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Med perks blog touches a nerve

By Jay MacDonald ·
Friday, February 10, 2012
Posted: 10 am ET

My recent blog, "Ending the doctor gravy train," that explored how health care reform plans to make transparent the commonplace practice of doctors accepting gifts of food, money and junkets from pharmaceutical companies really hit a nerve with doctors out there.

Here's a sampling:

Doc: This article is ridiculous. Virtually all gifts and freebies that doctors might have been given in decades past stopped years ago by mutual agreement from all the major pharma companies. This article is totally off base.

JP MD: The pharmaceutical industry itself agreed to stop offering such extravagant perks to doctors to pitch their drugs many years ago. Even when I was a premed, the most a drug rep would provide a doctor at the office would be lunch for the staff, some articles, and a short lecture. I currently work at a hospital, as a senior medical resident, that has virtually banned pharmaceutical representatives from soliciting propaganda to medical trainees (I have attended 2 "drug-sponsored" lunches in 3 years, served with our normal noontime lecture).

Big City Doc: It always strikes me as odd when one of the least ethical groups in America, the Congress (75% of whom are lawyers), seeks to control the ethical behavior of the most ethical group in America, the physicians. Our government runs on SuperPacs, lobbyists, influence peddling, but doctors are likely to sell their soul for a pad of sticky notes. Given the effects government has had on medicine to date, their biggest and best contribution in the future would be to stay out of healthcare.

Robert Skversky: As a practicing Bariatric physician (medical weight-loss) who uses pharmacotherapy (off-label) with great safety and long term efficacy; my staff and I are brought "free lunch" about every 2 months by a variety of intelligent, well trained pharmaceutical reps. They are usually accompanied by a physician who is an expert in his/her specialty of medicine who gives a meaningful and informative discussion relating to a particular drug prior to an open exchange of ideas and questions. No trips to Hawaii, and no gifts of money. PS The "free" food?? usually mediocre and too many carbs!

My take? Obviously drug companies aren't flying all doctors to golf resorts to get them to use tongue depressors. Presumably they're spending their marketing budgets on those specialists in a position to prescribe their latest, greatest and costliest products.

In fact, during my recent chat with Dr. Otis Brawley, chief medical officer of the American Cancer Society, he brought up the subject in the context of gene testing. Here's an excerpt:

A company flies oncologists, surgeons, some GYNs to Utah, gives them this two-day discussion about screening with gene testing, sends them back to their offices, then the company buys local air time about gene testing and genetic screening with an 800 number. If you call the 800 number, you get referred to one of these docs, who are not trained as genetic counselors.

If junkets and cash gifts are as outdated as these readers claim, then there should be no harm in requiring the pharmaceutical companies to post what they've given to whom online under health care reform.

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March 28, 2012 at 7:05 am

Well Dmitry, you obviously have an ax to grind with doctors. What's your line of work that is so full of integrity and high ethics that you are so comfortable throwing these stones? Why is medicine the only industry that has to put up with all this nannying from the federal government? Heard about any military industry junkets and perks lately? How about manufacturing? IT firms? Attorney conferences? You're a bitter fool.

Linda Hollaway
March 07, 2012 at 2:00 pm

Wake up Americans. This is hype from the big big big business of insurance. Who do you think received the $100 billion (not a typo it is billion) from the drug companies to have their drug covered under the formulary drug plans that insurance companies sell. Call your state senate and house pharmacy/health committee. Obamacare is making this worse.

K Patrick McDonald
March 03, 2012 at 12:39 pm

Dmitry said:

". . .calling physicians "the most ethical group in America" invokes in me sarcastic laugh and reaction not dissimilar to desire to punch someone in the face."

Amen and underscore the sentiment, Dmitry. Thank you.

For those of us who investigate physician misbehavior for a living, let me reiterate your comment, and add an eye-opening footnote to it:

1. Almost exactly 10 physicians PER DAY are found guilty of felony-level misdeeds. For the record, there exists no evidence that any other group of professionals in society comes close to those numbers.

2. Since 2005, 11,000 doctors have been convicted of severe misbehavior, in the categories of Patient Sexual Assault; Medical Fraud; Drug-Running; Child Rape; Homicide; Filming their nude patients; injecting fake Botox, just to name a few.

3. The U.S. Department of Justice Annual Report states law enforcement and courts nationwide spend a jaw-dropping $500,000,000 PER YEAR on physician crime & medical fraud.

