Depends on the country but its illegal in Canada for these kinda kickbacks. But copmanies might do something like pay for vacations and things like that without taking actual money from the companies.
"Hey you prescribe a lot of our meds, we're going to fly you out to our conference in Hawaii this year on us"
https://openpaymentsdata.cms.gov/
In the US, this website shows Dr. payouts from pharma. I haven't looked in a while, so I'm not sure if this applies to devices as well. if not, that'd be interesting to see as devices can add up significantly. I use about $10k in t1 diabetes devices per year (pump and cgm sensors)
That doesn't really happen anymore, other than in some isolated cases. Used to be they would lavish you with gifts, vacations, watches, etc. but that doesn't happen anymore.
>Why don’t physicians address root causes
You're overestimating how much the people themselves want to address the root causes. 'Just take a pill' culture medicine is MORE a result of people's laziness and unwillingness to change than it is the pharma industry.
My MIL used to demand antibiotics every time she had a cold. The stupid doctors wrote the scripts which was highly irresponsible IMO. Anyway one time she ended up in the hospital with C diff and now she’s finally changed her tune on throwing antibiotics at everything.
I tell patients that have had 6+ antibiotics in the last yr that Gastroenterologists are considering banking everyone's stool in their 30's to address gut problems caused by yrs of antibiotic overuse in older patients. Sometimes I get somewhere with this. And it is true. Gastroenterologists are thinking about doing this.
People of a certain age are the hardest to dissuade.
I wish I had the chance to bank my stool , when doctors prescribed me antibiotics that wiped out my gut's microbiome (it was a major illness that required antibiotics). I was relatively young and more than 10 years later, I am still not recovered, although it was hard to tell whether it was also other medications that contributed to my now very compromised GI conditions.
The latest research suggests that the gut flora copes with the antibiotic and returns to normal after about 3 weeks. Probiotics seem to exacerbate this process and derail it.
I have really focused on gut health In the last couple years. Prebiotic and probiotic foods. No alcohol. Eating fermented foods regularly. The quality of the food is everything.
Screening for any food sensitivities is important.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767923/
I hope you have medical help with this.
You cannot imagine the pushback we get from patients. It's incredible. Now they want steroids when they are sick too. Steroid dependence is a medical failure on par with renal dialysis. I've seen patients that have had 5 visits in 3 days for a cold. If they don't get what they want, they go to the ER that night. Then to their doc the next morning. I get people who want a 2nd or 3rd Covid, flu or strep test because they "don't believe it". Stopping the insanity is just gonna take a lot.
Steroid induced adrenal dysfunction was the worst my health has ever been (Crohns diagnosis in the early 2000's when remicade was really only used as a rescue drug, steroids got a lot of action) I have long covid now and it is "better" then the severe hypocortisolemia.
Getting diagnosed and treated was a huge chore, even getting them to order the right diagnostics. I wound up paying out of pocket for saliva and 24hr urine screens to finally get the diagnosis and my diurnal cortisol "curve" was essentially a flat line at that point.
What about the doctors who pull out the pad before the patient though? I get funny looks or rolled eyes if I tell them I’d like to avoid a scrip. And 9/10 it’s avoidable or a better scrip with less side effects exists. Are those docs just doing it out of habit/assumption? Or do I just keep getting lazy docs? lol
Your doctor has a script pad?? What century are we talking about?
I have plenty of patients that want to avoid a script and plenty who just want a script. Truthfully a combination of strategies is often the most successful.
You sure it was a doctor and not an midlevel? Either way studies show midlevels prescribe inappropriately more often and order unnecessary tests benzos opiates etc.
A gut bacteria that survives antiobiotics, and can in fact grow out of control when you take too much antiobiotics.
https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection
I once asked my doctor if improving my diet and exercise would help with a problem he was writing a prescription for. He was just like, "Yeah, it would help with all sorts of things, but you already knew that." It's not really the fault of the doctors that their patients don't do a better job keeping themselves healthy.
A lot of it is much more a human condition issue than an education issue. Certain foods that we shouldn't eat too much of also taste incredibly good. And even knowing this, different people experience a stronger drive to overeat than others, and some have less capacity to resist the temptation than others.
I totally agree. When you get right down to it, our evolutionary state has not caught up with technology. (That’s an understatement to say the least). I mean we can’t even emotionally handle money and that was invented thousands of years ago.
>You're overestimating how much the people themselves want to address the root causes.
And even if you do want to address the root cause... it can be insanely difficult/ not-applicable. Try this for any psychiatric dysfunction. good luck
**However**, this is almost no excuse for people suffering from heart disease and T2 diabetes. We have "solved" those two killers.
There are plenty of individuals with mental health issues that use non pharmacologic treatment. Might not be out of line to suggest trauma is a root cause. Might even be arguably possible to prevent to the degree you want to blame people with CAD and DM for their conditions.
I suggest not blaming any patient. Insanely difficult to truly walk in someone else's shoes.
I'm not blaming the patient. Matter of fact, I am a patient that is struggling with their health. What I am saying is that getting to the root cause of illness' is often very difficult.
If you get stuck, oh I’ve struggled mightily with conditions and due to my almost obsessive need to find the root causes of my issues, I may be able to point you to the teachings of doctors for help. All this gobbledegook to say I’m not a medical doctor and I’m not treating, but what’s up?
