Dollars for Doctors

Friday, January 20, 2012

Transcript

As part of the Obama administration’s healthcare reform, patients will, for the first time, be able to see what money pharmaceutical companies are paying to physicians and how – every notepad, free trial and conference junket. Reporters Charles Ornstein and Tracy Weber have, over the last 18 months, have been engaged in a kind of dry run, following a money trail that 13 pharma companies were legally required to disclose.  They speak to Bob about their work.

 

Comments [18]

Ann from atanta

We are living in a day where there's no ethics, hearts have waxed cold. Any doctor that will prescribe a medicine that is worst than anything a drug dealer sells to me is a legal killer, went to school to come out taking lives, that's whats messed up. This primacor iv is legal this medicine destroys the muscle,liver, kidneys and neuro how can we look down on any country that use chemical weapons on their people, when the same thing happen here but in a different fashion. murder is murder but for doctors to do this is a disgrace before the Lord. They will stand before the maker and be held accountable for each life they destroyed.

May. 08 2013 10:46 PM
Ann from atlanta

I think this is good, one of my daughter doctor did not want to do anything different for her CHF. It is so sad.. I believe the doctors that push primacor IV ( which desroyed my daughter life) The doctor just ran it 24/7 it effected neuro, kidneys, liver, mentally no medical profession would stop it as i requested, now at 27 she's deceased. How messed up is that.

Jul. 30 2012 06:09 PM
Bob Deans

This report’s inference that physicians (MDs) are influenced to place personal gain ahead of patient welfare is surprisingly biased & full of errors & omissions.
1. Despite the recent court decision overturning the VT law banning the use of MD prescribing (Rx) records for marketing purposes (proposed in 25 states), physicians can & do individually ’opt out’ of disclosure. The claim that “drug companies track every prescription that every doctor writes” is erroneous.
2. Healthcare (HC) is driven by evidence-based outcomes. MDs prescribe Rx's proven to produce optimal clinical outcomes, or specified by a patient’s HC formulary & prescription benefit plan.
3. Industry-sponsored continuing medical education (CME) is strictly regulated by professional associations i.e. the ACCME, AMA, etc: promo material is not permitted in lecture rooms; presentations must include full disclosure & present ‘fair balance’; etc.
4. In 1990 the AMA developed extensive guidelines that regulate 'Gifts to Physicians' in any form or facsimile: pens/pads; honoraria; the cost of a dinner; where a meeting, ad-board or CME can/cannot be held (facility, city, country); etc.
5. All industry-sponsored clinical research & CME is governed by the rigid tenets of ‘unrestricted grants’ …monitored by the ethics committees of every public or private health care facility where research or CME is conducted, as well as the peer-reviewed journals that publish results.
6. In the prescribing chain it is pharmacists that benefit the most financially through volume discounts, higher margin generic substitution and the sale of prescribing data.
7. Aside from treatment algorithms, formulary restrictions and pharmacy preferences, the biggest influence on MD prescribing is the patient – not pharma sales reps or industry sponsored CME.
There will always be a few profiteers that abuse resources made available by the pharma & medical device industry. Concluding that “One would suppose that they wouldn’t spend billions of dollars if it wasn’t working” is just that: an unfounded supposition.

Jan. 27 2012 10:56 AM
Chris Gray from New Haven, CT

Can't disagree with Dr. Friedman but I, for one, will be grateful that this information will be available not so much so I can read it but for the psychological impact on practitioners knowing that it can be easily found. I trust that the honest strugglers will be be rewarded by the sunlight and the others will sweat.

Jan. 26 2012 08:15 PM
Eliot Friedman, MD from Allentown, PA

I listened with interest to your "Dollars for Doctors" piece last weekend. I have long been an opponent of pharma handouts to physicians and have refused to participate in speaking engagements for the pharma industry despite numerous requests to do so. However, I find it incredibly hypocritical for our legislators to mandate the reporting of every "perk" received by physicians by virtue of the "Sunshine Act" when they do not need to disclose contributions made to their campaigns. These contributions and subsequent actions of our congressmen and senators affect the citizens of the United States far more than free lunches for physicians. This is especially true in the face of Citizen's United ruling where there is absolutely no transparency when examining behavior and voting records of Congress.
Eliot L. Friedman, MD
Chief of Hematology-Medical Oncology
Lehigh Valley Health Network
Allentown, PA

Jan. 26 2012 04:16 PM
Jim

You mentioned in your report that many doctors are "struggling" financially. Would you mind providing some context here? Exactly what constitutes "struggling"? e.g. What does the average family practice doctor (arguably the least-compensated class of physicians) earn in a year? I would bet it's several times the average compensation of regular Joes out there. If that's the case, I would argue doctors are FAR from struggling.