The doubters out there may want to go back and look at all those zeros.

So the end note here is this: we are fortunate to have hundreds of thousands of terrific MDs out there. We need them.

But until all those good guys take the initiative to start weeding out the medical miscreants in their midst, health care will continue to - among other things - remain the 3rd leading cause of death in the U.S.

By sweeping the crimes of their lunatics under the rug, medicine is ignoring its own self-inflicted wounds.

February 10, 2012 at 8:08 pm

With all do respect Dmitry, physicians are not paid based upon the drugs they prescribe. Your examples demonstrate why you do need a doctor. Statins are not linked to renal failure and actually high doses of niacin is associated with far greater hepatic side effects than are statins. The point is, physicians are not getting "rich" prescribing certain meds or performing "unwarranted" tests. We must get approval from your insurance first. We are fighting to care for you. Your insurance company provides you with their formulary of acceptable drugs. We often simply chose a "class" of medication not a specific one. My payment is also determined by the insurance company not by me. Call your accountant or lawyer tonight and you will receive a bill. Call your physician, request information that carries a 7 figure liability, and he cannot bill you. Seven days a week, 24 hours a day he or she will answer. Getting rich? I do not think so. Let your clients call you anytime day or night free-of-charge. I am not complaining. I chose the profession and would do it again, just think about this next time you need our services.

February 10, 2012 at 4:27 pm

Dear Jay MacDonald, if possible please forward my message to Big City Doc, and others who you feel it applies to.

While I agree the Congress is an easy target for criticism, calling physicians "the most ethical group in America" invokes in me sarcastic laugh and reaction not dissimilar to desire to punch someone in the face.
There were just too many incidents of clearly unethical behavior that are not rumors, but things that happened to myself, my family, and friends, or behavior admitted by doctors (or their wives) who were stupid enough to think it makes a good dinner story.

I'm not even going to count the discovery documents I personally seen from the original gravy train litigation - my favorite one was handwritten note to a major drug manufacturer with several errors, incoherent, and incomplete sentences to the effect of "I need $10,000 dollars. I heard you can give it me if I just write you and ask for it." - how does one become a doctor without ability to write a simple sentence? May be you can tell me Big City Doc, as most doctors seem to think the world of themselves.

The most benign incidents were deceptive billing practices, since only damage made was the money. I'd post more details, but I'm afraid more doctors will follow this route. That was a brilliant exploitation of insurance loophole. During the prolonged process of complaint it turned out if you have a complaint about a doctor with your insurance it will go LITERALLY nowhere (internal record is made, no action taken), or you can complain to Medical Association Board that consists of other doctors, some of whom have complaints against them... That would be like trying to convict a bank robber when the jury consist of thieves.

More troubling was prescription of unnecessary drugs. Tell me, doctor, do you know many physicians that tell their patients that for most cases Slo-Niacin (over-the counter) is just as good as Lipitor and other new statin drugs? And with lower probability of serious side effects. But what would be profit in that? Let 1 in 10,000 have a kidney failure - that 2nd home won't pay it's mortgage by itself, right?

I know that there is at least one man walking around with heart device which the doctor himself considered inferior but used it so that his wife could get an interview with a medical device maker's higher ups. How ethical is that?

Then there was my friend who woke up with 20 inches of intestines missing without his authorization, on when whim of the doctor who was supposed to do biopsy ONLY. On top of it those 20 inches where healthy and did not need to be removed.

Then there was that physician that tried to convince my wife to have baby delivered at 35 weeks citing she had gestational diabetes(which did not make sense as lungs develop slower with gestational diabetes). Turns out, that was due to his travel plans. He could have one of his colleagues to handle the delivery, but no! He wanted to have all the money even if it put a life at risk. He delivered her(C-section) jetlagged next day after flight from Africa. She was born at 39.5 weeks 5 pounds 11 ounces. Glad we did not listen.

So, get off your high horse, doctor. You must be either blind to the conduct of your colleagues, or a liar (read how 1 in 10 doctors admitted to lying to their patients). For every good doctor there are many bad ones - just like any other profession where big money are involved (like Congress). Until we have doctors who are in it not just for the money, I will question every recommendation/diagnosis I hear. I have my reasons.
And I do DEMAND more transparency and accountability as long as there are "few" bad doctors out there.