Annals should be commended for publishing articles such as that by Taragin and associates [1] and the companion editorial by Bovbjerg [2]. Yet, too little attention has been given to the problem of medical prostitution, a problem I encounter frequently in my practice, which is limited to the defense of health professionals and health care institutions accused of malpractice. An emergency physician testified that, on the strength of a chest roentgenogram alone, he was able to diagnose pneumococcal pneumonia. A family practitioner testified that she knew the standard of care for an orthopedist because she had taken an orthopedics rotation in medical school, had observed orthopedists providing care to her own children, and had discussed the facts of the case at hand with an orthopedist over dinner. An obstetrician-gynecologist testified that a practitioner of his specialty, on the basis of a mid-trimester ultrasound, should have been able to diagnose the hypoglossia-hypodactylia syndrome in a fetus at 20 weeks' gestation.

I could cite numerous other examples; my experience is far from unique. Physicians must understand that 1) a plaintiff unable to identify an "expert" who is prepared to testify to breach and causation does not win the case; 2) integrity is not universal among holders of the MD degree; 3) testifying is for some an occupation unto itself; 4) statements that would be scoffed at by doctors may be believed by lay juries; and 5) unless and until truly massive tort reform is undertaken, and maybe even despite such reform, expert testimony will continue to play a major role in malpractice litigation. In addition, certain companies turn a handsome profit by lining up "experts" to testify against physicians, and some of these organizations actually perform this service on a contingent fee. These facts put the medical profession in a position to do more about the malpractice liability problems than merely to kvetch about it.

If physicians do not police the activities of medical prostitutes, then they must accept at least some of the responsibility for the spread of the malpractice virus. Witnesses such as those I describe bring no credit to law or medicine.