find a home in this illustrious company? Two members of the AMA House of Delegates were making a pitch for joining and remaining in the AMA. After two days of horror stories from doctors and attorneys, many stating that the AMA can no longer be reformed, one AMA delegate addressed the assembly and admitted sadly, “I have to agree.”

Well, it has been a rough season for Hippocrates’ modern Kin. For those of us on the inside of organized medicine, we have enormous challenges ahead. Thanks for your constant feedback and keeping me posted of medical practice in the trenches. Best wishes for a great year for medicine in 1999 with less government prosecution–and persecution–of doctors.