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Medical Industrial Complex (The Underground Knowledge Series, #3)
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MEDICAL INDUSTRIAL COMPLEX > Kickbacks for doctors

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message 1: by Lance, Group Founder (last edited Jun 10, 2017 01:15PM) (new) - rated it 5 stars

Lance Morcan | 2791 comments Excerpt from MEDICAL INDUSTRIAL COMPLEX: The $ickness Industry, Big Pharma and Suppressed Cures

It was Cicero who said, “In nothing do men more nearly approach the gods than in giving health to men.” Certainly, the medical profession, in its purest form, is a noble one. And doctors are clearly at the apex of the profession. We have no wish to denigrate doctors, or to denigrate anyone who devotes their life to helping fellow man. However, it would be remiss of us not to bring your attention to some, shall we say, gaps in the system – gaps that allow doctors to abuse their position if they are so inclined.

And we stress that those who do (abuse their position) are very much in the minority. That said, the numbers of doctors who have brought their profession into disrepute, worldwide, are staggeringly high. Certainly far too many for so noble a profession, we would argue.

The following report was aired by BBC News on November 6, 2014: “Until recently, paying bribes to doctors to prescribe their drugs was commonplace at big pharmas, although the practice is now generally frowned upon and illegal in many places. GSK (GlaxoSmithKline) was fined $490m in China in September for bribery and has been accused of similar practices in Poland and the Middle East.

“The rules on gifts, educational grants and sponsoring lectures, for example, are less clear cut, and these practices remain commonplace in the US. Indeed a recent study found that doctors in the US receiving payments from pharma companies were twice as likely to prescribe their drugs.

“This may well exacerbate the problem of overspending on drugs by governments. A recent study by Prescribing Analytics suggested that the UK's National Health Service could save up to £1bn a year by doctors switching from branded to equally effective generic versions of the drugs”.

“Isn’t it a bit unnerving that doctors call what they do practice?” –Grammy-winning American actor/author George Carlin

The “recent study” referred to by BBC News was a detailed 61-page report compiled by the University of California, San Diego (UCSD), and dated January 2014.
This report starts out with the comment that “While rent-seeking behavior may not be surprising generally, that financial conflicts of interest could influence physicians’ advice might be less expected. For one, doctors are highly paid, with most falling in the top 5% of the income distribution within the US”.

The UCSD report continues, “When drug companies have financial relationships with physicians, medical decisions may be influenced by pecuniary motives not directly related to patient health…

“We find that men are over twice as sensitive to payments as women. This confirms experimental and field evidence suggesting that women are, on average, more honest and less corruptible than men”.

The report’s conclusion is that “Using data from twelve drug companies, more than 330,000 physicians and nearly one billion prescriptions, we find that when a drug company pays a doctor he is more likely to prescribe that company’s drug.

“Whether these results are surprising likely depends on whether one views a physician – and her opinions – as sacrosanct. To a cynical reader, perhaps the presence of influence is self-evident from payments: after all, if payments from firms to doctors did not change doctor behavior, why would profit-maximizing firms choose to make them in the first place?

“While this view seems sensible from an economist’s perspective, it ignores the fact that payments may reflect (rather than cause) the opinions of physicians or represent valuable transfers of information from firms to doctors. Given that the balance of our evidence is best explained by either persuasive advertising from drug companies or rent-seeking behavior from doctors, to a less-cynical reader our findings suggest a consideration of outside influences when taking in medical advice”.

Reading the UCSD report, we got the feeling the researchers were choosing their words very carefully – as they should of course. However, the distinct impression we were left with was they went above and beyond to ensure that criticism of the medical profession was presented in the most benign and inoffensive terms possible. But we concede that could be a cynical view.

“The purpose of a doctor or any human in general should not be to simply delay the death of the patient, but to increase the person's quality of life.” –Patch Adams

A US Federal Government report unveiled in September 2014, detailing 4.4 million payments made to doctors and teaching hospitals by pharmaceutical and medical device companies sheds more light on the vexing kickbacks issue.

ProPublica.com, a watchdog site that prides itself on providing “journalism in the public interest,” analyzes the Federal Government report in an article dated September 30, 2014 by award-winning reporter Charles Ornstein.

