Tuesday, January 17, 2012

Physician, Leave That Bagel

The Times reports today that the Obama administration will require pharmaceutical companies, equipment maker and the like to disclose payments to physicians. These payments can run from a bagel and lox lunch spread to consulting and lecture fees in the millions:

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.


This move is long overdue. Such emoluments are ubiquitous, and pose a moral hazard all too often bowed to, and sometimes not even acknowledged. What's a bagel?

The subject of marketing of such things to physicians is, politely put, a target-rich environment. For instance, drug companies routinely recruit cheerleaders, pretty ladies with a positive attitude, as saleswomen:


Another, perhaps more morally hazardous example: prostate cancer can be treated with radiation or surgery, or, in the case of a slow-growing tumor, even ignored. Specialized radiation units are being marketed, and sold, to the very urological surgeons who usually make the decision regarding treatment. The DaVinci surgical robot has become a marketing tool for both urologists and hospitals eager to increase their market share of prostate treatment without clear benefit over skilled surgery (or sometimes radiation or observation). Tidy profits are made, the units are sometimes leased and always depreciated on taxes by their owners. If you own a hammer, you look for a nail, especially if the nail is worth thousands of dollars to you. Not a part of the free enterprise, profit driven health care system that appeals to a patient interested in an unbiased decision with his needs unambiguously at the core of it.

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