Unhealthy medical practices

I’m not a doctor, have no medical training, and fully expect you to dismiss this tirade as “naive.” However, I believe that the practice of pharmaceutical companies paying doctors to prescribe their medicines is outrageous.

The catalyst for this comment is a story in today’s New York Times, “Doctors Reap Millions for Anemia Drugs,” which begins by saying,

“Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.”

and continues

“Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers.”

When you or I go to a doctor, and he/she says that we need to take drug xyz, in a specific dose, we would like to think that it’s because the doctor

• truly believes that we need to take a medication for a specific condition
• and of all the medications available, he/she has chosen xyz because it’s the best for me
• and he/she has chosen a specific dosage of xyz because it’s the best for me

If the drug companies are providing physicians with incentives, rebates and payments to promote their medication, there’s a conflict of interest. Is it possible that the condition might be curable without medication? Is it possible that medicine abc would be better for us than xyz? Is it possible that a smaller dose of xyz might be enough?

Maybe, maybe not.

But if the doctor makes money, money in his/her pocket, by prescribing xyz, it’s hard to be certain that my best interests are paramount. Sure, there are codes of medical ethics that to tell doctors to focus exclusively on the patient. But it’s hard to ignore the temptation. The story continues,

“The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company’s drugs exclusively typically receive higher rebates.”

In what way does my own health benefit from the doctor’s signing an exclusive agreement with a single pharmaceutical company?

The story adds,

“Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them.”

No. Disclosure is not the answer. So, I learn that the doctor makes money from prescribing xyz. Does that empower me to make an informed decision about my treatment? Does that mean that I should insist on abc (assuming that the doctor informs me that there’s an option), or should I decline the medicine entirely, because of that disclosure? Of course not. Only the physician is trained to make that sort of recommendation. We need honest answers from our personal health care advisers.

The problem is, that my personal health care adviser is working for the drug company, not for me. Disclosures would make me more skeptical, but it wouldn’t improve my ability to make smarter choices.

Doctors — and their patients — should not be placed into the situation where the doctor profits by prescribing certain medicines (and doesn’t profit if he/she doesn’t). Doctor, clinics and other such facilities should be strictly revenue-neutral when it comes to medicine, being paid for time and professional services only.

The for-profit sale of medications by physicians, and any kickbacks for making prescriptions, should be banned outright as a complete violation of medical ethics. Doctors occupy a uniquely trusted position, in our society. They should be worthy of that trust.

Z Trek Copyright (c) Alan Zeichick