Incidentally, the site’s management advises subscribers that “ProPublica is investigating the financial ties between the medical community and the drug and device industry,” and “in 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors”.

We quote Charles Ornstein quite freely in this chapter, so it’s worth sharing his credentials with you. According to Wikipedia, Ornstein is a graduate of the University of Pennsylvania and was a reporter for the Washington bureau of The Dallas Morning News and the Los Angeles Times; he was a Media Fellow with the Henry J. Kaiser Family Foundation and is vice president of the Association of Health Care Journalists; he shared the 2005 Pulitzer Prize for Public Service, citing “courageous, exhaustively researched series exposing deadly medical problems and racial injustice at a major public hospital”.

In his ProPublica column, Ornstein points out that the Federal Government’s “new trove of data” covers the period August to December 2013. He writes, “According to officials from the Centers for Medicare and Medicaid Services, companies spent a total of $3.5 billion during that period on 546,000 individual physicians and almost 1,360 teaching hospitals”.

Under the heading ‘Where Did the Payments Go?’, Ornstein provides the following breakdown of general payments (that drug companies make to physicians) by category. (Amounts in US dollars):

Royalty or licence payments – $302m; promotional speaking – $202.6m; consulting fees – $158.2m; food and beverage – $92.8m; travel and lodging – $74.1m; grants – $38.1m; education – $26.7m; honoraria – $25.5m; gifts – $19.2m; the balance of payments included space rental, charitable contributions and entertainment. (Payments excluded research or payments to physician owners of a company).

Ornstein states, “Similarly, companies reported payments associated with particular drugs in different ways. The expensive drug Acthar, which is marketed for a variety of different conditions, is listed under at least eight different name variations…There is one drug simply listed as ‘KNEES’ and another as ‘Foot and Ankle’.”

One of his most alarming observations is that more than 1.7 million records did not include the names of the doctors or hospitals that received the payments. By his calculation, that amounts to 40% of the payments.

Ornstein also calculates the redactions were even more extensive. “About 64 percent of the total spending by companies wasn’t attributable to a particular doctor or hospital (the names, addresses and other identifying information were removed)”.

He concludes, “Doctors were paid for more than 200,000 trips by companies in the last five months of the year…Their top destinations were Toronto, Copenhagen, Amsterdam, Paris and Barcelona. Drug and device makers paid for doctors to travel to about 80 countries in all”.

“An apple a day, if well aimed, keeps the doctor away.” –P.G. Wodehouse

Ornstein also figures in an item CBS News ran on March 4, 2014. Headed ‘Does your doctor have ties to Big Pharma,’ the report states, “Big pharma routinely pays doctors to promote its products, but soon patients will be able to get a clearer picture about a doctor's possible connections to the companies that make the drugs they may prescribe”.

The report continues, “The practice of pharmaceutical companies working with doctors to develop new medications to treat conditions and help promote those medications has been in place for decades, but Ornstein, who is investigating this practice, says, ‘The promotion part has gotten a lot of attention in recent years because drug companies have paid hundreds of millions and sometimes billions of dollars to settle lawsuits that have accused them of improper marketing and giving kickbacks to doctors’.”

The same report addresses the all-important issue of trust – trust between patient and doctor. As Ornstein points out, “When you go to your doctor, you trust that the doctor is giving the best medication for you, but there's a lot of different interests that your doctor has to take in mind in prescribing you drugs”.

In response, Matthew Bennett, senior vice president of the Pharmaceutical Research and Manufacturers of America, is reported by CBS News as saying the discovery of new and improved medicines is dependent on research collaborations between physicians and biopharmaceutical companies. “Clinical trials sponsored by biopharmaceutical companies have led to breakthroughs for people suffering from cancer and other life-threatening diseases”.

We don’t doubt there’s some truth to that, but it doesn’t address the concerns held by many – that it’s illegal to give kickbacks to doctors to prescribe drugs.

Of equal concern to us is that it is legal for pharmaceutical companies to give money to doctors to help promote their drugs. How tempting it must be for doctors to put impartiality aside when recommending certain drugs to patients. And how tempting it must be for unscrupulous doctors to recommend lesser or inferior drugs, knowing promotional payments – aka kickbacks – are on offer.

