Payola in Medicine – Insights into the Murky Side of Patient Care
The federal government rolled out its new tool that it hopes will increase transparency of the rampant payola that still plagues medicine. The idea is that they now require all pharma and device companies that take money from Medicare to report the payments they make to doctors. So is this tool a good thing?
The Money Flowing Around Me…
The first thing I did, like any human being would, was to plug in my name. I was paid by big pharma and device companies, the grand total of…wait for it…twelve dollars and sixty three cents! I’m not even sure how it got to be that much, as I avoid drug and device reps in my office like the plague!
What’s really fascinating is plugging in the name of colleagues. What did I find? A surgeon north of me who dabbles in stem cells had a total exceeding $300,000! Most of that came from the value of a company that makes a surgical device that is implanted in spines. A local pain management doctor just a few miles away was at nearly $100K, with most of that coming from a drug company that makes a powerful narcotic. An academic physician that I have great personal respect for was paid $22K by a device company.
Payments and Decision Making
One of my favorite stories of how these payments can impact physician behavior is about an old colleague. He told me one day that a drug company had flown himself and his wife to Aspen for a conference of “thought leaders” on a new drug. I kind of knew this was pharma code for a method to funnel money to doctors to try and buy their loyalty. The doctors there sat around in a fancy hotel while their significant others were skiing and shopping. They were basically led through a script that caused them to conclude, by answering questions, that the company’s fentanyl lollipops were great for post-operative pain management. The company also had numerous fancy studies performed by many fancy university professors to show it. So my colleague did what most doctors do in that situation, he began prescribing these powerful narcotic lollipops to patients after surgery and injection procedures.
What happened next was predictable and awful
For the next year, I kept seeing post operative patients who just couldn’t get off those cute little $20 lollipops. They went from being in pain before their surgery to being in pain after their surgery and hooked on narcotics that looked like candy. I tried in vain many times to wean patients off of this stuff, to no avail. When I approached my anesthesia colleague who had been prescribing these after his Aspen trip, he told me there was research showing that the patient getting addicted to these lollipops was nearly impossible. I told him to tell that to the now 20-30 new drug addicts I had in my practice that were created by another doctor’s pain lollipop prescriptions!
This kind of thing in medicine is common. With each new government rule that tries to prevent payola, the drug companies get a little sneakier. These days, money can be funneled to orthopedic surgeons for “post marketing surveillance” of knee and hip replacement devices, which means that the doctors fill out a form about complications. A lot of money also changes hands in the way of samples. As an example, the new “amniotic stem cell” companies (who are selling dead tissue and not real stem cells, but that’s another story) can provide a doctor with 10-20 free vials of product that the doctor can then turn around and charge patients for. Another way the payola scene works relates to payments for research. In this case, doctors are paid money to perform studies for a manufacturer.
Who got the distinction of being paid the most (at least in one category)? Orthopedic surgeons were right up there, usually due to payments from device manufacturers. For example, a surgeon is paid money by the manufacturer of a certain hip replacement device and magically, he or she almost always implants that device.
One of my favorite stories was of a spine surgeon who always used one company’s hardware. He had an entire one-half of his building paid for by the company! Spine surgeons these days have found new ways to circumvent rules, for example, by owning part of the company that makes the fusion hardware they implant.
So is this payola a big problem? It can be.There are many stories of doctors who are easily swayed by these payments. But like anything else in life, much of the problem depends on the individual doctor.
The upshot? This is a great tool for patients. Have fun plugging in your doctors name and state and you can be the judge of whether the money he or she is taking from the industry determines what gets prescribed!