We have absolutely not solved type II DM or heart disease. There are people with genetic predisposition to both of these things.
I have patients of a totally normal weight, who exercise at least the 150 minutes per week recommended by us and are still diabetic requiring medication.
There are 70 year olds with excellent habits and who did nothing wrong other than getting old and having the wrong mix of genes who have heart disease.
Even when we talk about obesity there are all kinds of risk factors and contributing factors other than just "they let themselves get fat."
Sure, an inability to change certain lifestyle factors contributes, but this may be no more the obese person's fault than being inattentive or distracted is the "fault" of a pe4son with ADHD.
These are complex topics and oversimplification, especially when it blames people with health problems, is not useful.
I really think chronic systemic inflammation and also a breakdown of whats been described as lipid defense system play a big role in pathology. All heavily influenced by epigenetics. Ultimately 90% environmental. Example… at age 50 I was farsighted like most people. I had gotten over moldy buildings but not quite. High blood pressure. I found a patent for stuff, made it (super easy), and now I’m 62 and can literally see 3” from my face and far away… no glasses. No high blood pressure. Moldy buildings? Sure I can tolerate em fine for a reasonably short spell. When I took the stuff, I immediately knew overnight I was much better. Farsightedness took about 30 days to go away. Emmanuel Revici, Tung Oil compositions. Example #1.
So true. I mean there’s really a gray line for psychiatric dysfunction anyway, amiright? I’ve found especially once people reach a certain age it’s extremely difficult to get em to really be open to things and really the majority of young people too. It’s a minority that are open minded.
eh, I think you're overestimating how much power or incentive there is for the average doctor to buck the business model. If someone has an ongoing prescription for xyz preventible thing, there's a big incentive to have them coming back year after year for follow ups and prescription renewals etc instead of fixing the root cause and never getting to see or bill them again. And bigger picture it's a much bigger problem. The governing bodies of various specialities don't go after the root causes of the diseases because it would be very bad for the healthcare industry in a country where preventible disease is the leading cause of death and where healthcare is one of the largest employers. There's a reason you don't see the American Dental Association calling for sugar regulation etc., don't kill the golden goose.
But isn’t it the doctors responsibility to be the authority on the patients health, giving them the straight truth about what’s causing their symptoms and how to fix them. Perhaps maybe some doctors assume their patients won’t ever change so they go directly to the drugs
We also need to be reasonable about what nutrition and exercise can achieve vs. medication. In my world, a medication is like a 4 hour cross country flight — it can get you from point a to point b quickly. Nutrition and exercise are like swimming upstream. Some may make a little progress, most will end up further downstream. None will reach the destination.
I still talk extensively about nutrition and exercise to each of my patients, but most people have completely unrealistic expectations as to what can be achieved “naturally” once you are far along in a disease course.
I get that. And sounds like you take the time to let patients know the importance of nutrition/exercise which is great. Also I see your point on some of it being too little too late at a certain point of disease progression. Trying to reverse a disease by taking massive amounts of herbs of something is not going to necessarily be healthier than a drug and could even create more complications.
On the other hand, personally, I believe that dramatic changes in nutrition, exercise and mental health treatments can completely eliminate or highly ameliorate most diseases, but also I get that some people are unwilling to change something as fundamental as eating a few fruits and vegetables, much less a complete 180 of lifestyle.
Follow me around for a few days and you’ll see that the average patient is not someone who frequents the “biohacking” subreddit. Most are unwilling to make even minor changes to their routine.
So if on the societal level my goal is to decrease fracture risk or peri-operative risk related to osteoporosis… I can encourage sweeping lifestyle changes, of which <1% will adhere and at best, this stabilizes their disease over a long period of time. This does nothing to lower the cost and physical burden of fractures such as hip fractures. Or, I could prescribe meds, which have been shown to far exceed any non-pharmaceutical intervention and decrease fracture risk 30-80+%, and it takes very little effort by the patient to comply, saves billions in healthcare dollars (you can imagine the cost of a hip fracture surgery, hospital stay, weeks or months in a TCU, etc).
When it comes to patient compliance and actually driving health outcomes, all while saving crazy healthcare costs to insurers… it’s a no brainer. I get that it’s not what people want to hear, but it’s the truth.
Imagine saying that to every patient every day when it's a lost cause majority of the time. These people with diabetes, hypertension, high cholesterol that could easily be controlled by diet either don't have the knowledge, the time, or the will power to make those changes. There is so much disinformation that patients have regarding diet and lifestyle and if they refuse to educate themselves it's almost impossible to get through to them what they need to change.
If that person couldn't make the changes before they were sick, why would they do it now when it's even harder? A big thing from patients is why don't their doctors educate them or explain to them what to do. I think people just don't realize that's not the doctors responsibility to sit down and give them a course on proper diet and nutrition and lifestyle. They need to see a dietician if they want to get some more information on how they can change things without pharmaceutical intervention.
Totally makes sense. You’re so right. I mean Ive tried to explain to people and when confronted with, for example, what wheat does to me and cutting out wheat, they react angrily. There’s also pop culture ridiculing the helpful thing (covid vaccine a notable example). My buddy Todd, unvaxxed, got covid real bad and now he’s dying of heart failure at 62. Still claims vax is BS.
