Are Doctors Getting Paychecks From Big Pharma?
"What do you want for lunch? We're getting fed by SATCo today."
I shook my head. I was trying to cut back on spending and calories, so take-out Tex-Mex wasn't going to happen.
"It's free. Here's a menu. Let me know what you want."
A free lunch? I'd always heard there was no such thing. Turns out that's true. The "free" lunch was a gift from a drug representative. Some of the doctors at our clinic prescribed more of their products than anyone else in Nashville. They got gifts and money, and support staff got lunch. Think it's an isolated incident? During my time at that clinic, we were offered sweatshirts and hoodies, tickets to sporting events, gift cards, tins of cookies, and "free" lunches.
Have you ever sat in a waiting room and watched as delivery people carried in bags of styrofoam boxes? Have you noticed overly cheerful, well-dressed people with rolling briefcases greeting the receptionist and nurses by their first names, often accompanied by the sort of hugs and howareyas one would expect to see from long lost friends? Those are not the hallmarks of largesse from the doctors or the return of a former employee or a walking medical miracle. They are the clinical equal to a visit from Santa. What you are seeing are drug representatives in action.
After I got the whole story, I started quietly refusing the gifts. Years later, I found out I wasn't the only one who was disturbed by this. When a new friend named Miriam** found out I'd worked in a clinic near hers, we started talking about what we loved and disliked about our work. Number one on the dislike list were visits from drug sales reps.
"I always called those visits 'Grifting Days'." She shook her head. "People in the office would get so excited to see them come in. Aside from the fact that it always took time away from people waiting to see a doctor, the food they brought had to be carried in past people who might have had to fast until their appointment. I mentioned that to one rep and she just shrugged."
And she stopped accepting the gifts, as did I when I had a similar position. In both of our situations, we had to be discreet. Our managers were afraid of offending the reps, so we were sent on errands and our breaks timed to coincide with the visits.
"I came back a little early one time to hear everyone in the break room giving the rep a round of applause as a thank you for lunch."
I've seen that, too. It has probably happened everywhere they're allowed to peddle pills and possibly influence diagnoses. The one upside I have seen to this is the practice of leaving bags of samples. Patients who cannot afford to buy their medication often leave the office holding a bag full of cardboard flyers that carry samples.
Still, one has to wonder. If treatment is influenced by the pharmaceutical companies, could it also be steering doctors to diagnoses?
Miriam and I both have relatives who take X____.*** Miriam's uncle had always been plagued by heart issues when his doctor prescribed it. Over the months that he took it, he noticed he was bruising easily. Being an outdoorsy type, it was hard to avoid being covered with black, blue and red marks that appeared even when he had the kind of bumps that shouldn't leave a mark.
According to Miriam, he was always frustrated with the medication. This came to a head when his son was nearly arrested for abuse. Someone had seen the bruises and came to the conclusion he was abusing his father. He asked his cardiologist if there wasn't an alternative and was told it was X_____, C______, surgical intervention, or he could find another doctor. He chose to find another doctor. This one monitors him very closely and has as of this writing, reduced his dosage.
My mother had a similar situation with her own heart specialist. For months, he and the staff talked about how her health was amazing. No interventions were needed. Then, she was put on X_____. Her side affects were similar to what Miriam's uncle experienced. Something as simple as brushing against a tomato cage can cause serious bruising. She asked if she could get off the medication and was told something quite similar.
Six months after that, her cardiologist suggested a stent. This was less than two years after continually praising her good health. My mother just wasn't not buying it. She did some research and found out her cardiologist was getting paid by the company that made X_____ and the company that made the stent he wanted to use and it turned out, helped to develop.
We went back for a followup visit. She told the cardiologist she did not want the stent. He tried to reason, no, the truth is, he tried to scare her into getting the stent. I promised Mom I would support her decision as long as she would talk it over with her GP, a doctor who has taken care of our family since the mid-80s. When the cardiologist saw he wasn't going to get his way, he told us the visit was over and we needed to check out. My mother asked the person doing the calendar if she needed to schedule a visit. She was told no, there would be no more visits.
A quick sidebar here: Nobody in either of these stories is operating on the idea that they know more than their doctors. They are taking a stand against cookie-cutter rubrics based on the bottom line replacing informed, considered diagnoses and the preservation of a degree of agency when it comes to planning care. It is their suspicion -and mine, too- that big pharma has an inappropriate amount of influence in these things. As people who love science, we want to trust our physicians. After her experience with her former cardiologist, she discussed the situation with her GP, who respects her choices and, best of all, listens to her.
How did my mother find out about the cardiologist being on the take? She consulted CMS's Open Payment site. I will include it and a few other useful links for further reading below. In the meantime, be informed and keep healthy.
For further reading:
CMS Open Payment - This site tells you if any drug companies are paying your doctor and how much.
Dollars For Docs - Another site that tracks payments to doctors by drug companies.
AMA Journal of Ethics - The AMA Code of Ethics' Opinion on Physicians' Relationships With Drug Companies And Duty To Assist In Containing Drug Costs
Physician Financial Transparency Reports - A collection of links pertaining to the Sunshine Act
* SATCo = San Antoni Taco Company
** Not her real name. In fact, I've asked permission to share these stories, but I'm changing the names.
*** My pet shark has warned me not to name names when it comes to drugs.