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Ending the doctor gravy train

By Jay MacDonald ·
Tuesday, January 24, 2012
Posted: 10 am ET

Before you swallow that new drug prescribed by your doctor, wouldn't you like to know whether the drug's manufacturer recently treated your physician to an all-expenses-paid golf junket to Pebble Beach or Hilton Head to extol its miracle properties?

The pills-for-perks dance is commonplace in modern medicine, where based on appearances alone, one might easily conclude that the tail is wagging the dog.

According to an analysis by The New York Times, about 1 in 4 doctors take cash directly from drug companies or medical device makers and 2 out of 3 take free food for themselves and their staff. And it works: according to the Times, those who ride the gravy train are more willing to prescribe drugs in unapproved or potentially risky ways.

Is your doctor prescribing the drug because he or she truly believes it's the best course of treatment for you? Or is it because Maui's Royal Kaanapali is the course they've always dreamed of playing?

Soon, you won't have to wonder. Healthcare reform architects are about to shine a spotlight into this ethical back alley by requiring all drug companies and makers of medical devices covered by Medicare or Medicaid to disclose all gifts or payments they make to doctors.

According to the Tampa Bay Times, every financial expenditure, from golf junkets to coffee and donuts for the doctor's office, will be posted by the federal government on a public website.

The bipartisan reform, sponsored by Sens. Charles Grassley, R-Iowa and Herb Kohl, D-Wis., was one of numerous consumer protections included in the Affordable Care Act.

Will public disclosure of the longstanding pills-for-perks practice end it? Hardly. The pharmaceutical industry isn't about to abandon one of its most cost-effective income-generating strategies, even if some doctors may beg off lest it cost them prestige and/or patients.

But at least it will finally give health insurance customers the opportunity to shop for a doctor who is not a frequent passenger on the pharmaceutical gravy train.

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March 09, 2012 at 10:30 pm

This has been known for eons, remember one thing, 60% of the doctors are opting out of medicare because of reducing thier pay, so let the gov. go after the doctors kick backs and 20% more will drop out of medicare, all when we will need all the saw bones we can get... But remember the socialist model is just what we need........???

Dr. James
March 09, 2012 at 8:30 pm

An excellent study, performed by a Medical Student, revealed the following: 85% of Physicians claimed freebies from Big Pharma did not influence their prescribing habits, but 85% of those same Physicians believed that their Colleagues were indeed influenced by the same freebies. It's astonishing how we all think we can stay above the obvious ethical pitfalls we see each other falling into day after day. It's depressing when what we recognize as obvious immoral behaviour in another becomes transformed or othewise justified when we do it ourselves. No wonder the worst abuses have become increasingly identified and eliminated, even as Pharm Reps & Physicians have found ever new and interesting ways to evade the limitations or get around the law.

March 09, 2012 at 7:29 pm

The only gifts that doctors in the clinic my family uses can accept are gifts of food, and by that I mean the occasional dining our gift certificate (the last one the doctor took over a year to use) or delivered healthy vegetable snacks that I bring our common doctor who shares them with other staff. (I know he only recommends health food choices for every patient, so I don't want to insult [or temp] him with cake, brownies, and pie.) I only do that because he routinely goes well above and beyond the call of duty for us, but is barred from accepting bonuses or other monwy from patients. The only subsidy he otherwise partakes of that I know about is from a hospital he usually sends patients to anyway for their personal location convenience in testing and procedures. He is the polar opposite of the one-minute appointment doctor, putting accuracy first.

When a medical supply or drug company offers a recertification class or seminar, no matter how cheap, it is common, just as it is in other industries for the host to supply food.

March 09, 2012 at 7:15 pm

Perhaps user "Escape" has primarily incompetent doctors or ones doing SEMI-charitable work in poor or rural locations in his family because reports family physician salaries of $128,000 to $299,000 with the average pay as $204,000 using information avaiable on the Internet from salary surveys. Specialists make even more with Orthopedic Surgeons earning from $228,000 to $1,352,000 and on average $459,000.

Smart group practices though, such as those generally found in the Pacific Northwest, don't even let Drug Detailers (sales persons) talk to all the doctors. Usually one doctor with the best understanding of biochemistry (or the least skill with people) hears the sales pitches to save working doctors time with patients, but those doctors are not going to do more than write a periodic summary of new avaialble choices, since doctors in general are very individualistic in their practices. Even in the cardiology clinic I use, no two doctors agree on all advice to patients and they admit it.

March 09, 2012 at 12:51 am

I have a few family members that are docs. These percs stopped almost twenty years ago.