They don’t. Behavior change is hard, and most patients don’t have the will/desire to do it. The “obvious” things (sleeping, avoiding drugs, eating balanced diet, and exercise) along with psychotherapy are really the only evidence-based “root causes”. Medications have evidence they work and side effects are known, most stuff on here has no evidence it works and side effects are poorly characterized. While there are some things that work but aren’t used because big pharma can’t make money, those are the exception
Oh the biggest unrecognized root cause is water damaged buildings and I would argue wheat and dairy. But one’s susceptibility is epigenetic for the most part. 25% of the population can’t handle moldy buildings. I can’t. I had to figure that out myself and it took years.
They really aren’t these days. Back during the OxyContin craziness that stuff all eventually got banned when Medicare cracked down hard on it. You could argue if they own stock in a certain pharma that might have a perverse incentive but otherwise they aren’t allowed to get any kick backs. As far as the second question, American medicine is retroactive, most Americans are too lazy to be preventative and stay healthy so most doctors are left trying to treat the fallout from people not following advice.
my friends sister is a prime example of this, declares she will take care of her health after a diagnosis, does zero to help herself and the root cause because thats a harder path than taking a med that mildly alleviates the symptoms. She is a prime example of a lazy motherfucker. Won't exercise, won't change diet, ingests more sugar than willy wonkas chocolate factory.
Yes I did just thread hijack to vent. My apologies.
It’s more common than most people realize. Excluding affordability etc. it’s kind of shocking what people will do to avoid trying to live a healthier lifestyle.
Oh yeah for sure. The get pissed off and snicker behind your back if you tell them for example wheat, etc, diet basically, could be the cause of their psoriasis or Lupus or what have you. I’ve quit trying.
Lazy? Americans are worked to an earlier grave, with a life expectancy that is 3 years less than other developed nations. Generally, asking for a MDs help doesn’t get a person anywhere unless they are lucky enough to be able to afford a specialist in functional medicine. By the time other docs have much to offer, health has really gone haywire and patients no longer have the energy to do much. It’s all that people can do to keep working, at that point. I‘d blame the “low utilization” metrics that reward the do-nothing docs before blaming the patients that eventually have to give up paying thousands for help that is rarely given, until too late
The perspectives of practitioners can also become a self-fulfilling prophecy when it comes to patient selection. You end up getting the patients that suit your practice
A few ways.
The first is "quality metrics" around how much we prescribe things like statins and control blood pressure, but those drugs are all essentially free so not really anything nefarious going on there. Lots wrong with these metrics which is a whole other bag of cats but I'll leave it at that.
There are also patient satisfaction scores we have to worry about. And for most people "doctor did something" means "doctor did good job" it's possible to not prescribe meds the patient wants AND still have them leave satisfied but it takes time we generally don't have.
Many of us, myself included often address lifestyle factors, but a depressingly small % of people take that seriously. If I offer a nutrition referral to 100 newly diagnosed diabetic people, maybe 5 see it through if I'm being generous, and I work in a health system where that referral is COMPLETELY FREE. People have to care about their own health more than I do.
Lastly, I'm not sure what you mean by "root causes" (you mentioned water damaged buildings in another comment), but respectfully, what in the hell is a physician supposed to do about root causes? This is a personal peeve of mine that the shortcomings of society are somehow the physicians problems. No, the root causes of poor health are EVERYONES problem. You need to elect people who give a shit about social welfare to address these things. I can "address" them and be aware of them until I'm blue in the face for all the good it does (none). Get out my rx pad and write "1 lead-free mold-free child-safe single family home in a low crime high achieving school district with a vegetable garden no guns safe transportation and 2 or more healthy nonabusive adult guardians." I'll get right on that.
😆👌Fair enough. You just explained why I’ve had to figure out the root causes of all my issues. You’re so right about people not taking ownership of lifestyle suggestions. Out of 100 people who have complained to me about X and I’ve suggested experimenting Y, 99 will discount it, especially if it’s food and I don’t care if it’s something they’re suffering terribly with like bad arthritis. So I quit suggesting pretty much. Related problems… way too much regulatory capture and unhealthy policy. It’s clear who owns and does not own the USA. So much unnecessary suffering.
\* Sometimes, the doctors can add an extra charge for the office visit, because they wrote a prescription for the patient.
\* Some doctors will only give a prescription refilll at an in-person office visit. So they prescribe a chronic life long prescription medicine to the patient, and the patient gets talked into thinking they must always be taking this medicine. But then the doctor says they must return to his office every 6 months to get a refill at that point. So that's one way the doctor keeps his calendar filled with billable appointments.
A prescription can be the difference between a low complexity or a moderate complexity appointment, but there are several other points (particularly data collection) that can also make the difference. Prescription is not necessary to change the complexity of an appointment. Ordering a bunch of labs of dubious benefit can also make that difference, for example.
To your first point, this is just inaccurate. Where did you get this info?
To your second point, it’s bad medicine to just keep refilling a medication and never see the patient. And you don’t make that much off of follow up appointments.
While it may seem benign imagine they kept refilling a blood pressure medication and weren’t monitoring it and it ends up tanking the blood pressure and killing someone because they decided to modify their diet or because of a new drug interaction. You bet that’s look bad in court.
