Does YOUR Doctor have a Conflict of Interest
Patients go to doctors to improve their health. They want the best care and advice possible. Patients today, in my experience, are often better informed but without experience to use the information effectively. Does this mean that they should not have the information?
It depends on what the information is and what I have to do about it. If it requires me to give a lengthy explanation when I am really pressed, I wish the patient did not have information they don’t fully understand in context. I love to explain things, it is a passion, but I like to pick the time and venue.
One thing patients might not fully understand but to which they are entitled is potential conflicts of interest their provider may have. Most people are aware that representatives of the pharmaceutical companies visit physician offices and clinics. The Drug Rep lunch is a staple of many offices, often more than once a week. These Reps have a budget that allows them to buy lunch for the whole office. During lunch, the Rep gives their spin for their companies drug, device or service.
The motive for this is to establish a relationship. With this relationship the Rep hopes to influence prescribing habits. Sometimes the best they can do is just remind the Provider of the availability of their drug. Along with lunches are occasional dinner invitations, odds and ends gifts of clocks, pens, pads etc that bear the name and logo of the product and the company that makes it. The provider must sign for samples received but not lunch, dinner or minor freebies.
I have made it a tougher and tougher personal policy to not accept anything except samples from drug companies. I have accepted a new stethoscope which I use daily. I removed the logo and can’t remember who gave it to me, but I think it was for a drug that has since been removed from the market due to safety concerns. I have also accepted a textbook and a headlamp in the past 5 years. The reps who gave those to me no longer call on me so they lost their influence. I have to admit that I was more sympathetic to them because of those gifts.
What about a physician who is paid to speak for the company? At about $1000 a speech, does this influence them? How about some one who is paid to sit on an advisory board? Aren’t they influenced a bit? They say they are impartial and unbiased and I am sure they try to be. I believe if you have a relationship, then you are biased in some way you would not be if that relationship did not exist.
BusinessWeek ran an article on this subject entitled Doctors Under the Influence.
The article deals with this issue and uses a case study of physicians who prescribe the drug Chantix. About disclosure one of the physicians said, Telling patients more about industry ties “would just puzzle them,”
I think you are entitled to know the extent of your physicians involvement with a drug company. I am not suggesting that he or she is unduly influenced. If they see reps, accept lunch and/or dinners plus occasional gifts they are influenced. This practice is so ubiquitous that there is no thought of impropriety.
In the state of North Carolina where I am licensed, the medical board is going to publish major negative uninterpreted data about providers. Any malpractice claims paid for them, any disciplinary action taken against them for any reason etc…
I feel like I am under a microscope sometimes. I am definitely held to a very high standard. I like it. I want to be part of a group that can say, “I have extremely high ethical standards.” I do not think that I need to see a Pharmaceutical Representative to get drug related information. I receive plenty of information from unbiased sources. I am happy to accept samples of medication and the price reduced programs that come with them. I just wish the companies charged prices in line with those of other countries. The reason prices are lower there is that they are capped legislatively.
That is socialism. It is a good form of it. I don’t know what if any concessions are given to the drug companies because of this. I do think you should know if a part of the reason you are receiving a drug has to do with the relationship your physician has with the company manufacturing that drug.
WHAT DO YOU THINK? Leave me a comment on this please.
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Comment by David Rogers on 6 July 2008:
It would be interesting to see if this is a worldwide issue. Certainly drug rep lunches are quite common, and practically every pen I use has a drug rep logo - and I’m someone (an Occupational Therapist) who has no influence over prescribing!
Comment by FightCellulite on 7 July 2008:
I am sure this IS a worldwide issue! I myself try not to go to typical doctors - I go to an Ayurvedic consultant instead. And I already got some simple diseases recovered, so i believe it is the way to go, since the medical science of India is very very old and does not have the negative impact on our health.
Great article!
Comment by Diana L Guerrero on 8 July 2008:
This is a big issue today. There is a book called the Power of Influence that outlines the reciprocity dynamic that comes from such activities.
Also, the industries involved with drugs and insurance also tend to dictate treatments instead of diagnosing by looking closely at the patient–more and more doctors are checking off lists.
I think it is a shame and why people are seeking more alternative health care options.
Comment by farmgirl on 9 July 2008:
I worked for a very large medical corporation for a long time. The practice of drug sellers trying to get docs in bed is nothing new. Patients are caught between a rock and a hard place. I have never been to medical school. When I need care I must seek out someone who has been to med school. I had a nice doc, but he was old and made a lot of mistakes. I paid a HUGE price for his mistakes. I can not say this enough…patient beware. Learn as much as you can. Keep your weight under control. Avoid junk food. Walk away from a job that eats you alive and people who carry “doom and gloom”
Bruce, I admire you for not getting in bed with the drug companies. I know the gifts can be addictive.
