Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their Special Communication
about physician-citizens, Dr Gruen and colleagues1 proposed
that public obligations of physicians should be proportional to 3 criteria:
the degree to which proposed actions directly address disease causation, their
feasibility to perform, and their efficaciousness. Critical among the factors
is the relation of the action to disease causation. Hence, in the authors'
view, actions targeting broad socioeconomic conditions that indirectly influence
health care are "aspirational goals," but not obligatory. Although the authors
provided examples for distinguishing direct and indirect causes of disease,
they did not establish specific guidelines. For instance, the authors stated
that actions addressing cigarette smoking and needle exchange are direct and
obligatory. By contrast, actions to address income disparities or to remove
environmental pollutants are indirect, and thus aspirational.
Wynia MK, Clark CC. Physicians as Citizens. JAMA. 2004;291(17):2075-2076. doi:10.1001/jama.291.17.2075-b