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Should physicians be penalized for accepting money from drug companies for writing a prescription to a patient for a drug manufactured and sold by the company?
Should physicians be penalized for accepting money from drug companies for writing a prescription to a patient for a drug manufactured and sold by the company? The U.S. federal government is suing and collecting penalties from the pharmaceutical companies who have continued this practice of "kickbacks" and fraud but not the physicians. Read the major expose article about this topic in the Washington Post
http://www.washingtonpost.com/business/doctors-avoid-penalties-in-suits-against-medical-firms/2011/09/14/gIQAQ8MpXK_story.html?hpid=z2
and then return and write your opinion here. How can the government prove that the intent of the physician was simply to get some cash from the pharmaceutical company and not to medically benefit the patient?
..Maurice.
http://www.washingtonpost.com/business/doctors-avoid-penalties-in-suits-against-medical-firms/2011/09/14/gIQAQ8MpXK_story.html?hpid=z2
and then return and write your opinion here. How can the government prove that the intent of the physician was simply to get some cash from the pharmaceutical company and not to medically benefit the patient?
..Maurice.
asked Sep 18 at 11:11AM in Other
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0Votes
answered Sep 21 at 09:13AMMaurice, thanks for raising this question and I am not providing any answer. I think this can be discussed in the light of recently introduced high price drugs like Denosumab $ 1700 per injection for cancer patients, Provenge $31000 per injection or 93000 for a full course of 3 injections for prostate cancer, Zelboraf $ 9400 per month for metastatic melanoma, Yervoy $30000 per injection for advanced melanoma and Xalkori $ 9600 per month for ALK positive NSCLC. Companies usually give discount to medicare, medicaid, governments, HMOs, Pharmacies, health insurances and hospitals. Why doctors in private practice should be excluded from say 10% discounts for finding a qualified patient and writing a prescription for life saving drugs?-
I had a heroin dealer that described his business the same way as you. One difference was that his drug didn't injure or kill as many people as the ones you just mentioned do.Mike A Cain commented Mar 15 at 04:48PM
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1Votes
answered Sep 21 at 12:54PMproving intent would be difficult. but there are 3 possibilities: in some cases the intent is to benefit the patient, in other cases to benefit the patient and get some cash, and in some cases just to get cash. on the supply side i doubt pharmaceutical companies would give cash for prescribing a med if it didn't increase sales. and at least some physicians would not tell their patient i'm getting cash to prescribe this and nothing to prescribe an alternative. even if the physician added but i think the one i'm getting cash for prescribing is better because... depending on how well i knew the doc and how long i've been with him or her I might consider seeing someone else for another opinion. i think it's not good practice and the profession should not rely on the courts to protect integrity by saying "prove it." -
1Votesanswered Sep 21 at 08:16PMKrishan, I am not sure why the physician has any responsibility for aiding a pharmaceutical company to sell a drug to a patient. The direction of benefit and advocacy belongs solely toward the patient. One might argue that every physician should work to keep pharmaceutical companies in good fiscal condition so that they can contribute to the development of effective drugs for the doctor's patient. I would say, let society help support drug companies, if society desires, through governmental funding, but I think doctors should not be "working for" drug companies when they write a prescription to treat the doctor's patient. I would like to read arguments against my point of view. ..Maurice.
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0Votesanswered Sep 25 at 12:20AMI think it is difficult not to have any bias in prescription written by physician even for generics. Some big generics company provide support in many ways to GPs which may influence their choice of a generic brand. Patient status, income, insurance, education etc may influence prescription for brands, for costly drugs a share of the price has some influence. For new drugs experience with testing, trials, opinion leaders, CME, medical rep visit, free samples may influence the choice. Infusions and injections provide extra income which is not available with oral prescriptions. Prescriptions for laboratory and diagnostic tests and imaging may be influenced by connections of these labs with the physician.
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2Votesanswered Sep 25 at 02:51AMyes it is difficult to eliminate bias. bias, though, can be minimized and knowing the source as you do helps do that. after a study we limited drug rep visits and stopped all gifts. i think that's now policy in some states including ny.
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Good point. On the other hand, I received a sample medication several months ago from my family doctor that worked extremely well. I wonder if a drug rep dropped it off to her. The free sample also saved me money.Kim M Robinson commented Oct 02 at 12:48PM
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2Votesanswered Sep 25 at 08:35PMIn general internal medical practice, I refused to see drug reps and never prescribed "new" drugs and only wrote for the established medicines. Because of that, I have never had to tell a patient to terminate a drug I prescribed because the FDA ordered it off the market because of serious side-effects. That's my experience. Is it typical of most doctors? I don't know, but apparently not..since someone is listening to drug reps and prescribing. My behavior.. was that a disservice to myself and a handicap for my patients? What do you think? ..Maurice.
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It is an honorable thing to do, and appropriately, highly ethical.Kim M Robinson commented Oct 02 at 12:46PM
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Kim, your response to my question above sounds very nice and thank you but... specifically, are you saying that my not accepting drug reps in my office and not prescribing their newest drugs is not an educational disservice to my medical knowledge and of no handicap for my patients? And specifically, for example, does it meet a professional standard for professional self-education--acquire learning from reliable resources (and therefore an honorable behavior towards the profession) and that--providing only safe and economical medications, it provides the ethical beneficence for the patient? ..Maurice Bernstein MD commented Oct 02 at 02:04PM
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"not accepting drug reps in my office and not prescribing their newest drugs"
As a patient, I appreciate said behavior. Quite frankly, I believe it would be an educational disservice to your medical knowledge and a handicap for your patients if you did not take the time to to wait for the "new drugs" to prove safe & effective.Nora J McCarthy commented Oct 19 at 01:36PM -
"not accepting drug reps in my office and not prescribing their newest drugs"
As a patient, I appreciate said behavior. Quite frankly, I believe it would be an educational disservice to your medical knowledge and a handicap for your patients if you did not take the time to to wait for the "new drugs" to prove safe & effective.Nora J McCarthy commented Oct 19 at 01:41PM
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0Votesanswered Sep 25 at 11:55PMMaurice,
Your example is a good one and on the right side of legal, ethical and moral aspect. One observes a whole spectrum of behaviors from doctors as well as patients reflecting the human society. On the other end of the spectrum there are many business minded doctors driven mainly by financial aspect. Such doctors attract lot of patients, well connected, on the lecture circuit and are well rewarded. -
0Votesanswered Sep 26 at 07:56AMSince I am only involved in the teaching of first and second year medical students, I am not sure what, if any, the students are taught in their 3rd and 4th years about techniques of running a business---their office. I really doubt they are taught much about that. Hopefully, students are not admitted to medical school with the goal to learn a "business" and from what I see from my students' behavior is that business is not their goal---at this point in their career. On the other hand, one may wonder if simply being a humanitarian without concern or attention to business is sufficient for a goal for my students...particularly after they have spent literally hundreds of thousands of dollars to become that humanitarian. ..Maurice.
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0Votesanswered Oct 19 at 01:22PM“Health-care decisions must be based solely upon what is best for the individual patient and not on which pharmaceutical company is paying the doctor the biggest kickback,” Rod J. Rosenstein, U.S. attorney for the District of Maryland...
It is my opinion that a doctor receiving any kind of benefit from a pharmaceutical company constitutes as a conflict of interests & jeopardizes the quality of treatment the doctor provides.
It is exactly this kind of practice that has led me, the patient, to be very skeptical of my own doctor's judgement. This lack of trust left me without proper care for over 15 years & still impedes my progress.
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