Jan. 26 2012 09:25 AM

Doctors do constitute one of the more privileged classes of society, yet obviously they still share all the normal human foibles.Plenty of them care more about their wallets than the well-being of other citizens. Medical care is a mixed bag, and the appearance and reality of conflict of interest certainly does not help patient confidence. I have an older relative who as a former nurse even claimed that pointing out the flaws of the medical system constitutes an unfair prejudice: judge not, so you will not be judged--but this happens to be a social justice and equality issue. There's plenty of inequity and lack of compassion in the U.S. medical system. The medical model unhelpfully focuses on illness, not health. Professionals need to be held accountable. Recently saw a cartoon that said that physicians hand- in- hand with Big Pharma practice "medicine" not health.

Jan. 25 2012 02:20 PM
Michael O. from Milwaukee

I thought it was an important piece - because even though laws are changing and more transparency is happening there still our 90 thousand+ reps and billions spent on their marketing efforts. So a key question that came up was what is going on post-plastic pen? I think a lot of medical anthropology has shown that reps create a 'feel good culture' an atmosphere that allows conversation and selling to take place, without doctors feeling like they are being sold - it just feels like everyday interaction.

Also, doctors mis-prescribe, overprescribe all the time, and often based on rep activity - a large part of a reps job is to get docs to write scripts for 'off label' use... that's how markets are made and bonus is made and money is made..(take it from me, a former rep...)

Jan. 24 2012 11:35 PM
David

Very poor journalism, haven't witnessed such a biased level of reporting in a long time.

If there are Doctors who are prescribing solely based upon payments, absolutely expose them. But the Doctors who get a speaking fee for educating other Dr's at a dinner are usually providing a very valuable service to everyone involved and there is nothing to be ashamed of. These programs are almost always about educating other medical personnel about new treatment options. They hire doctors because they are the ones who have the background to educate the other doctors.

If a Dr is prescribing the wrong medications because he is getting paid off by pharmaceutical companies, you don’t think he would be completely exposing himself to malpractice suits?

Jan. 24 2012 01:55 AM
Karen from Pennsylvania

As a family physician who works with low-income, mostly uninsured or barely-insured patients, I take serious issue with your characterization of doctors as "pigs feeding at the trough" and the "I might cry" comments about working hours. Shame on you for your snide comments.

I do not see pharmaceutical representatives. They are not allowed in our community health center. My largest "formulary" to select the drugs I prescribe is the $4 list at the big box store pharmacies. Sometimes my patients have the luxury of state Medicaid insurance and I prescribe off their restricted formulary. There are no name brands for medicines for hypertension, diabetes, allergies or ulcers for my patients.

However, I provide contraceptives for patients, mostly little or no cost through our sliding fee scale. There is exactly ONE implantable contraceptive, Implanon (soon to be replaced by Nexplanon). It has unique advantages in that it releases a lower dose of hormone than oral or injectable contraceptives and it does not need to be inserted through the cervix into a woman's uterus like an intrauterine device, which limits IUD acceptance. It is manufactured by Merck. I can ONLY prescribe it if I attend a manufacturer-provided training course. This is an FDA requirement. So now that I have attended a course I'm on "the list". Does this put me in the same category as someone who is paid to consult and give "drug dinners" pushing one "me-too drug" over another? And as a residency faculty, if I train residents to place the device, I must be certified by Merck to do so. Now I'm a dreaded "consultant". Again, am I providing the only medication of its kind, an innovative product that I am giving to many patients for free through my clinic, and serving my low-income population with the same options that insured patients can access, or am I a lackey of Big Pharma? What's worse, communicating with the manufacturer or denying access to comprehensive contraception services?

This is a nuanced topic, deserving of serious discussion, not flip and dismissive comments that taint all physicians. I do expect better from OTM. Of course there are cases of egregious abuse of the system. Why not say that and provide more thoughtful, balanced coverage of the issues?

Jan. 23 2012 04:23 PM
Mike from Chicago

At first I was interested in this story and by the end of the story I was frustrated and disappointed n the reporting. The reporters tried to lump all doctors into the small barrel of those that take money, dinners and pens from pharma. Those few that are on the take do not represent all physicians. Also what about pharma now concentrating on nurses, nurse practioners, physician assistants, pharmacists, etc. In my experience these medical professionals love lunches supplied by the pharm reps. If there is going to be a black list for physicians shouldn't thereby one for all medical practitioners. Also no one complains about Dr Oz or Dr Weil promoting and selling there own products or specific products (that have no data that they work).

It seemed that this story was tring to blame physicians for the problems in the health care system and trying to place that blame on the money that physicians make. the snarky comments by the host were intolerable as well

Overall very awful report. I doubt I will listen to our program again

Jan. 23 2012 01:13 PM
listener

Anyone missing the irony here?
This regulation is to discourage "some" doctors from accepting a meal or hotel stay from private drug companies so that "some" doctors will not be pressured to give expensive and unnecessary drugs and treatment to treat a real illness of their patients.
The solution.
The government demands millions more in revenue from patients and other tax payers to police the personal financial business of doctors and private companies which discourages growth in the practice of "all" doctors and may discourage R&D in the drug and medical device industry.
Is the cure worse than the disease?