Your GP is making less than 100k a year now. Does that make anybody feel better?

Not me.

Dr. Pt Care
March 08, 2012 at 10:05 pm

Oh and by the way I donate the free pens to my local school since there doesn't seem to be enough money in the budget to provide school supplies to keep our students learning!

Dr. Pt Care
March 08, 2012 at 10:02 pm

I agree with you Dr. Chill. I am a primary care doctor and will often sit and listen to drug reps. I do the same as you...interpret the data, challenge them if it doesn't sound right but I always prescribe the best drugs for my patients (which are often the generic anyway). In return I get a bunch of free samples. The most my office has ever received is free lunch for my staff.

I often give the samples to my patients to try a therapy or to help their financial hardship by giving them a month or 2 worth of their current therapy. In the end it saves the patients money as the free samples are passed on to the patients. Furthermore I often donate the surplus to the free clinic that is locally run for the disadvantaged that can't get health insurance coverage for whatever reason, let alone drugs. Often these people are cooks and laborers. They work for 5-6 $ per hour. They can't afford health insurance let alone drugs. Treating them with free samples often prevents progression of their conditions which eventually saves the taxpayer money as they don't end up in the ER's or worse.

It is my opinion that the general public is in economic hardship and when people think of high paying jobs they think of doctors and lawyers. It seems human nature, mainly greed and jealousy get the best of people and they look to bring others down "because its not fair". This attitude angers me as doctors train 7+ yrs to earn autonomy and go into $250,000+ of debt in schooling. We have worked very hard and sacrificed our families and often the best years of our youth to be able to help the general public. No one is going on these so called "drug company" trips and we are just trying for the most part to just get reimbursed by the HMO's!

The public needs to stop picking on MD's and be thankful that there are people who want to even do this often thankless job. It is predicted that there will be a huge shortage of primary care doctors in the near future and people need to be thankful that they are able to get care....and free medications (samples) given by the drug companies.

The perception of what drug companies give MD's is grossly inflated.

I agree with you Dr. Chill...stop picking on doctor's and look to the government if you want to track wasteful spending.

Oh by the way...I just got home from volunteering at the local free clinic!

Dr. Chill
March 08, 2012 at 9:24 pm

There used to be good junkets, but that's 10-20 years ago. Maybe there still are, but I haven't heard of any. Sure, 10 years ago, I took some dinner cruises on the Potomac to listen to a lecture, or maybe a free book from a drug rep. Get real - I was broke, and anything that would further my education for free, I'd take it. Since I've been in practice, the most I've been given is a free dinner, or perhaps lunch for my staff. In return, I'll listen to a drug rep's spiel...if it doesn't sound kosher, I'll challenge it. In short, I've never heard of Pebble Beach outings, and I've never been influenced by these "perks". However, I do see a great harm with this scheme - drug reps frequently leave samples in my office. I use these samples to see how well patients tolerate a therapy before I send them to fill a script that may cost several hundred (or thousand) dollars. Under this scheme, I'll have to refuse the samples, and my patients will suffer.

Seriously - why is everyone crucifying the doctors right now? Go pick on the Ford Motor Credit rep who spends thousands taking dealers to sporting events so they won't tell their customers that ordinary bank financing is cheaper. Go pick on Boeing or Lockheed Martin for buying a Skybox to influence foreign governments to buy tankers. Why aren't there federal registries for these things?

March 07, 2012 at 3:17 pm

Corporations have business ethics courses warning against this. Why should it be acceptable in the medical community of all things? Most big companies specifically prohibit accepting anything resembling a "gift" from a vendor in any circumstances, but most particularly if it's in exchange for purchasing from that vendor.

March 07, 2012 at 2:00 pm

Oh, yeah. And it happens with dentists as well. My entire life, I was putting my dental health at risk (according to my dentist) by using a regular toothbrush. She talked my wife into switching us to an Oral B, which we did for several years, with no apparent reduction in cavities or other procedures. Then, suddenly (following her vacation to the Bahamas), her office was packed with display models of SoniCare, and we were told that we were putting our dental health at risk by continuing to use Oral B, so my wife got us a Sonicare, and its battery gave out fairly quickly. While my wife replaced it and continued to use the thing, I ran across an old wives' tale about brushing one's teeth with hydrogen peroxide and began doing that only, using a regular Walmart toothbrush. Five years later, still haven't had a cavity, while the family continues to use the trendy Sonicare and Madison Ave toothpaste and get one or more fillings a year. And we all use the same dentist.
So yeah, the junkets are bogus, but the samples are good when put to a good use though.