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Australian pharma ad. You'd think constipation is less of a problem upside down.

One of the quiet scandals of US America's for-profit healthcare "system" is the routine bribery of doctors by pharmaceutical companies. We're not talking the free pens and notepads with drug logos, but generous funding for travel, "consulting," and speaking fees to "educate" other doctors at conferences. A new ProPublica report found that the amount of money the industry pays to doctors hasn't changed, despite efforts to call attention to the potential conflicts of interest. And some doctors are really making out like bandits, while prescription drug prices continue to go through the roof.

That's not a mixed metaphor, that's American healthcare today: a bandit house with holes in the roof.


ProPublica notes that when it reported on Big Pharma's gravy train in 2013, it found that over the course of four years,

one doctor had earned $1 million giving promotional talks and consulting for drug companies; 21 others had made more than $500,000.

That's nothing, it turns out. In its latest review of payment data, ProPublica found over 2,500 physicians who'd received at least half a million bucks over the last five years, from pharma and medical device companies. More than 700 of the docs had made over a million dollars in the same time. Honestly, take a few minutes to click around ProPublica's interactive "Dollars for Docs" page, where you can find information on payouts to doctors and teaching hospitals in your state, the most generous companies and heavily-promoted meds, and a list of the top ten doctors getting pharmabucks. The biggest winner is a Memphis neurosurgeon who raked in $29 million, which must make the number-ten doc, a San Diego dentist who collected just $6.25 million, feel like an underachiever.

"Holy smokes," said Dr. Walid Gellad, an associate professor of medicine and health policy at the University of Pittsburgh, where he leads the Center for Pharmaceutical Policy and Prescribing. It is "quite striking" how much money doctors were earning from "other activities aside from patient care," he said.

My own doctor here in Boise is pretty bad at grifting; he took in a paltry $796 in pharma largesse in 2018, virtually all in the form of meals paid for by pharma reps -- we're guessing at conferences, since the amounts are almost all under $20 bucks. But he did get one $212 dinner date from the makers of the "Da Vinci Surgical System," a robot-assisted surgical doohickey The company paid just under $40 million last year to docs and hospitals to promote it.

See? You can chase down a whole load of information, and you start getting a sense of just how much money is flying around out there. I'm pretty sure my doc -- who works in a plain old family practice telling middle-aged bloggers to go on keto diets -- does zero surgery, robotic or otherwise. I don't think there's anything suspicious here -- my doc is a fan of single payer -- but it illustrates that virtually every physician in America will end up dipping a finger into the river of promotional money that drives how healthcare in America gets done.

ProPublica makes clear just how common the payments are, even for docs who aren't getting rich off the grift:

Over the course of five years, 1 million doctors, dentists, optometrists, chiropractors and podiatrists received at least one payment, most often a meal, from a company. Of those practitioners, more than 323,000 received at least one payment every year. About 240,000 received a payment in only one year. And the rest received payments in more than one year but in fewer than five.

For context, there are about 1.1 million doctors in the United States.

All that data, we should mention, is reported under a little-noticed (at least by the general public) part of the 2010 Affordable Care Act called the Open Payments Initiative, which was aimed at creating greater transparency by making companies disclose all their payments to physicians and teaching hospitals. (It's also one more part of Obamacare industry would love to get rid of.)

The idea may have been to use sunlight to discourage the practice of paying docs to "educate" them about particular drugs, but there doesn't appear to have been any change at all in corporate spending. Or in doctors' willingness to make some cash on the side, or at least listen to a pitch during lunch. The annual payments and number of docs taking them have remained steady over the first five years of mandatory reporting.

"It makes me wonder whether patients are using this information or whether physicians are even aware this information is out there," said Dr. Joseph Ross, a professor of medicine and public health at Yale who has studied pharmaceutical marketing. "It's almost like it's not happening."

Studies also show that there's a real link between drug promotions and prescribing behavior, especially over time.

Dr. Aaron P. Mitchell, a medical oncologist and health services researcher at Memorial Sloan Kettering Cancer Center, said his research has shown that when doctors interact more consistently with a drug company they are more likely to prescribe that company's cancer drug. The drug industry, Mitchell said, "knows that they need to cultivate relationships over more time, so that's what they're really trying to do. It's not just one drug meal. It's consistency."

The ProPublica study also tracks the payments made to promote particular meds and devices; if you watch cable TV news much, you'll easily recognize at least half the twenty meds with the highest total payments to docs from their ads on the Chris Hayes and Rachel Maddow programs (the ProPublica study doesn't include advertising budgets). Just looking at the list may make you start humming some 70's pop hits repurposed as drug jingles.

And wouldn't you know it, many of the most-promoted drugs are very, very pricey, and are in stiff competition with other, similar drugs:

in most of the drug classes on the list, "there are more than one available drug — sometimes all with the same mechanism of action — indicated for the same condition selling for very high prices," Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said in an email. [...]

"Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions," Kesselheim said.

ProPublica also turns up some fine examples of Pharmocapitalism at its very best, when it shades from "educating" docs into outright illegal kickback schemes. One doctor at one long-term care facility was a paid speaker for Nuedexta, a drug used to treat "pseudobulbar affect, or uncontrollable laughing or crying." This doc went a teensy bit outside that diagnosis, and

put "entire units" of patients on Nuedexta. Another doctor at the facility, which had a number of dementia patients, routinely stopped the Nuedexta, only to have the first doctor restart it, according to a Department of Justice press release [...]

The manufacturer, Avanir, agreed to a $108 million settlement to resolve "criminal and civil allegations that it paid kickbacks to doctors and marketed the drug for unapproved uses, including behaviors associated with dementia." And four employees involved in the scheme are "no longer Avanir employees," which we like as a way of not saying whether they were fired or allowed to resign.

So hooray for transparency! Now that the reporting is mandated, as Kesselheim told ProPublica, "we need to figure out what to do with this," since just making the information public doesn't appear to be changing a damn thing.

Here's a crazy idea: Take obscene profits out of the equation and institute Euro-style single payer and strict price controls? Haha, we are joking, no one wants to live in a socialist hellhole like France, where people can't even go bankrupt from medical treatment.

[ProPublica | "Dollars for Docs" tool by ProPublica]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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