As Ornstein advised CBS News, “Some doctors make tens of thousands or hundreds of thousands of dollars a year beyond their normal practice just for working with the industry”.

Yes, you read that right: tens of thousands or hundreds of thousands of dollars a year beyond their normal practice.

Of course, this is nothing new. The practice has been around for ages, but we’ve limited the bulk of our research to cases dating back to the mid-2000’s.
One earlier case that caught our attention was reported by New York Times on March 3, 2009. Under the heading ‘Crackdown on Doctors Who Take Kickbacks,’ reporter Gardiner Harris writes, “Federal health officials and prosecutors, frustrated that they have been unable to stop illegal kickbacks to doctors from drug and device companies, are investigating doctors who take money for using these products”.

Harris states, “For years, prosecutors rarely pursued doctors because they believed that juries would sympathize with respected clinicians. But within a few months, officials plan to file civil and criminal charges against a number of surgeons who they say demanded profitable consulting agreements from device makers in exchange for using their products.

“The move against doctors is part of a diverse campaign to curb industry marketing tactics that enrich doctors but increase health care costs and sometimes endanger patients. Taken together, the new measures are likely to transform the relationship between medicine and industry”. Harris concludes with a quote by the US attorney, Mr Sullivan, who said, “Officials hoped to send a strong message to doctors,” and “I have been shocked at what appears to be willful blindness by folks in the physician community to the criminal conduct that corrupt".
MEDICAL INDUSTRIAL COMPLEX The $ickness Industry, Big Pharma and Suppressed Cures (The Underground Knowledge Series, #3) by James Morcan


message 2: by James, Group Founder (new) - rated it 5 stars

James Morcan | 11213 comments Doctored: The Disillusionment of an American Physician might shed some light on this subject.

synopsis:

Doctored is the shocking follow-up to Intern, Sandeep Jauhar’s widely praised chronicle of the harsh realities of a hospital residency. Now the director of the Heart Failure Program at a Long Island hospital, Jauhar uses his own story as a scalpel to lay open the American health-care system.

The patient is ill indeed. A perverse system forces doctors to prescribe unnecessary tests and participate in an elaborate system of cronyism just to cover costs and protect themselves from malpractice suits. Jauhar reports cases where a single patient might see fifteen specialists in one hospital stay, fail to receive a full picture of his actual condition, and leave with a bill for hundreds of thousands of dollars. Jauhar himself wrestles with his conscience as, struggling to make ends meet, he moonlights for a practitioner who charges exorbitant fees for tests of questionable value.

Doctored is a cry for reform; a fascinating look at what really goes on in examining rooms, ORs, and your own doctor’s mind; and, most of all, a deeply personal and unsparing act of introspection by a physician who wants to return meaning and moral grounding to a noble profession that has lost its way. It is certain to kick off controversy and heated debate at a time when the dysfunctionalities of our health-care system remain at the top of the nation’s agenda.

Doctored The Disillusionment of an American Physician by Sandeep Jauhar


message 3: by Kathy (new)

Kathy  | 15 comments I have worked for years in the US healthcare system as an accountant and lawyer. The problem that I find with the U.S. healthcare system is that it is treated as a business. This is particularly true when it comes to legislation. Our Congress is so swayed by the lobbying efforts of powerful (rich) industries, Big Pharma and the Insurance Companies, that any laws that are passed to protect consumers are laughable. This should be a non-issue because in the early 2000s, legislation was passed that limits gifts that can be given to doctors from pharmaceutical companies to the status of like free coffee mugs. But, obviously, this is being ignored. There are grass-root efforts that have been started like "The No Free Lunch" program. In our practice, the practioners refuse to meet with drug reps and any "educational" material they want to be passed along is left at the front desk or mailed. However, the crafty industry has now inundated television programming with commercials designed to influence the direct consumers. I find the commercial with the three grannies doing "donuts", sharp circles on the lip of the Grand Canyon in their power wheelchairs particularly amusing! It is amazing how many requests that we receive from patients for drugs that they have seen advertised on tv.