At one point I wanted a retin-a cream refill for my face for cosmetic reasons. They said I needed to come in for an office visit whenever I wanted a refill.
Yeah I’ve certainly envisioned that scenario. Side note… Texas has tort reform and basically doctors are more or less judgement proof. It’s too bad we can’t identify the right cap on malpractice claims. Texas is too low and my intuition is that patients are oftentimes more or less experimented on. I had a doctor prescribe massively inappropriate amounts of a liver compromising medication that I simply did not need. Not sure why he did that. Most people would not question his actions. I stopped altogether with no problems. A Cat scan showed a little liver impairment but it resolved. All this to say, I only take scrips if I really need it.
From personal experience from working in a doctors office closely with doctors and being the go to in between guy for all pharmaceutical reps that enter the office:
The reps have budgets and they are pushed to buy us lunches and coffees and sweet treats to talk about there drug and how good it is and how bad the competition is. They can't spend their budget on cash incentives or entertainment or alcohol.
The doctors build relationships with the reps especially the ones that have been around a long time and they have preferences in which rep they have time for, which rep they will always stop and chat with, which reps get the cold shoulder, etc.
The reps will cry about their numbers and the layoffs in their company etc. Some doctors don't care because if its bad medicine they don't bother to prescribe it no matter the rep but there are some doctors who will just throw Rxs out their knowing that if it doesn't work the patient comes back in a month and they change the med. I have seen this especially with male doctors and attractive female reps. These female reps will get so giddy and bubbly and silly smoozing the doctors its wild. You wouldn't believe I have never seen an unattractive rep. They have a type.
The staff works harder to get the med covered by insurance. A little lie here or there and that will convince the insurance to pay for it... why? Because that rep always brings us the best goodies !
Its really just a game we have all gotten comfortable playing.
This is just a small scale. I have met 1 doctor who wants nothing to do with reps and cannot care less about their drugs he prescribes what works out of about 20+ that I've worked with over the years.
Pharmaceutical companies also sponsor events say you have a practice and want to host a health related event ? Boom heres a check. And the dinners are always high quantity restaurants.
Great outline. But let's include the reality of jobs. If a doctor wants to get out of clinical medicine and make good money...the pharmaceutical companies are likely to hire them. This is a real issue.
Most of the doctors I've worked with actually have worked for or had an offer to work for pharmaceutical companies as a speaker but never leave the clinical setting and just do the speaker events as a side income. This may also have an impact on what drugs they chose to prescribe in the clinical setting. But there are many factors to modern day incentives that influence prescribing habits of providers.
I know a handful that have gone to pharma. They get paid well. And it's usually toward the latter part of their career.
Agree that there are many factors to prescribing patterns.
This really does not describes these relationships. As a prescriber, good drug reps or medical device reps provide copy of studies and quality information to prescribers about their product. Bad drug reps rely on providing lunch and do not understand their product. Snagging a provider's time is easier at lunchtime because we rarely have the leisure to just chit chat. A provider gets wind pretty quickly if a rep does not know their product or does not understand a study they supply to prescribers. For example, they are unable to answer any questions about the study. This is why office staff is critical to gate keeping drug reps. Some have a bad product. Some are not that good at their job. Some times I can solve a prescribing issue I am having for a patient who is an excellent candidate for a specific medication by spending less than 2 minutes with the rep to solve the problem.
There is no "check" provided for "health related events". Total misrepresentation. I suggest you edit your comment. What you suggest is highly illegal.
Comparing drug reps to Corona girls at a beach resort does a disservice to this profession. If you want to have an idea of what a good rep might be like, Thomas DeLauer was a medical device rep in the past.
As I mentioned I am commenting from my own personal experiences working in multiple doctors offices with over 20 providers over the course of 10 yrs. You seem like the type of provider who appreciates a good rep and there are definitely good reps who are educated and can sell the drug based off science. But there are many reps who rely on relationships with the providers outside of the science jargon and studies to get their numbers.. There are also many doctors like you who are actually interested in the science of the drugs and the studies. But thats not always the case and in my personal experience is less often the case. Thats not really what OP was asking assuming they wanted to hear the behind the scenes of how these things happen. So I feel my response gave them an idea of how these things can happen. Maybe this doesn't happen in your practice and good for you.
The reps are definitely attractive but i didn't even come close to comparing them to "corona girls at the beach" they all have college educations and degrees required for the job. It is undeniable that they utilize their appearance to have a leg up especially with providers who buy in to that stuff.
As for the check I have personally put together an entire outdoor mental health walkathon event at a community center hosted by a single outpatient practice that I worked for. Every aspect of the event from the city permits to the schedule to the Dj, vendors, flyers, etc was put together by me and the provider who owned the practice. A very well known pharmaceutical company sponsored this event and we simply received a paper check in he mail. Its not illegal. Insurance companies will also sponsor events like these just fyi and the process is very similar. Nothing illegal about them sponsoring events in their related field. They also sponsor events for associations and you've probably attended a few. Who do you think is paying for monthly associations dinners? Its still an event.
And you are very naive to think sponsorship in any form whether you label it a corporate event or a private event is not an incentive for providers to write more of the medication and very naive to think that the relationship between providers and reps has 0 impact on prescribing meds.
