We devote an entire chapter to kickbacks in our book. However, we stress to readers we have no wish to denigrate doctors, or to denigrate anyone who devotes their life to helping fellow man.
After all, it was Cicero who said, “In nothing do men more nearly approach the gods than in giving health to men.”
Certainly, the medical profession, in its purest form, is a noble one. And doctors are clearly at the apex of the profession.
And we stress that those who do (abuse their position) are very much in the minority. That said, the number of doctors who have brought their profession into disrepute, worldwide, is staggeringly high. Certainly far too many for so noble a profession, we would argue.
It would be remiss of us not to bring your attention to some, shall we say, gaps in the system – gaps that allow doctors to abuse their position if they are so inclined.
The following report was aired by BBC News on November 6, 2014: “Until recently, paying bribes to doctors to prescribe their drugs was commonplace at big pharmas, although the practice is now generally frowned upon and illegal in many places. GSK (GlaxoSmithKline) was fined $490m in China in September for bribery and has been accused of similar practices in Poland and the Middle East.
“The rules on gifts, educational grants and sponsoring lectures, for example, are less clear cut, and these practices remain commonplace in the US. Indeed a recent study found that doctors in the US receiving payments from pharma companies were twice as likely to prescribe their drugs.
“This may well exacerbate the problem of overspending on drugs by governments. A recent study by Prescribing Analytics suggested that the UK’s National Health Service could save up to £1bn a year by doctors switching from branded to equally effective generic versions of the drugs”.
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“Isn’t it a bit unnerving that doctors call what they do practice?” –Grammy-winning American actor/author George Carlin
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The “recent study” referred to by BBC News was a detailed 61-page report compiled by the University of California, San Diego (UCSD), and dated January 2014.
This report starts out with the comment that “While rent-seeking behavior may not be surprising generally, that financial conflicts of interest could influence physicians’ advice might be less expected. For one, doctors are highly paid, with most falling in the top 5% of the income distribution within the US”.
The UCSD report continues, “When drug companies have financial relationships with physicians, medical decisions may be influenced by pecuniary motives not directly related to patient health…
“We find that men are over twice as sensitive to payments as women. This confirms experimental and field evidence suggesting that women are, on average, more honest and less corruptible than men”.
The report’s conclusion is that “Using data from twelve drug companies, more than 330,000 physicians and nearly one billion prescriptions, we find that when a drug company pays a doctor he is more likely to prescribe that company’s drug…
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“The purpose of a doctor or any human in general should not be to simply delay the death of the patient, but to increase the person’s quality of life.” –Patch Adams
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A US Federal Government report unveiled in September 2014, detailing 4.4 million payments made to doctors and teaching hospitals by pharmaceutical and medical device companies sheds more light on the vexing kickbacks issue.
ProPublica.com, a watchdog site that prides itself on providing “journalism in the public interest,” analyzes the Federal Government report in an article dated September 30, 2014 by award-winning reporter Charles Ornstein….
Ornstein points out that the Federal Government’s “new trove of data” covers the period August to December 2013. He writes, “According to officials from the Centers for Medicare and Medicaid Services, companies spent a total of $3.5 billion during that period on 546,000 individual physicians and almost 1,360 teaching hospitals”.
Under the heading ‘Where Did the Payments Go?’, Ornstein provides the following breakdown of general payments (that drug companies make to physicians) by category. (Amounts in US dollars):
Royalty or licence payments – $302m; promotional speaking – $202.6m; consulting fees – $158.2m; food and beverage – $92.8m; travel and lodging – $74.1m; grants – $38.1m; education – $26.7m; honoraria – $25.5m; gifts – $19.2m; the balance of payments included space rental, charitable contributions and entertainment. (Payments excluded research or fees to physician owners of a company)…
He concludes, “Doctors were paid for more than 200,000 trips by companies in the last five months of the year…Their top destinations were Toronto, Copenhagen, Amsterdam, Paris and Barcelona. Drug and device makers paid for doctors to travel to about 80 countries in all”.
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“An apple a day, if well aimed, keeps the doctor away.” –P.G. Wodehouse
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Ornstein also figures in an item CBS News ran on March 4, 2014. Headed ‘Does your doctor have ties to Big Pharma,’ the report states, “Big pharma routinely pays doctors to promote its products, but soon patients will be able to get a clearer picture about a doctor’s possible connections to the companies that make the drugs they may prescribe”.
The report continues, “The practice of pharmaceutical companies working with doctors to develop new medications to treat conditions and help promote those medications has been in place for decades, but Ornstein, who is investigating this practice, says, ‘The promotion part has gotten a lot of attention in recent years because drug companies have paid hundreds of millions and sometimes billions of dollars to settle lawsuits that have accused them of improper marketing and giving kickbacks to doctors’.”