Is the government proscribing massively expensive and unncessary treatment to treat a problem for the extortion "in a box" of several million dollars in new federal bureaucracy paid for by the public? That is slightly more than just a free lunch or travel expenses paid for by the private sector?

It seems a private industry scam means "pigs at the trough" and a gigantic governmental scam is praise worthy "sunshine" and a snide barb or worse will be the non-answer to anyone who questions it.

Jan. 22 2012 09:21 PM
David from NC

Rather disappointed in the shallow and simplistic approach, no delineation of prevalence of the most egregious offenses, lumping all physicians as guilty of malfeasance. More offensive to me is that my medical info is sold for cash by pharmacies- where is the outrage there? Walgreens is a paragon of virtue, but my family doctor's pen with a logo makes her a tool of industry? You are capable of better.

Jan. 22 2012 07:21 PM
gina schrock from Spokane, WA

Reporters Ornstein & Weber offered some interesting information about their reasearch. However, your snarky and demeaning remarks about physicians were inappropriate and decidely unprofessional.

Jan. 22 2012 06:19 PM
Mary Hamilton-Homer from Plattsburgh, NY

Clearly there has been a history of drug companies providing perks for doctors in the form of trips, dinners, cash, etc. Clearly this needs to come to a halt. Your smug attitude toward physicians, however, is unprofessional and an example of clearly subjective journalism. I am not a physician but I have many physician friends, many of whom are internists and family practitioners. These docs are clearly having difficulty making ends meet in a world where medicare and medicaid reimbursement is shrinking and overhead costs (which include mandatory, costly and incredibly time consuming electronic medical record programs) are skyrocketing. They DO work many hours at odd times over weekends and all night. And not only are they doing that but what they are doing during those odd hours is saving people's lives, listening to people's worries and concerns and treating their physical and emotional needs. Please do not belittle them with your "oh, I think I am going to cry" comments.

I thought On the Media as better than this.

Jan. 22 2012 11:02 AM
listener

Not sure what this has to do with the media but it is an interesting topic so it is a pity only one view gets a hearing. Is there any negative impact of this massive government regulation or is it all sweetness and light?

Will these regulations have any effect on research and development and incentive for medical progress?
Now that government bureaucrats and regulators, who are of course free of corruption and influence are massively regulating medicine, will they do for heath care what they did for the housing market?
Will the "Sunshine Act" be another equally sublimely named "Community Reinvestment Act" ?
Will huge government medical contracts be rewarded to those that are disclosed as government cronies and denied to those who are not?
If the regulations are a failure and cause harm in the long run to the public health, will the politically unbiased public media be trusted to report the failure honestly?
These regulations may be a good thing but why not have an opposing view so the sneers can be answered intelligently...or is that exactly why there is no opposing view?

Jan. 21 2012 11:46 PM
Mary Kolk from Ohio

Read the books, "On The Take: How Medicine's Complicity With Big Business Can Endanger Your Health" by Dr. Kassirer who was Editor in Chief of the New England Journal of Medicine for eight years. A quote from his Introduction page: "Away from the eyes of the public, the pharmaceutical industry captures the loyalty of physicians with gifts and lavish meals, pays them as consultants (even though they may do little or not consulting), funds their research, and pays for the expenses of their continuing education. Equally obsucrred is the willingness of many doctors to accept this largesse. Trinkets bloom into meals at fine restaurants, meals grow into speaking fees; speaking fees morph into ongoing consultations and memberships on drug company advisory boards --positions that command up to six figures a year."
Who should know better about what is going on with physicians and Big Pharma than a man who for eight years was the Editor in Chief of the New England Journal of Medicine aka Medicines Bible.
He testified before Congress on June 27, 2007 - the transcript of his testimony can easily be found by searching Google for Dr. Kassirer to the Senate Select Committee on Aging - June 27, 2007
No wonder the Republican's want to get rid of the new Health Care Law - it hurts their greedy friends and supporters pockets. UGH!

Jan. 21 2012 06:21 PM
nis from pittsburgh

There is a problem with the health care system but you all made doctors out to be "pigs at a trough" and nearly pitched out of your chairs about free pens and lunches. Are you kidding me? Laws are already in place about this type of behavior. Please report on something with more substance; like how much money is funneled to the law makers from lobbyists? I think you will find that a free lunch is a laughable "bribe" compared the the offenses you will find in our sold out government.

Jan. 21 2012 05:03 PM

Leave a Comment

Register for your own account so you can vote on comments, save your favorites, and more. Learn more.
Please stay on topic, be civil, and be brief.
Email addresses are never displayed, but they are required to confirm your comments. Names are displayed with all comments. We reserve the right to edit any comments posted on this site. Please read the Comment Guidelines before posting. By leaving a comment, you agree to New York Public Radio's Privacy Policy and Terms Of Use.