Legally-Sanctioned Pushers

Legalize marijuana by all means and shift the upside from cartel to state tax collector, regulating and controlling that substance through trustworthy channels. But there is another drug dealer in our midst who carries the imprimatur of medical certification and a government license to prescribe drugs, from narcotics to treatment medications, including prescriptions and implants, that may be motivated by greed and not care. We call these practitioners “medical doctors,” and while most clearly care about what’s best for a patient, there is large segment of practitioners with questionable ties to the pharmaceutical and device manufacturing companies that pay them, directly or indirectly. These pharma/device-maker dollars are staggering, and the pragmatics of this inherently questionable practice clearly are major drivers of increasing healthcare costs.

“Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released [September 30^th]. Other doctors made millions of dollars in royalties from products they helped develop.

“The data sheds new light on the often murky financial ties between physicians and the health care industry. From August to December 2013, drug and device companies made 4.4 million payments to more than half a million health care professionals and teaching hospitals — adding up to about $3.5 billion…

“The [new federal web] site, required by the recent health care law, is part of a broader push for transparency. Proponents say such disclosures are an important tool to help limit drug and device makers’ influence on doctors… But the website is being questioned by the industry, which says that technical problems and data inaccuracies limit its value. For example, about 40 percent of the records do not tie back to a specific professional or teaching hospital, accounting for 64 percent of the overall payments.” New York Times, September 30^th. Even if you take the questioned numbers completely out of the mix, the remaining data is more than enough to challenge the integrity of the entire system.

You may remember, back in 2010 when Obamacare was passed, that the pharma lobby made damned sure that we could not legally buy prescription drugs from reputable nations (e.g., Canada, U.K., etc.) – because of the pharma myth that we “cannot verify the purity and quality of the drugs,” which are controlled under standards that are at least as stringent as those in the U.S. They made sure that they would reap the profits from the highest prescription drug prices in the entire developed world: American prices. Read: eliminate price competition. But wait, there’s more: As this bigger doctor-pay-off scheme becomes increasingly transparent, it seems that we may be frequently subjected to treatments and prescriptions authorized by physicians with a financial stake in such medical treatments. Worse, these alternatives may not be the rights choices… or even necessary or advisable.

But we also want to encourage medical innovation, incenting doctors who invent new devices and drugs with appropriate royalties, while also preventing these incentives from distorting appropriate treatment options. It is a difficult balancing act. As we gather facts, we also need examine how we can insure that patient care is the only priority. “The data is likely to raise questions about doctors’ financial interests. Several studies and reports, including one by The New York Times, have shown that doctors with relationships to industry are more likely to prescribe expensive and potentially inappropriate drugs.

“‘When you look at why do drug companies and device companies make gifts and offer consulting payments and honoraria to physicians, the main goal is to influence prescribing practices,’ said Dr. Michael Carome, the director of Public Citizen’s Health Research Group. ‘The interest of those companies is to improve their financial bottom line, and not necessarily represent the best interest of patients.’” NY Times. Speaking fees, royalty payments, gifts or whatever to doctors… we need to know where that money is coming from… and why. As the data is refined, we need to focus on administrative rule-making that will protect consumers (patients) from questionable and even unscrupulous practices. We desperately need doctors, but we need doctors that we can trust.

 I’m Peter Dekom, and transparency is simply the next step in managing American healthcare into a cost-efficient and effective system.