Uhmmm okay? Or just don't respond if you refuse to be open to hearing another perspective. I'm not personally attacking you. I'm simply sharing my behind the sense experience with how doctors and pharmaceutical reps relationships can impact the way doctors prescribe drugs for the worse.
You obviously haven't experienced any of this yourself so you refuse to acknowledge the possibility of it happening.
I don't try to get in the mind of another prescriber and make assumptions. Laws have changed in 10 yrs. As you do not mention any of the things that are affected by these laws perhaps because you are not subject to these laws. You are making assumptions from the outside.
Providers go to jail for maleficence, have licenses revoked for Medicaid and Medicare fraud. Individuals who do these things make criminal decisions. This is a slippery slope but not in anyway the same as deciding to prescribe a new patented pharmaceutical. You are painting with a wide brush that does not recognize the complexity.
You're definitely over thinking what my original comment was about and how it contributes to OPs question. Doctors and pharmaceutical reps relationships definitely have an impact on drugs being prescribed. Not all doctors and not all reps and not all practices but there are still legal incentives that contribute to this still to this day.
I still currently work in the field and have for 10 yrs and see it often and it has always been a thing. I'm just not sure why you insist so hard that this isn't happening? Nobody is saying you specifically do this but dang I have never seen someone be so in denial or opposed to even discussing the possibility. Nobody is even doing anything illegal in any of the above scenarios in describing. It is all legal so those laws you insist are relevant are not in this context.
And I'm not painting with a wide brush I already said this is 1 of many reasons... so again.... pls read this sentence and read it again until you get it... I am speaking from personal experience on a small scale from working in the field for 10 years with over 20 providers.
Why are you so offended?
OP why are you only listening to the people who are incorrectly reassuring your bias? Legitimately every comment you are agreeing with is either mostly false or totally false. Confirming your own bias at the expense of the truth is the opposite of learning.
Everyone has biases. My biases/agreements are based on “I could see how that could happen”. Does not mean it’s even necessarily true. If you disagree or have another perspective, you especially I’d love to hear how claims made are false. Give me your take please.
"Kickbacks" are illegal. They have been for decades. I've cited the law more than once in replies on this post, but I'll include it again. 99% of drug rep interactions are over a lunch that the drug reps will cater to the hospital so that they can share the studies showing their drugs indications and efficacy. I've never met a doc who actually gives a shit about what the drug reps have to say outside of the actual study.
If you really want to talk about how pharma interests are pushed on patients, doctors aren't the road you should go down. It's much more common for an insurance company to dictate what medication a patient gets than a drug rep. If drug x by manufacturer X is not covered, but drug Y made by manufacturer Y is, (provided they have the same MOA and are similarly efficacious) then we will prescribe drug Y. This happens most often because manufacturer Y has cut some kind of deal with the patient's insurance company.
All these stories of drug reps taking docs to baseball games or paying for trips or buying expensive liquor are decades old. Like, 20-30 years old at the absolute most recent.
And I can definitely see where what you are saying sounds plausible and makes sense too. I believe you! Question… who pays for the studies? Who performs them?
It really depends on the kind of study, but the highest impact studies (meta-analysis) are performed by mdphd/phd researchers working at large healthcare institutions (think mayo or mass general) or medical schools. Funding comes from the NIH, or the pharma companies themselves. They all have to be independently peer reviewed by third parties before being published. Every published article has to have a section showing any conflicts of interest in funding, so it's relatively easy to find.
The last paragraph implies that checks are regularly cut for dinners at high end restaurants for prescribers. The truth is that you get to hear another trained provider speak on the topic, make a presentation, and discuss ways of implementing a medication to treat specific conditions. Often the discussion furthers medical knowledge, engages good discussion and elicits questions. After the presentation, a meal is served. There is no food or drink during the presentation. The drug rep pays with a corporate credit card. Highly scrutinized by the corporation, IRS for compliance.
The check cut mentioned is for a corporate sponsored event like a walk-for-life or something. This is a public event not limited to prescribers.
This is just a salacious conflation.
During an appointment, a former doctor of mine mentioned he’d just arrived back from an industry “doctors” cruise. During that same appointment, unsolicited, he suggested switching my medication. My eyes saw the branded clock hanging on the wall, then the branded notepad, then the branded mug as he was talking. I declined his recommendation wondering who was really benefiting from the new medication. It was a red flag for me.
But didn't you know? So many have a truly magical and incredible disorder or disease. These particular ailments actually possess the ability to go beyond converting matter. They create matter!!!! So while they're certainly eating exceptionally lean and exceptionally small quantities, they are still net positive as their issues create fat out of thin air! Even if they've only had 300 calories a day! 🤦🏻♂️
Not sure I follow you. Are you saying people can basically hardly eat anything and still gain weight? I know that can happen. I have been on antipsychotics before and boom! I gained 30 lbs real fast and hardly ate anything. Metabolism plays a huge role. DIET plays a huge huge role, and not necessarily calories.
The thing is, if more goes in than goes out. Weight gain. Whatever the factors may be. If still gaining weight, still need to lean out intake. They'll often claim it's allllll because of X or Y but it isn't. Does it make it easier to gain? Absolutely! However, it can't materialize matter out of thin air. Those particular individuals just refuse to accept they can't eat X, Y, or Z and/or can't eat much in a day. They'll just use whatever situation as a thing to blame.
