Medicynic

The New England Journal of Medicine has an article this week on the relationship between PHARMA (the drug industry) and physicians. The article notes (its available on-line):

” Most physicians (94%) reported some type of relationship with the pharmaceutical industry, and most of these relationships involved receiving food in the workplace (83%) or receiving drug samples (78%). More than one third of the respondents (35%) received reimbursement for costs associated with professional meetings or continuing medical education, and more than one quarter (28%) received payments for consulting, giving lectures, or enrolling patients in trials. Cardiologists were more than twice as likely as family practitioners to receive payments. Family practitioners met more frequently with industry representatives than did physicians in other specialties, and physicians in solo, two-person, or group practices met more frequently with industry representatives than did physicians practicing in hospitals and clinics.^“

These companies don’t give away money for nothing.

I see parallels between the student loan scandal and standard practice in medical office.

“numerous college aid offices have been caught conspiring with lenders to carve out sweetheart deals that benefit everybody but the students

The shady practices include fees to colleges to put lenders on their “preferred” lists; trips and other perks for financial aid officers; and valuable stock benefits for college aid directors.”

In medicine, physicians and researchers receive fees, trips, consultant contracts, salaries, stock benefits and other gifts from drug companies and other vendors. These gifts seem designed to influence the physician’s choice of treatment or procedure. If you will, the company wants it’s drug on the physician’s “preferred” list.

While it’s not clear how effectively these emollients subvert physician’s decisions, the companies continue to spend billions of dollars on this type marketing.   There is, as in the student loan scandal, the damning appearance of a conflict of interest .

The non-news of the day. This issue was generated by anti-abortion types who started what can only be called a rumor about an association of cancer and pregnancy termination. The issue is difficult to analyze because of the high rate of 1st term abortion (spontaneous and other) and the long lag time between supposed events and disease development. This appears to be a definitive study on the subject–there is no risk of breast cancer from pregnancy termination.

However, what has been long known known about breast cancer and sexual activity is that nuns have a higher rate of the disease.

Bad week for Hormone Replacement therapy–here and here. What does this say about all the studies in the past showing little risk–almost all drug company sponsored.

Do you think this financial disparity has anything to do with our ineffective health care system?

“According to the U.S. Census, black households in 2005 had a median income of $30,858, compared with $50,784 for non-Hispanic white households. The black poverty rate was 24.9 percent. The white poverty rate was 8.3 percent.”

The answer is obvious as is the need for a systematic approach to health insurance.

We lack value in our medical establishment. This $11,000 fractured rib is one extreme.

An article about insurers denying claims of long term care beneficiaries. Should we be surprised given that insurers are in business and their first priority is their profit, not the well being of their clients?

It’s also instructive that this appears in the business section of the International Herald Tribune and the NYT, rather than the health section.

The equivalent of forty 747’s crashing each year is the reported death toll from our lack of a national health insurance scheme.

“Across the United States, the ranks of the uninsured have swollen from 40 million to 47 million since 2000 for an increase of nearly 18 percent, according to a report by the Commonwealth Fund, a New York-based foundation focused on health care. The same report indicated that the working population aged 18 to 64 makes up rising numbers of the uninsured as insurance premiums soar and companies cut back on coverage.”

“The consequences are increasingly well known: inequities in access to care, avoidable mortality and poor quality care, financial burdens on people who are uninsured or under insured, and lost economic productivity,” Commonwealth Fund President Karen Davis wrote in a report. “The U.S. spends twice as much on health care as the median industrialized nation but does not systematically achieve the best quality care.”

“Gaps in health-care coverage lead to an estimated 18,000 deaths and as much as $130 billion in lost economic productivity annually, according to Commonwealth.” (bold emphasis is Medicynic’s)

In India, we’re just back from a visit, cab and rickshaw wallahs receive commissions from emporiums and other shopping outlets for bringing customers. As a result, when you are with a cab driver they recommend only those places which gives them commissions.

Cab drivers are thus not reliable sources of information about shopping and may even resist your attempts to get to the places you really want to visit. The situation is complicated by the fact that in India shops’ names are often near duplicates of each other and every store will claim to be that government emporium your guide book recommended.

Sound familiar? While on a different monetary scale, the situation is similar to the corroding effect of drug company’s gifts, consultant fees, salaries, “fourth phase” research funds etc, on physicians in the U.S. We’re talking thousands to millions of dollars here. At the most basic level, these funds, commissions if you will, are designed to encourage physicians to bring their clients to the pharmaceutical company’s products. These payments at a minimum give the impression that physicians are not objective sources of information about treatment and may have an actual conflict of interest. In the U.S. we’ve more fully developed the system so that the agents of the pharmaceutical companies (detail people) can actually check with pharmacies and confirm that their physician wallahs are recommending their product and if necessary provide more effective incentives to influence them.

This timely article explains, in part, how it works.

What the hell has happened to my profession!

Article in Archives of Internal Medicine debunks the myth.

The scientists, led by Dr Christopher Gardner at the Stanford Prevention Research Center, California, tested raw garlic and two well known garlic supplements in adults with moderately elevated levels of LDL or “bad” cholesterol.

They found that despite the widespread claims, none of the three forms of garlic lowered cholesterol.

Americans like to believe in magic. Garlic, while wonderful, is not magic. Eat your heart out Larry King!!