Doctors Profit from Treatments (part II)

A couple weeks ago I wrote about oncologists who recommend chemo to their patients and then profit from those chemo drugs they’ve recommended. One doctor I talked to said that oncologists are the only doctors who do have that “privilege.” I haven’t been able to verify that, however….

A whole ‘nuther part of this conversation came up yesterday when I interviewed a cardiologist on my radio show (see yesterday’s blog entry). We were discussing the New York Times article that discussed the tens of thousands of patients who needed heart by-pass surgery and had, instead, received stents to unblock their arteries. Just a few years later, some of those stents are becoming problematic. The medical community is now second guessing whether stents are actually all they were cracked up to be.

During the interview, I asked the doctor why that would happen (and it’s discussed in the Times article, too) — he suggested it was because patients are talking only to the doctors who do angioplasty (“you’ve got a blockage, and we can fix it real quick right here in my office this afternoon”) — and afterall, that’s what those doctors will always recommend. Patients don’t take the time to look into the possibility of some other treatment — they choose the quicker and easier because that’s the carrot held in front of them.

Well — duh! (my reaction – not his!) That’s what they are trained to do — and — THAT’S HOW THEY MAKE MONEY!

You know — as patients we will never EVER get around the fact that doctors — just like us — want to make as much money as they can. What we need to remember is that that’s even more important to them than fixing us. We can’t blame them for wanting to make as much money as they can. Who doesn’t?

But there are a couple of lessons to be learned here. First: never trust a doctor who has a financial stake in your treatment to recommend the best treatment for you. Period. I don’t care who the doctor is, I don’t care how benevolent s/he is — if the doctor recommends a treatment to you that is a profit-center for him/her — then get a second opinion from someone who will not profit from your treatment.

It’s not that the doctor isn’t trustworthy. It’s not that the treatment recommendation is wrong, and it’s not that you might not benefit from that treatment — it’s that skepticism can be healthier for you.

Second: the real question here is objectivity. The doctor can’t be objective because s/he has a financial stake in the outcome. You can’t be objective because the doctor has offered you a way out of your bad health dilemma, you are feeling grateful (maybe), and it’s an answer. That’s why a hefty dose of skepticism can be helpful. It allows you to take a step backwards and acquire some of that objectivity you really need.

Unless you have an emergency, gather the information you need from your about-to-profit-from-your-treatment doctor, then get a second opinion. THEN decide what you want to do next.

If, in fact, the decision is to go with the treatment from that first doctor, then by all means — return to that doctor for the treatment if you want to. By then you’ll be informed, empowered, and confident you’ve made the right choice.

And that’s really what it’s all about.

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2 comments

    • gdpawelski on December 23, 2008 at 5:31 pm

    When an oncologist recommends a treatment the reason behind the recommendation may be complex. It can be a result of the doctor’s training and experience in combination with the investments made by the hospital or the doctors own research interests or their financial relationships with various outside entities. In short, a patient and their family must be their own best advocate and get at the heart as to why a specific treatment regimen is being suggested. Don’t be afraid to ask questions to make informed treatment decisions!

    Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need. It would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments. It is suggested by some that we make the search for minimum effective doses of these treatments one of the key goals of cancer research.

    An increasing number of drug studies are developed through collaborations between academic medical centers and drug companies. In fact, pharmaceutical-industry investment in research exceeds the entire operating budget of the NIH. It is important to understand the influence that industry involvement may have on the nature and direction of cancer research. Studies backed by pharmaceutical companies were significantly more likely to report positive results.

    Over the past couple of years, if you watched TV with any regularity, it would have been difficult to miss the direct to consumer advertising that touted the benefits of some drugs over others, especially for patients undergoing treatment for cancer. Even to the point that buses covered with “shrink wrapped” advertising being strategically placed outside major cancer centers for patients and their families to see (EPO anyone?).

    Drugmakers are going directly to the consumer at a time when their products are indeed at the margins of evidence-based medicine. On one hand, pharmaceuticals advertise extensively and the advertising is manipulative in the extreme. On the other hand, even NCI-designated cancer centers do this sort of direct to consumer, hard sell advertising. And in cancer medicine, the media advertising is no more misleading than the one-on-one communication which often goes on between a chemotherapy candidate and an oncologist.

    More must be spent on analyzing drug data, and the need for larger and more detailed studies to figure out why there is an association between pharmaceutical involvement and positive results.

    • gpawelski on December 24, 2008 at 3:50 pm

    Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists

    http://www.healthyskepticism.org/news/2007/Jun.php

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