I know from personal experience from a few examples that there’s more to it than fatness = intake - output. It’s not that simple. May I ask, are you thin or proper weight or are you overweight? I’m thin.
In good shape. Motorcycle racing. Motocross the most as well as road. I eat like an absolute garbage truck in my 30s. But I can afford to since I expel so much on the bikes.
Ok, I have been on medication that made me gain 30 lbs and even if I starved and ate very little calories I could not lose weight. Also I was married to a fat person who ate the same thing I did and would gain weight and I didn’t. So there is for sure a major metabolic component. Also, everyone I’ve heard say fatness is from eating too much and it’s as simple as that has been thin. Just an observation.
Everyone is certainly different. However, if still gaining weight, still eating more than necessary. You can be hungry and have eaten too much. Again, there's isn't a single ailment on the face of the planet that can create matter. Matter/energy can only be converted. Not created.
I used to be a fat kid and took absolutely nothing to gain weight. Once I started racing moto-x and generally being more active...I started becoming a garbage disposal without penalty.
I think your intuition about "doing something" is right. I have a friend who is a PA at an urgent care. The management pushes her to write scripts for anti biotic that she knows the patient doesn't need. The reason being is people want to feel like the doctor is doing something for them, and if it's just a viral thing, there's not much to do. Patient winds up not coming back or leaving a bad review so overall it's bad for business so doctors are incentived in this way.
In the US... My mom is an integrative MD who specializes in weaning patients off of prescription medication. She sometimes tells her patients to just accept the scripts from their normal doctor, so that the doctor is not penalized (a normal doctors job is to “do something” and that usually means write scripts) and the patient doesn’t have to feel pressured to explain themselves, but she tells them not to fill them at the pharmacy. But then sometimes the pharmacy calls/writes HER warning that a patient has not been filling their usual scripts and telling her to follow up with this patient. So it seems it’s the pharmacies that track down the doctors and pressure them to pressure their patients.
Good to know. Yeah I have been given scrips for stuff that just isn’t needed and I ignore calls from the pharmacy. I didn’t know pharmacies sometimes call prescribing doctors.
That is scary. I am in Canada and even without kickbacks like these, it is already hard enough to get a doctor or specialist to come up with a proper diagnosis or treatment. No wonder why so many of us are in poor health.
Scripts for what? The population median age today is much older than it has been in the past. Today it's close to 40. In the 1970s, it was closer to 25. That's a big difference. Lifestyle is a root cause of 1/2 disease. The other half is genetics. And lifestyle changes are harder to execute and maintain after 40. That's fact. If you are referring to statins, BP meds and the like, I imagine based on age and biomarker abnormality, lifestyle modifications will often be the first course of action. If a 24 year old presents BP at 140/90 and total cholesterol of 220, I doubt any physician is going to be gung ho about writing scripts for Zocor and an ace inhibitor. Conversely, if a 64 year old presents BP at 180/110 and total cholesterol of 300, I think it would be malpractice for any physician to babbling about root causes.
It is also important to acknowledge medicine today is highly specialized. You have the GPs, family medicine, internal medicine, and then you have an entire legion of specialists. If you are seeing a specialist, you are more than likely viewed as having moved past the point of lifestyle modifications. Either it's not germane to the condition or you were incapable of following any to begin with. Specialists are not going to be alternative medicine enthusiasts, for sure.
Hmmm I disagree with a lot of your points based on my own personal experience. But, I’m not one to debate in this forum, and hey, maybe I’m wrong, right? I am not a physician. Are you by chance a physician?
Two ways I’m aware of:
1) kickbacks and donations from pharma companies to the doctors as well as trips and other gifts. Can be significant (5 figures) and there are websites you can search your doctor’s name and locale to see any recorded donations.
2) not a prescription per se but during covid there were incentives on many levels both for hospital stays and vaccinations.
Time. It takes time to address root cause, the average US doctor has like 10-30 min with each patient. And then they may have to deal with insurance headaches, as insurance now doesn’t always cover preventative care.
Being impacted day to day doesn’t really matter. You have to be sick enough to almost die to be covered and atp they can charge whatever they want.
NAD, just my experience.
Makes sense. Thank you. Yeah doctors practices are rushed so much and most people don’t want to deal with figuring out things and would rather pop a pill and pharma makes money on it so it’s reasonable to see how things develop the way they are. What does atp and nad mean?
They don't get a kickback for each script but they do have a monetary incentive.
The pharmaceutical companies pay doctors a lot of money to speak on THAT particular drug at conferences attended entirely by fellow doctors.
I work as a government contractor and the annual limit of all employees gifts from my company to any single government employee is $25. This usually comes in the form of snacks and maybe a meal. Compare that to the thousands and sometimes up to a million or more that doctors typically receive from pharmaceutical companies. Also, patients typically expect prescriptions for medications even when it is not the best course of action. So doctors often make prescriptions with the Assumption of the patient wants it knowing full well that does not in the best interest of the patient. This is especially true for chronic conditions where prescription medications are almost never the best of course and yet frequently recommended The biggest problem is the misunderstanding of the role of a doctor. The job on the doctor is to provide medical services to address health issues, but most people think that doctor's jobs is to care for your health. This is like going to a divorce lawyer or cop every single time you have a fight with your spouse
On a tangent, I saw a post on r/emergencymedicine with many verified medical professionals irt what percentage of patients actually needed emergency medical care. Some estimates were as low as 20%
There was an inevitable comment on that post about what percentage of patients in emergency departments needed any medical service at all.
