1. Health
Send to a Friend via Email
Trisha Torrey

Moonlighting Brings Doctors Millions

By November 8, 2010

Follow me on:

Suppose your car mechanic always uses a specific brand of replacement parts, considered to be very expensive. For the majority of what might ever go wrong with your car, those parts seem to work well. You have confidence in him, and OK - he may be expensive - but you're usually pretty sure he'll be able to take care of your car when you run into a problem.

Then, in a conversation one day with a friend, you find out that the reason your mechanic always uses that particular brand of parts is because he's paid on the side, by that company, to talk to other mechanics about their choice of car part brands. He makes tens of thousands of dollars every year going around to speak to those mechanics, recommending that brand, and making sure those mechanics begin using that brand of parts, too. And of course, he needs to use that brand, too, if he's going to talk about it.

Is that OK with you? It's certainly more expensive for you - because you are paying for that more expensive brand. But he does a pretty good job fixing your car each time it needs work, so does it matter that he's being subsidized by the company that makes those expensive parts?

Switch gears now, to healthcare and the fact of doctors being paid many thousands (sometimes in the hundreds of thousands) of dollars to speak on behalf of specific drugs. I raised some of this in a blog post a few weeks ago when a group called ProPublica began publishing a series of articles about doctors who are paid to speak on behalf of pharmaceutical companies. It floated to the top again yesterday when an extensive article in my local Sunday newspaper made me give it even more thought. Is there a difference between an auto mechanic being supported by a parts manufacturer and a doctor being supported by pharma?

I try to look at all points of view on a subject like this. So I called a person close to me who is a drug rep. It's her job to convince doctors to prescribe her drugs. Included on occasion are her invitations to them to speak to other doctors about the drugs she represents.

She did give me some different perspectives. For example, she mentioned the fact that, by law, she is not allowed to discuss off-label uses for drugs. I happen to know of several friends and loved ones who have found great improvement in their health based on off-label drug prescriptions, so to the extent these speaking events may be a way doctors can learn about off-label drugs, then OK. That makes sense to me. Except - isn't that information they could also get from medical journals? Why paid speeches? And doesn't that, in turn, drive up the cost of drugs for all of us?

When asked whether these extra payments for their extra efforts influence their prescribing, few doctors will own up. Yet, despite their assertions that their moonlighting on behalf of pharma doesn't influence their prescribing, I just cannot accept the ethical imbalance this creates. Studies show that we are easily influenced by the smallest of gifts (see links below) - even those pencils, pens and tablets drug reps used to give their customers (now illegal). Yesterday it was a Bic. Today it's lunch for the entire office or an expensive dinner for a room full of specialists.

Further (and a thanks for this heads up from HealthNewsReview.org and Gary Schwitzer) a report from Medicare shows that when financial incentives are removed, prescribing rates go way down. In this case, they went down by 30% for "inappropriate uses." It seems the same study could be done for every drug prescribed, although that is not to say that each drugs rate of inappropriate prescribing would be so high.

The extensive information in ProPublica (excellent) includes steps we patients can take to be sure the drugs we are prescribed will help us, not simply line a doctor's pockets. Those steps include asking your doctor directly if he or she is being paid by pharmaceutical companies - for any reason. I would add that it's a good idea to look up your doctor's name ahead of time - before you ask. Then see if your doctor is being straight with you. That, by itself, will give you additional information about his or her ethics.

How do you feel about doctors being paid by pharmaceutical companies to promote their drugs? OK? not OK? Take this poll -- and comment, too. Any ideas for a better system?

Here are some resources for you as they regard this topic.

Search for your own doctor, or a doctor you are considering seeing, from ProPublica. Note that this list is comprised only of those doctors who have been paid by 7 different pharmaceutical companies, representing about 36% of all drugs prescribed in the US. By 2013, all drug companies will be required to provide the names of those doctors they pay for promoting their drugs.

How Patients Can Use this Data from ProPublica

Physicians and the pharmaceutical industry: is a gift ever just a gift? Wazana A. 2000 McGill University, Montreal, Quebec, Canada

Drug representatives: Giving you lunch or stealing your soul? Steven P Higgins M Dermatology Online Journal 13 (4): 5

D Katz et al. All Gifts Large and Small. Toward an Understanding of the Ethics of Pharmaceutical Industry Gift-Giving. Am J Bioethics 2003;3(3):39-46 (read about the social rule of reciprocity on page 7)

(Thanks to Dr. Gregory Eastwood, Upstate Medical University's Department of Bioethics and Humanities, for providing the journal references above.)