What is more disconcerting to me is how powerful and manipulative insurance companies, and I include Medicare, the government run insurance company is to the cost of healthcare. In their efforts not to pay for services that they have promised their customers, they require the doctors to run unnecessary tests and try useless medications before paying for the treatments that the patients really need. In answer to the accusation that they are practicing medicine, they say that the patient can pay for the treatment or medicine themselves if they wish to forego the insurance companies requirements.

What I am trying to say is that it is disingenuous to lay the blame for high healthcare strictly at the feet of "unscrupulous doctors". There are a lot of offending parties involved least of which is our own government. My mantra is follow the money, who gains the most from these practices.


message 4: by James, Group Founder (new) - rated it 5 stars

James Morcan | 11213 comments Yep, you're right Kathy - doctors are but one cog in the machine that is modern medicine. It's a business as you say. Given your experience, I find your comments insightful and irrefutable in many ways. Makes sense that it's the likes of insurers and Big Pharma that are the real crooks.

Still though, I think some blame in what has occurred in recent decades must reside with doctors - even if only a small amount of blame. Point is doctors should be the ones with morality and they are the last line of defence to protect patients.


message 5: by Kathy (new)

Kathy  | 15 comments True, doctors are the last line of defense in protecting patients. I wish I could say that all doctors acted with the morality that their profession warrants. I think most try to but we are all human and even priests are not always pure. However, everyone needs to act with the best of intentions and not hide behind the corporate veil. Decisions should not be based on business and self-interests but on humanitarian goals. I am not sure this can be done as long as healthcare is considered a business. The US govt and US voters have not instituted a govt run healthcare system for this country --Medicare is strictly for retired and disabled folks. The rest of us are on our own.


message 6: by Jim (new)

Jim (jimliedeka) I think it's also fair to say that it's hard for doctors to keep up with everything unless they are very specialized. That sort of puts them at the mercy of drug reps who say they have a pill for X.


message 7: by Lance, Group Founder (new) - rated it 5 stars

Lance Morcan | 2791 comments Jim wrote: "I think it's also fair to say that it's hard for doctors to keep up with everything unless they are very specialized. That sort of puts them at the mercy of drug reps who say they have a pill for X."

Quite agree Jim. The amount of reading and research they must do (to qualify in the first place and to keep abreast of medical developments) must be daunting. All the more reason for us (the patients) to do our own research and take more responsibility for our own health and our own bodies.


message 8: by Jim (new)

Jim (jimliedeka) Agreed but it's hard to be sure you are getting good information. Big pharma bombards us with ads for all their pills. The internet is full of pseudoscience and other forms of taurine excrement. You need your sword of reason and wand of intuition.


message 9: by Lance, Group Founder (new) - rated it 5 stars

Lance Morcan | 2791 comments Jim wrote: "Agreed but it's hard to be sure you are getting good information. Big pharma bombards us with ads for all their pills. The internet is full of pseudoscience and other forms of taurine excrement. ..."

...and a dose of luck methinks.


message 10: by Kathy (new)

Kathy  | 15 comments Another aspect of this industry (treated as such labeled as such) that is disturbing is the collection of patient data that is being gathered by the govt and insurance companies. It started a couple of years ago when the U.S. govt (I can only speak for this country) started penalizing doctors by reducing their Medicare payments for office visits if they did not have an electronic medical record system. An electronic records system is basically a canned database in which all patient information and all office visits are recorded and stored off site in the great internet miasma. Medicare (US govt runned medical insurance), the driving force behind the EMR system said that the reason for this is that it will save doctors time in making their notes, it will be more streamlined for doctors to share notes with consulting physicians, and the ever popular it will save paper. Medicare was not forcing doctors to use EMR systems; however, those that don't will be penalized by an increasing amount of money each year -- I believe it was supposed to stop at 16% in 5 years. They keep changing the threatened amount.

