One of the first posts I wrote here, was a about how pharmaceutical reps provide lunch for physicians while presenting information about a medication that they are promoting. The post, and others like it, have generated visceral reactions on the part of the public. A similar article to the one that I wrote (also on kevinmd) prompted comments like “Get over yourself and buy your own lunch” and “I’m certainly glad that you are not my doctor”.
The opinions were so strong I was invited to speak on CNN about the topic. In particular, I was asked to speak about all the other extravagant things that physicians get from drug companies. I ultimately did not do the interview on account of me not having any experience with receiving any of the extravagant things they were talking about. It seemed to me that individual physicians receiving lunch was (excuse the pun) small potatoes compared to what happens behind closed doors in the halls of power. While upcoming rules will soon provide the public with a window into the value of goods provided to physicians by drug companies, they will provide little insight about where pharma has its greatest and most effective influence: behind the closed doors of those halls with thought leaders, opinion makers and legislators.
To that point, a story came to my attention recently that reminded me about that fact. The Dean of Weill Cornell Medical College, a prestigious and highly regarded medical school, has apparently kept close financial ties with industry, as reported in the the college’s newspaper. The college’s Dean, a highly accomplished and awarded physician researcher, has retained positions with a major pharmaceutical company and a laboratory equipment company. In these roles last year she reportedly received about $260,000 from one of the companies and about $277,000 from the other last year. The Cornell Daily Sun also reports that she has apparently received millions of dollars in compensation from both companies over the years as well as more than a million dollars worth of shares and stock options in the companies. Continue reading “Should a Medical College Dean Take Money from Pharma?”
It happens thousands of times a day, all across the country. People go to their doctor’s office after some testing has been performed. The physician, unaware that any testing has been ordered by another physician, asks their usual questions. The patient, awaiting an opinion rendered on the recently performed test begins to answer the doctor’s questions with increasing impatience and trepidation, fearing the worst. “Why is he asking so many questions. . . why is he not telling me the results? Did my cholesterol panel show cancer?” And finally the question comes to the fore;
“ Doctor did you get my test results?”
“No, what test did you have”
“But I told them to send it to you!!” Continue reading “Where Medical Reports Go to Die.”
I’m Talkin’ About My Generation.
**Update: Treasury has just issued its reports on Medicare and Social Security, the results making this article more timely and relevant than I had intended. Together SS and Medicare make up 36% of federal spending. The Social Security trust fund is predicted to run dry in 2033, while the Medicare hospital trust fund (for inpatient services) is slated for extinction in 2024. Link to the report here.
Over the past few months i have struggled with how to portray the recent changes coming down the pike for medicare, what with ACO’s, and impending cuts due to mounting deficits and the ever increasing costs of medical care. What viewpoint, I wondered, should this blog take on these issues?
Should I take the role of the traditional physician-blogger, and share the viewpoint of the myriad other physicians around me who live with uncertainty about how to run their practices in the current fiscally deprived environment? Should I write about the constant worry about whether congress will extend the recurrent doc-fix or let the draconian cuts in reimbursements go through? Will I write about whether there will come a time when it will no longer be feasible to accept Medicare or Medicaid?
Continue reading “Healthcare Armageddon 6: Medicare and Generation X”
Will the The Needs of The Many Outweigh The Needs of The Few?
That was the axiom a dying Spock posed to Captain Kirk just after he saved Kirk’s behind (again). Well in that case, (spoiler alert),the needs of the many did outweigh the needs of the few. . .until they didn’t (if you’re really curious watch Star Trek 3, or better yet, don’t and just take my word for it). Curiously, I wonder if things will unfold in a similar fashion in regards to findings reported by the National Cancer Institute in its CT lung cancer screening trial published last June in the New England Journal of Medicine. Continue reading “CT Lung Cancer Screening, Star Trek 3, and Other Disappointing Things”
Please enjoy this recycled oldie-but-goodie while I spend the next 6 weeks juggling a high case load with studying for the boards with taking care of two babies, etc. . .
The migration has begun. All over Michigan, the annual migration of flocks moving south is in full swing. And behind those flocks, the other annual Michigan migration is starting too. Our office is starting to see our winter ‘checkout’ patients before they migrate south for the winter.
Over the next month, I’ll see a multitude of patients come in to get ‘checked out’ and get paper prescriptions to take with them to Florida in case they find themselves under threat of missing a golf outing due to varying states of cougheyness and/or wheeziness. Many of them have physicians in Florida that they sometimes see, and occasionally they get hospitalized while down there. They usually come back with an impeccable tan, an extra spring in their step, and a story of their various physician visits and /or hospitalizations with more holes in it than your average disability application. They also explain that any tests that I’m about to order have probably already been done by their physicians in Florida, and they’d like me to take a look at those records before I order anything. We then start the dance of trying to get copies of their charts, which goes something like this:
Records Requested: Records Received:
Request for chart. Nothing
Second request. Nurses notes
Third request.. Copy of diet recommendations.
This whole dance has started to make me wonder about my ardent support for the electronification of medical records, which is supposed to do for medical care what the invention of sliced bread did for a fledgling sliced deli meat industry. By now we’re all aware that the Institute of Medicine (which by the way, to me sounds like a made up name) tells us that a gazillion patients are unnecessarily being decapitated every day because physicians’ illegible orders for ‘allow decaf for patient’ are being misinterpreted by hapless nurses as ‘and now decapitation’. Electronic medical records, says the Institute, would successfully ameliorate the silent killer that is physician penmanship.
But how does this impact the care of patients who had treatment from another physician or medical system, whether it was across the country or across the street? Nada. If I want to see those high tech electronic records, it still requires that I talk to a person, those records must then be printed, then faxed. Because of this, many of these tests end up being duplicated, and because of the awesomeness/stupidness of medicare, it has continued to pay for the duplication of these tests even if it has only been days since the original tests were done.
It seems to me then, that adding electronic medical records to the current system is kinda like adding a microchip to an abacus. . . in the end all you get might be nothing more than a fantastically expensive Goldberg machine. To me the only way that electronification of medical records will ever be the revolution that it’s backers claim it will be, is when there is a high degree of compatibility between systems. This would allow patients’ data to be shared among multiple different records systems. It would provide patients greater mobility between medical systems, rather than being tied to whatever system their PCP happens to be in. That greater mobility in turn might place greater pricing pressure on different medical systems as they are forced to compete to a greater degree. So how exactly do we implement this? I don’t know. But I promise I’ll start thinking about it once I’m done faxing all these diet recommendations to Florida.
And that solution is. . . to become a drug rep. A fake drug rep. And get access to all the free free brand name (no generics here) medications your heart desires. The story at Pharmalot states that a well dressed man:
“walked into a physician’s office in East Northport, New York, which is on Long Island, and helped himself to about $300 worth of drugs from a shelf after claiming he was a pharma sales rep.”
The man was apparently later caught. Perhaps he was sent to jail. I say send him to D.C., this may be the kind of creative thinking we need to reduce our health care costs!
See the full story here. And the follow up here.
You may have noticed the rash of medical news spewing from your favorite news outlets with greater frequency. As a medical professional you probably cringe as you envision the calls that are about to flood your office, “Doctor Smith, I heard a report on the news that this drug you prescribed to help me quit smoking is bad for my health!” or, “I want a referral to The Hoffenheimer Institute to get peduncular ray beam therapy for my hypertension, they are reporting great results!” And, like me, you probably curse the media, as the stream of bogusness is regurgitated in high def. My advice? Don’t hate the game, hate the players. Continue reading “The Medical Press Release”