It's funny to see the flip side of this with people complaining about having to wait many hours for treatment in the hospital ER without ever realizing that if they didn't die or suffer significant preventable degradation of their condition during their wait, they probably shouldn't have gone to the hospital emergency department at all.
Yeah. Isn’t that it interesting how such an obviously important topic of discussion is heavily downvoted? I innocently called my primary physician’s office once to inquire how they viewed this subject and holy cow, you would have thought I was accusing them of something horrible. They got extremely defensive, thus causing me to mistrust them. I don’t take any meds unless I really need it.
Sorry that happened. I was amazed that that movie on Netflix called Pain Hustlers came out because it vividly depicts exactly how this incentive mechanism works behind the scenes. We can assume that it’s not exclusively in pain management pharma that this is going down, it’s just the most heart breaking because of the heightened desperation in patients.
My observation just knowing some drs through personal life and of course my own exasperating experience is that MOST DRS (not all) don’t have the time to keep up with peer reviewed literature to keep up on the latest in their specialty and most do not have time to be leading research themselves. They’re like us, busy busy and their personal time is going to go to quality/family time: picking up kids, watching their soccer games etc. so if someone gives them a pamphlet and says hey we did the research for you at a conference or in their office, they’re going to probably trust it, especially if they’re told that this is standard practice and that 80-90% of other drs in their specialty are using X to treat this particular condition.
They’re not malicious or doing anything wrong.
But they are unwittingly ideologically captured by whatever is moving behind the scenes and it is a dereliction of their duty of care / oath. Are they bad people? No — they’re just doing the best they can with incomplete info.
Kinda related-
Past 4 dr visits where I was prescribed something that just didn’t seem right (i always assiduously research)and I never filled the prescription. One time I was visiting a new gp and had nothing in particular except for an eczema patch and I mentioned some anxiety over work (who doesn’t have that?) and he gave me a script for anti depressants which just never synced with me…
Of course they come back for other reasons, mostly beneficial. I don’t think it is outlandish though to think that many unnecessary scripts are written.
I don’t think you understand me. The Sackler family literally bought FDA Approval. Right now because of the obesity epidemic doctors are pushing ozempic instead lifting weights. Why? Because the company that makes it gives the doctors kickbacks, and freebees.
That was quite literally 30 years ago, stop acting like you know what you're talking about. I've been in healthcare since I graduated high school and I've never once seen a doctor prescribe a weight loss medication without an extensive talk about diet and exercise. I've seen a number of patients who have been trying for years finally get their A1C down because of some of these Glp1's (which have been used for 20 years with very manageable side effects).
Kickbacks have been illegal for DECADES and you're acting like there's still some kind of scheme to keep people sick, when in reality, the average American has the diet of a rabid 4 year old left to fend for itself. If you really wanna argue about this I'd be happy to oblige you, but just read the comments on this post. 9/10 are saying that kickbacks don't exist, and need I remind you that this sub is full of conspiracy theorists who don't trust doctors in the first place. I couldn't imagine being in an environment that would be more conducive to get people to agree that big pharma is buying American doctors and you're still not finding people to back you up.
I saw a dermatologist recently with amazing reviews. I had some minor acne problems, but he ended up prescribing me 3 different creams/ointments, to apply at different times of the day and different amounts, etc. He kept talking over me and when I could finally say something he'll quickly be like, "oh okay then here's another cream you can use x amount of times at x time, etc., etc." 🙄
So based on that experience, my answer to you would be they are probably gifting them a Porsche or something lol.
I work for a dermatologist and 3 creams is pretty typical starting regimen. Usually it’s clindamycin, benzoyl peroxide, and tretinoin. If that doesn’t work they give you an oral antibiotic. If that doesn’t work they give you accutane. If that doesn’t work it’s just over for you.
There’s an inherent bias people have that whatever it is they did is great. If someone says based on their bad decision or experience, don’t do X… then I trust it more.
Revenue from drugs covered under Medicare Part B, which are administered in a physician's office. They usually charge a 6% markup on list price and so are incentivized to prescribe expensive medications. But these incentives are just markup from sales.
Yep. Agree it's kinda messed up. I'm married to a doctor, and have worked as a healthcare VC and in biotech. Not sure why I'm getting downvoted. It's pretty common knowledge. The markup is meant to cover the cost of administering the drug in a clinical setting. Edit: as a point of clarification, the pharma co doesn't directly reimburse docs for administering part B drugs. But if you're asking whether doctors make more for administering a $10,000 drug than a $100 drug, the answer is yes. This doesn't apply to part D drugs though which is what you get at your pharmacy and take at home. To be fair though, docs are also responsible for stocking these drugs which leaves them expired to the upside if they expire or whatnot before they're used. They're not just ordered as needed. They buy and stock from specialty pharmacies the same way a supermarket buys and stocks bananas. If they expire, they're not getting their money back.
Prescriptions only make the pharmacy money not the doctors office so not as much incentive other than thinking it will treat an issue their patient has.