The disturbing part is the increased demand by all insurance companies (including Medicare) for access to this information. It is called an audit, and the reason for this request is supposed to be to verify that the office is charging the correct code for levels of office visits. Last year, United Healthcare demanded that we give them 3 years of office notes for 20% of our UHC patients. When I complained that this was excessive for monitoring our coding practices, they said they would send a company rep in who could download this information at no trouble for us. The rep just needed a computer to hook up to. I have even had an insurance company offer to send me a zip drive that I can mail back to them thus saving paper. Call me "a conspiracy theorist" but there is no need for this mass invasion of privacy by the govt and insurance industry. Honestly, if you are really checking coding practices pick one or two random visits a year not 3 entire years worth of visits. Cleverly, we do have a privacy act called HIPPA which allows insurance companies to access any patient information for the purpose of making sure that billing information is correct. And the patient never knows. Don't get me started on how Medicare will only pay now with direct deposits into the doctors' bank accounts -- which means that they must have your bank account numbers -- and when things can be deposited they can also be taken out. But surely that will never happen . . .


message 11: by James, Group Founder (new) - rated it 5 stars

James Morcan | 11213 comments Kathy wrote: "Don't get me started on how Medicare will only pay now with direct deposits into the doctors' bank accounts -- which means that they must have your bank account numbers -- and when things can be deposited they can also be taken out. But surely that will never happen . . ...."

That'd be the final straw!


Kevin Coleman | 17 comments The major problem we face on the ground in Primary Care Medicine is a lack of credible data / and their interpretation in a world of confounding variables and multiple under-researched hypotheses. Take the fructose / inflammation hypothesis for vascular disease, for instance. Folk with high uric acid / urate in their blood profile may be unable to metabolise sugar (50% glucose / 50% safely. Rather the fructose ends up on their gut , as abdominal obesity, associated with hypertension, diabetes and heart disease. Health (Disease) care policy is often drug orientated , rather than preventative; and in the pursuit of profit, Evidence Based Medicine has become more like "Evidence" based marketing.
Unless there's a pill for the ill, it's simply not researched. Moreover , there are systemic biases in the biomedical research. An editorial in the British Medical Journal, 5th Feb 2013 by Philip Calder, Study raises questions about dietary fats and heart disease guidance , noted that over half of all completed biomedical research is not published, moreover, the raw data on which their conclusions are based are not open to third party scrutiny! Hello??
Statins are apparently a panacea for every thing from Ischaemic heart disease, to cancer to alzheimer's. Cardiologist will push for the highest dose possible, though side effects are not systemically tested for, everyone working in their drug cocooned silo of care.
I'd like to think that most doctors are decent and ethical, but the system is corrupt , and corruption is insidious.
We (in Australia) need an essential primary health care research initiative. Most GPs (Primary Care Physicians) are computer linked..but usually no front end data gathering or retrieval capacity. The programs are geared to selling pills, despite good epidemiological tools programs been developed in the past.


message 13: by Lance, Group Founder (new) - rated it 5 stars

Lance Morcan | 2791 comments Kevin wrote: "The major problem we face on the ground in Primary Care Medicine is a lack of credible data / and their interpretation in a world of confounding variables and multiple under-researched hypotheses. ..."

Well said! Two statements jumped out at me... "everyone working in their drug cocooned silo of care." and "I'd like to think that most doctors are decent and ethical, but the system is corrupt..."

I believe that's spot on. In my experience most doctors are also highly dedicated, hardwording and committed to their patients. BUT, as you say, the (mainstream medical) system is corrupt. We only need to look at the scale of inducements (aka kickbacks) TO doctors FROM pharmaceutical and medical equipment supply companies to start to get the picture.


message 15: by Feliks (new)

Feliks (dzerzhinsky) If anyone here somehow does not know that the accident/injury/rehab/lawsuit/insurance payout scenario which runs rampant in this country 365 days per yr isn't a RACKET, then I just wouldn't know what to say to you...


message 16: by John (new)

John Graham Wilson | 154 comments One way of getting into US medicine (the courses were prohibitively expensive) was to qualify overseas. I had an acquaintance who did this in Italy: lived like a monk, got the qualification, dumped his supportive girlfriend, and is now living in California as a highly paid consultant blah blah. In the US doctors "ransom the patients for their lives" and he knew that.


message 17: by Lance, Group Founder (new) - rated it 5 stars

Lance Morcan | 2791 comments Doctors Receiving Kickbacks For Fentanyl Are Prosecuted http://www.legalreader.com/doctors-re...

S.Korea to fine Novartis unit over unfair drug promotions
http://www.nasdaq.com/article/skorea-...


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