Please would you give the reference. There seems to be considerable financial incentive to clinics in America to prescribe amyloid antibodies for Alzheimer Dementia even though their effect on preserving cognitive function is minimal and quite possibly a placebo effect.

Dear Andrew Sutton,

Thank you very much for your comment and for emphasizing the importance of providing proper references.

I have indeed based the statement regarding substantial financial incentives for prescribing amyloid-targeted antibodies in the U.S. on a recent article, which I cited in the chapter. To clarify this for readers, here is the full citation:

Marisa Wexler, “Most MS neurologists in the US have received physician pharma payments,” Multiple Sclerosis News Today, September 4, 2025.

Available online: https://multiplesclerosisnewstoday.com/news-posts/2025/09/04/ms-neurologists-us-received-physician-pharma-payments/

This article highlights a U.S. study showing that nearly 80% of neurologists prescribing multiple sclerosis (MS) therapies received payments from pharmaceutical companies, and it demonstrates a clear association between receiving such payments and a higher likelihood of prescribing those companies’ drugs—especially when payments were larger, more frequent, or more recent.

Please let me know if you would like the full citation of the underlying study published in BMJ Open or any additional sources.

Best regards,

Dr. Islam Ghanem

Thanks a lot. Our system is very dependent on financial incentives. I found that out many years ago when a treatment for AD worked well in its first, well-designed clinical trial, was published in the main journal in 2004 yet it was completely ignored because patents were weak and it was a nutraceutical. Too many spurious claims are made for nutraceuticals so they are ignored by academics and the more wealthy industry who can afford trials.

https://en.wikipedia.org/wiki/Colostrinin

It's a good article, well referenced. Thanks for the link

Your question raises a global ethical issue: medical decisions are often shaped not just by individual choices but by institutional ties with the pharmaceutical industry. Upholding integrity and prioritizing patient welfare must remain universal

"My sincere thanks and deep appreciation to my father and esteemed professor, Abdullah Abd El-Ghani Ghanem, for his profound and valuable contribution. You have clearly highlighted that integrity and patient care are not merely professional values, but universal human ethics that should guide medica

The ethical challenge here lies in balancing professional integrity with financial entanglements. When neurologists accept payments from pharmaceutical companies, even for speaking, consulting, or educational purposes, the perception—and often the reality—is that prescribing behavior may be swayed. This raises concerns about honesty in medical decision-making and whether patient welfare truly remains the primary focus.

Core medical ethics can still be upheld, but it requires strong safeguards: full transparency of financial relationships, strict conflict-of-interest policies, independent continuing medical education, and institutional oversight to ensure prescriptions are evidence-based rather than incentive-driven. Without such checks, even well-intentioned clinicians risk eroding patient trust and compromising the principle of non-maleficence.

In essence, the tension is not only about individual integrity but about systemic pressures. Upholding ethics demands more than personal restraint—it calls for structural reforms that minimize undue industry influence while preserving collaboration for drug innovation.

Dear Dr. Hezam Dhaifallah,

Thank you very much for your thoughtful and well-articulated reflections. I would like to stress that I fully agree with your perspective regarding the ethical challenges posed by financial relationships between neurologists and pharmaceutical companies. Your analysis is precise and valuable, especially in underscoring the importance of keeping integrity and patient welfare at the core of medical practice.

From an academic standpoint, I find your argument entirely consistent with the principles of medical ethics and the scholarly debates surrounding conflicts of interest in healthcare. I particularly support your emphasis on transparency, strict conflict-of-interest regulations, independent continuing medical education, and institutional oversight as essential safeguards to ensure that prescribing practices remain evidence-based and trustworthy.

In conclusion, I consider your position both academically sound and practically important, and I fully endorse the call for structural reforms that reduce undue industry influence while preserving the collaborative spirit necessary for medical innovation.

Sincerely, Dr. Islam Abdullah

such payments are linked to increased prescribing of the paying company’s drugs, raising concerns about impartiality and patient welfare. This risks undermining medical integrity, especially when high-value or frequent payments coincide with influential roles—such as clinical guideline authorship—making transparency, strict conflict-of-interest management, and institutional oversight essential to restore trust and balance industry collaboration with unbiased patient care

Thank you, Dr. Bhattacharya. You are right—industry payments can affect prescribing and raise conflicts of interest. Strong transparency and oversight are essential to protect medical integrity and patient trust.