Comment by Shulamit Lazarus on 30 July 2008:
I am totally with you Bruce, When I was a nurse I was one of the few nurses that loved to float from area to area because I love working with variety. One of the departments I worked in was pediatrics. When I first worked there I’d notice that the moms would sign the consent for the kids to get their vaccines then the baby was vaccinated and then they were told what might be the negative side effects. I was astounded. I was also an idealist as I am still today and I felt it was backwards, So I “foolishly” asked the mom if she wanted to have the child vaccinated. She said “my doctor says I have to”. I asked her “do you do all your doctor says just because they say so”. She looked at me puzzled. I told her that she had a choice and that there was reason that she was signing a consent. At the time I was also a homeopath and on the whole homeopaths don’t support vaccination. I asked the nurse of the dept. what would happen if a mom said no. “She would be reported to social services”. I was stunned. I said “you mean if I decide not to vaccinate I am brought to social services regardless of how much I’ve intelligently studied the issue and made my choice?’ She said “Yes”. When I worked in other places after that I handled the whole issue by leaving the patient in the room with the insert from the vaccine box. I told them to make their decision based on what they felt they should do. Not what I felt or the doc felt. I gave them time and then returned for their answer. In that clinic I had some pull since I was one of the only holistic nurses and a homeopath ahd they had an alternative dept. there. Often when I came back the person would decide not to vaccinate. If we knew the truth about things we would do many things differently. Thank god for the net. Everyoen is so much better informed.
At the same time I was working in this clinic I heard that the polio vaccine was creating polio. I went immediately to my head doc and told her. I expected her to say we would stop using it. Instead she said we would continue to use it until the American pediatrics association told us to stop. I wondered how she could look herself in the mirror knowing that she was continuing to potential hurt so many children.
I left nursing soon after that.
The Hippocratic oath says “above all do no harm.”
What’s’ wrong with this picture.
If I give you a comment on drugs this would go on for pages!
Comment by Bruce Bair on 30 July 2008:
Though I don’t agree on the whole that immunizations are bad, I understand your point. The timing of immunizations should be individualized but we treat everyone like a number. I really disagree with giving newborns Hep B immunizations unless the Mom is positive for instance. I don’t think many physicians are conflicted about immunizations although they are stuck if they buck the major organizations recommendations. They are on the other hand given perks that are free, including meals and some are paid for their opinion, especially when that opinion is positive. The Drug conflict is a much larger issue.
On the theme of do no harm, it is your view point that determines that. I do not think immunizations are harmful, but I think they might be if they are timed improperly and too many are given together. The polio vaccine did cause some polio, especially in elderly care takers who had no immunity to one of the polio strains. The Canadians finally did something about it and we finally followed suit. Now polio is given as an injection with no cases caused by the vaccine. I appreciate your comments. Your website appears interesting.
Comment by Shulamit Lazarus on 31 July 2008:
Hi Bruce,
I’m glad you found my site interesting. I spent much effort writing all the information there to explain things to potentially skeptical individuals. I’m part scientist and I’m also a healer so both facts and intuition are important to me. Knowing the facts and trusting our inner being seem to marry the two disciplines together.
Timing of vaccinations is important, I’ve seen so many given when child had a cold. What is the reason we strain the immune system when it is still immature. I think that the least that should be done is to wait until a child is well and to space the vaccines more. I waited for 3 years to give my daughter vaccinations since my son became quite ill from a half dose of DPT. At the time I didn’t know we had the right to vary the vaccination schedule. My daughter was an incredibly healthy child until then. They gave her all the vaccinations in one day and she was not well for six months
When I was a student homeopath we had many visiting homeopaths teaching us. One third generation homeopath was a physician from India. In India Homeopaths and physician are synonymous terms.
He said something that has always stayed in my mind. He said that he worked in two clinics. One where the rich people take their kids and another where the poor kids go. The poor couldn’t afford to vaccinate their children so instead they were vaccinated with homeopathic remedies. He noticed that the children who were vaccinated western style had febrile seizures more often than the children who had homeopathic vaccinations. I always felt that was striking observation. I’m not against anything without reason. There is a place for everything. But western medical treatment is not individualized as homeopathy is. Homeopaths see each person as an individual with their own constitutional nature. There are some children who respond very negatively to vaccination and some who seem not to be phased. Sadly, In my role as a homeopath, I’ve treated the children who got hurt from vaccines. Parents would bring them to me to try to reverse the adverse symptoms. If we knew that we might hurt some with a preventative therapy, even if a few benefited, we still wouldn’t give it out with out proper screening. I see a major double standard here. When they introduced the chicken pox vaccine and I read one of the the reasons was because of moms lost time from work - I was horrified. Then I found out that they were giving the heb B at birth. I became speechless. Anticipating blood related disease in newborns!
I am so glad that parents are educating themselves and that they know their rights. If I knew then what I do now, I would have asserted my rights to a different vaccination schedule. But I didn’t know then.
Regardless of what choice someone makes it should be one that they feel good about. I find it one of the toughest decisions parents make. I support any choice a person makes as long as it’s an educated one.
One novel way to deal with illness in children was one that our parents used to do. Putting all the kids in the same bed to get them all sick at the same time. That naturally challenges their immune systems and cuts down on moms sick days. Now that’s creative!