Update 11/9/2011 From USA Today: Doctors cut some drug company ties amid rising scrutiny

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Learn more or join the conversation!


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Photo Microsoft Image Gallery

November 9, 2010 at 10:02 am
(1) Steve says:

This is indeed a troubling issue and has been for decades. The ethics question needs to be asked on two different fronts. Pharmaceutical sales/marketing ethics and the ethics of doctor who take these “tributes” which many consider bribes.

Many will tell you that ethics/sales is an oxymoron. Sales people including lobbists seem to be willing to do what it takes to get their prodcut sold. While the pharma industry does promulgate ethical standards, if you read them they have many many loopholes. The job of marketing is to influence the buyer.

The job of the doctor is to provide the right treatements/medicines at the right time to the right people. While pharmaceutical companies may have questionable ethics in using “educational fees” to influence doctors, in the end the doctors don’t have to take them. No one is forcing them to take these influencing tributes. The end game ethics lie with the doctor. If doctors want to remain unbiased and maintian integrity then they can educate themseves using available literature. There is no mandate to take money from Pharma to promote brand name drugs.

About a year ago my Family doctor was “pushing”, indeed bullying me to take several brand name drugs for which there are generic alternatives. The brand names cost me ove $80 in co payments and charged my insurance company over $500. The generic cost me $20 i co payments and my insurance company only $100. I looked up my doctor on the site you mentioned and found out he took over $20,000 in payments from the company who manufactures thes drugs.

I have a new doctor.

November 9, 2010 at 10:13 am
(2) Trisha Torrey says:

Steve – you make a great point about the fact that the companies can offer the incentives and money, but it lies with the doctor on whether or not s/he should accept.

I looked up my doctors, too – and found my previous primary, the one I left last year because I didn’t like, or more like, didn’t trust her. I couldn’t put my finger on it then – I just didn’t get good vibes, even after trying to give her second and third chances.

Even though our options for primary care will continue to dwindle over the next many years, we patients still have the option of voting with our feet in most cases. We have the ability to LEAVE a practice and find another doctor who is ethical and respects his or her patients, too.

Thanks for posting.

November 9, 2010 at 6:32 pm
(3) Rick says:

This is interesting and most revealing. As I read here, my mind goes to back ER and the elderly patient I know about who suffered a mild blockage (infarct) stroke; an attack, later revealed, to be just somewhat worse than a TIA. The attending neurologist told the trusting family the patient suffered massive bleeding so was not a candidate for clot buster tPA (patient had arrived ER within the 3-hour window). The doctor, however, was insisting the family sign papers to allow him use of a double-blind experimental clot buster called Viprinex (Neurobiological Technologies of Emeryville in California) which had a 6-hour window. The family later found out by researching the patient’s medical records. The long and short of this story is that the patient died, needlessly, because the doctor lied to the family present and poisened the patient with furosemide combined with hydromorphone and other drugs. It is believed the doctor had a financial interest in maltreating the patient the way he did, but his name is yet to be confirmed on a payoff list. The family is still looking and wondering. The police are now involved.

November 13, 2010 at 7:48 pm
(4) Kathy says:

I just checked out my doctor and he’s making bank! But he’s never pushed new drugs at me…in fact the only thing he’s prescribed are generics. Guess that doesn’t stop him from prescribing to other people. Oh well. He is good to me so I am not changing doctors…but this is good-to-know info. Thanks.

November 14, 2010 at 1:49 pm
(5) Robin says:

This is a very misleading article. As a physician myself and somebody who personally knows hundreds of physicians, the pool of physicians who work on the side for pharmaceutical companies is miniscule. A primary physician will deal with hundreds if not thousands of different medical conditions and there are many thousands of medications on the market which he will prescribe over the course of his career. So, you are talking about a miniscule population of physicians having an undue influence when prescribing one drug in likely one or a few conditions. Then you are using this tiny point to suggest, erroneously, that this is a widespread problem and physicians every where are lining their pockets like this whenever they prescribe medications. You are eroding, unfairly, into the physician-patient relationship and this can only be detrimental to both parties involved. I always wonder why patients think I get a kick back whenever I prescribe them a drug and then I have to see a site like this. If you want to be fair, at least try to find a single statistic to show how widespread this problem is. BTW, to the other poster, furosemide and dilaudid are not poisons and have many legitimate medical uses. Please keep your ignorance off the web.

Leave a Comment

Line and paragraph breaks are automatic. Some HTML allowed: <a href="" title="">, <b>, <i>, <strike>

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.