The same report addresses the all-important issue of trust – trust between patient and doctor. As Ornstein points out, “When you go to your doctor, you trust that the doctor is giving the best medication for you, but there’s a lot of different interests that your doctor has to take in mind in prescribing you drugs”.
In response, Matthew Bennett, senior vice president of the Pharmaceutical Research and Manufacturers of America, is reported by CBS News as saying the discovery of new and improved medicines is dependent on research collaborations between physicians and biopharmaceutical companies. “Clinical trials sponsored by biopharmaceutical companies have led to breakthroughs for people suffering from cancer and other life-threatening diseases”.
We don’t doubt there’s some truth to that, but it doesn’t address the concerns held by many – that it’s illegal to give kickbacks to doctors to prescribe drugs.
Of equal concern to us is that it is legal for pharmaceutical companies to give money to doctors to help promote their drugs. How tempting it must be for doctors to put impartiality aside when recommending certain drugs to patients. And how tempting it must be for unscrupulous doctors to recommend lesser or inferior drugs, knowing promotional payments – aka kickbacks – are on offer.
As Ornstein advised CBS News, “Some doctors make tens of thousands or hundreds of thousands of dollars a year beyond their normal practice just for working with the industry”.
Yes, you read that right: tens of thousands or hundreds of thousands of dollars a year beyond their normal practice.
Of course, this is nothing new. The practice has been around for ages, but we’ve limited the bulk of our research to cases dating back to the mid-2000’s.
One earlier case that caught our attention was reported by New York Times on March 3, 2009. Under the heading ‘Crackdown on Doctors Who Take Kickbacks,’ reporter Gardiner Harris writes, “Federal health officials and prosecutors, frustrated that they have been unable to stop illegal kickbacks to doctors from drug and device companies, are investigating doctors who take money for using these products”.
Harris states, “For years, prosecutors rarely pursued doctors because they believed that juries would sympathize with respected clinicians. But within a few months, officials plan to file civil and criminal charges against a number of surgeons who they say demanded profitable consulting agreements from device makers in exchange for using their products.
“The move against doctors is part of a diverse campaign to curb industry marketing tactics that enrich doctors but increase health care costs and sometimes endanger patients. Taken together, the new measures are likely to transform the relationship between medicine and industry”.
Harris concludes with a quote by the US attorney, Mr Sullivan, who said, “Officials hoped to send a strong message to doctors,” and “I have been shocked at what appears to be wilful blindness by folks in the physician community to the criminal conduct that corrupts the patient-physician relationship”.
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“Doctors put drugs of which they know little into bodies of which they know less for diseases of which they know nothing at all.” –Voltaire
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A Washington Post report that was picked up by media around the world in February 2015 points out that Americans spent $329 billion, or approximately $1000 per person, on prescription drugs in 2013. Quoting John Oliver, of the Last Week Tonight show as its source, the newspaper reports that nine out of the 10 big pharmaceutical companies spend less on research than on marketing. (A lot less as it turns out).
The report confirms that US television channels screen ads for pharmaceutical products that require a doctor’s prescriptions. It concludes with the following quote from Oliver: “Ask your doctor today if he’s taking pharmaceutical money (then ask) what the money is for…Then ask yourself if you’re satisfied with that answer”.
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Little mention has been made thus far of kickbacks physicians receive from medical equipment manufacturers and suppliers. As with the relationship between the pharmaceutical companies and doctors, business dealings between medical equipment representatives and doctors are worthy of scrutiny.
There’s no doubt that an honest relationship between these two parties makes for a win-win for all. There’s potential to progress science and technology, and to help ensure the health and safety of patients. However, the key word here is honest. For there is potential for fraud and abuse, and, as it turns out, some are taking advantage of this…
For a snapshot of just how widespread corruption is within the medical equipment supply sector, and unfortunately, amongst their clients within the medical profession, take a look at the website of New York trial lawyer John Howley, Esq. It lists numerous examples of historic kickbacks deemed illegal under the Anti-kickback Statute and subsequently successfully prosecuted.
These examples include the case of a physician and the owner of a medical supply company pleading guilty to a conspiracy to defraud Medicare by submitting false claims for power wheelchairs, a durable medical equipment (DME) supplier being imprisoned for paying kickbacks to co-conspirators for medical prescriptions and a doctor pleading guilty to accepting kickbacks from the makers of power wheelchairs and other DME…
Hopefully, this insight into doctors’ kickbacks from the likes of Big Pharma and the medical equipment suppliers hasn’t destroyed your faith in your family doctor. We stress that those who succumb to the temptations on offer are in the minority and so, statistically speaking, we’d like to think there’s a very small chance your doctor is one of the culprits.
However, if you are tempted to consider alternatives (to conventional medicine) then upcoming chapters on alternative health and natural medicine may well be of interest…
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