Like most physicians, I receive a tremendous amount of medical junk mail. I get so much of the stuff that, if I started burning it in my fireplace, I could probably heat my home all winter for free. I rarely respond to any of this mail, but they keep sending it to me. So rather than fight it, I've learned to laugh at it.

The best piece of medical junk mail I ever received took the form of a certified letter. With some trepidation, I went to the post office to pick up the letter, which turned out to be from one of the major insurance carriers in my area. The letter informed me that, among other things, the insurance carrier did not discriminate on the basis of race in its employment policy and that some of the words in its contract, such as “practitioner,” were now capitalized. Presumably every doctor in the state received the letter; I actually received it twice, the second time in noncertified form. I sent a response to the corporate drone who had sent the letters and thanked him for alerting me (twice) that his company did not feel it was exempt from federal civil rights legislation and that its shift keys were in good working order.

One piece of junk mail I get a lot is the unbelievable family medicine job offer: “How would you like to earn $225,000 a year working only four days a week with 1-in-7 call?” It sounds good, except they don't mention the lengthy prison term for insurance fraud, and they leave out the part about the four days a week being a single, sleep-free 96-hour shift with patient visits every 15 minutes. I own my own practice and know how much it costs to run things. Who are they trying to fool?

For a while I kept getting a questionnaire in the mail about irritable bowel syndrome. The letter that accompanied the questionnaire said my views were important because I am a “thought leader” on the subject. Prior to receiving this survey, I had no idea I was a thought leader on irritable bowel syndrome, or anything else.

I receive quite a few unsolicited CME offers through the mail, many of them beckoning me to far-flung destinations. Do I really need to spend eight or 10 hours trying to make connecting flights and languishing in airport terminals to learn that high cholesterol should be treated with diet, exercise and a statin drug? I think I'll pass.

Some medical junk mail is as menacing as it is annoying. I have not been a member of the AMA since I graduated from medical school many years ago. Despite having paid no dues, and having moved four times and sent no change of address notification, a crisp new copy of JAMA lies waiting in my mailbox every week. The CIA should be so proficient at tracking people down.

Of course, JAMA isn't the only unsolicited medical journal that lands in my mailbox. I'm convinced that somewhere in America there is a publishing facility where trees enter one end of the building and medical journals gush out the other end. These latter are all shipped to my house. While some journals are lacking in prestige and usefulness, they at least offer an honest, if sometimes disturbing, portrait of the practice of modern medicine. For example, I once received an emergency medicine journal with a cover story about erectile dysfunction.

It is a rare day that I don't receive a credit card offer in the mail. If I responded to all the offers I receive over the course of a month, I would probably have sufficient credit to purchase the lion's share of North America.

Another perpetual favorite is the large envelope that has the word “alert” or “urgent” or some other term betokening a missive of critical importance. Since it is now common for medications that have been used efficaciously for years to be discovered to have ghastly side effects that, curiously, none of my own patients have ever reported, I always open these envelopes. Nine times out of 10, I discover that I have yet again been duped into looking at an advertisement from a pharmaceutical company.

As the costs of postage and printing rise, I would expect the deluge of unsolicited job offers, journals, credit card offers and advertisements to finally abate. But hey, I'm no thought leader.