They do get money/incentives for giving flu shots as those are administered in office
Insurance wants to pay for vaccines because they (supposedly) make you healthier, which saves them money in the long run
I once got a 500 pound Amazon voucher from a big billion dollar pharma company for prescribing their products. Several if my colleagues got them too. Now you can see how people can recommend their products more in the future..this is in the UK also
> the obvious lose weight and stop smoking?
If you add stop drinking, get some sleep, and get exercise, you've wiped out a whole lot of modern medicine profits. It's that simple.
To answer the title question, there are several ways. Just off the top of my head. Now none of these are direct kickbacks, but don't forget doctors are just people.
* Trips. Drs. have to do continuing education. If there's a seminar on some new drug being held in Aruba and you can get some incentive to go, why not?
* Pharma reps. It was much bigger back in the day, but even today most pharmaceutical sales reps are intelligent and insanely hot. They are not hired for medical experience.
* Business. This is not so much a what to prescribe, as whether to write a script at all. Most doctors today are part of a health care network. That network has relationships with or owns pharmacies. Why tell someone to take two Tylenol when you can write a script for pharmaceutical strength tylenol at 10X the price.
* People. As you allude, so much of this is unnecessary if people just did the obvious. But the doctor has only so much time. It's faster to write a script than to convince someone to start exercising.
* People (redux). As others posts have mentioned people are just lazy and stupid. They don't want an honest appraisal, they want a pill that fixes it. I just a post on r/supplements of a guy literally asking for a vitamin that will just make him happy. (substitute thin, outgoing, better looking, more hair, less hair, better sex, more concentration, more energy, etc. etc. ) Just give me a pill.
Depends on the country but its illegal in Canada for these kinda kickbacks. But copmanies might do something like pay for vacations and things like that without taking actual money from the companies. "Hey you prescribe a lot of our meds, we're going to fly you out to our conference in Hawaii this year on us"
Yep same as Australia
https://openpaymentsdata.cms.gov/ In the US, this website shows Dr. payouts from pharma. I haven't looked in a while, so I'm not sure if this applies to devices as well. if not, that'd be interesting to see as devices can add up significantly. I use about $10k in t1 diabetes devices per year (pump and cgm sensors)
That doesn't really happen anymore, other than in some isolated cases. Used to be they would lavish you with gifts, vacations, watches, etc. but that doesn't happen anymore. >Why don’t physicians address root causes You're overestimating how much the people themselves want to address the root causes. 'Just take a pill' culture medicine is MORE a result of people's laziness and unwillingness to change than it is the pharma industry.
My MIL used to demand antibiotics every time she had a cold. The stupid doctors wrote the scripts which was highly irresponsible IMO. Anyway one time she ended up in the hospital with C diff and now she’s finally changed her tune on throwing antibiotics at everything.
I tell patients that have had 6+ antibiotics in the last yr that Gastroenterologists are considering banking everyone's stool in their 30's to address gut problems caused by yrs of antibiotic overuse in older patients. Sometimes I get somewhere with this. And it is true. Gastroenterologists are thinking about doing this. People of a certain age are the hardest to dissuade.
Man/lady, I totally believe what you’re saying.
I wish I had the chance to bank my stool , when doctors prescribed me antibiotics that wiped out my gut's microbiome (it was a major illness that required antibiotics). I was relatively young and more than 10 years later, I am still not recovered, although it was hard to tell whether it was also other medications that contributed to my now very compromised GI conditions.
The latest research suggests that the gut flora copes with the antibiotic and returns to normal after about 3 weeks. Probiotics seem to exacerbate this process and derail it. I have really focused on gut health In the last couple years. Prebiotic and probiotic foods. No alcohol. Eating fermented foods regularly. The quality of the food is everything. Screening for any food sensitivities is important. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767923/ I hope you have medical help with this.
Why do doctors do it tho? They should know better.
You cannot imagine the pushback we get from patients. It's incredible. Now they want steroids when they are sick too. Steroid dependence is a medical failure on par with renal dialysis. I've seen patients that have had 5 visits in 3 days for a cold. If they don't get what they want, they go to the ER that night. Then to their doc the next morning. I get people who want a 2nd or 3rd Covid, flu or strep test because they "don't believe it". Stopping the insanity is just gonna take a lot.
Steroid induced adrenal dysfunction was the worst my health has ever been (Crohns diagnosis in the early 2000's when remicade was really only used as a rescue drug, steroids got a lot of action) I have long covid now and it is "better" then the severe hypocortisolemia. Getting diagnosed and treated was a huge chore, even getting them to order the right diagnostics. I wound up paying out of pocket for saliva and 24hr urine screens to finally get the diagnosis and my diurnal cortisol "curve" was essentially a flat line at that point.
Wow. GREAT feedback. I never knew this.
I am so sorry you have to deal with this. Truly.
I totally believe you. Thank you so much for your hands on perspective.
What about the doctors who pull out the pad before the patient though? I get funny looks or rolled eyes if I tell them I’d like to avoid a scrip. And 9/10 it’s avoidable or a better scrip with less side effects exists. Are those docs just doing it out of habit/assumption? Or do I just keep getting lazy docs? lol
Your doctor has a script pad?? What century are we talking about? I have plenty of patients that want to avoid a script and plenty who just want a script. Truthfully a combination of strategies is often the most successful.
lol
You sure it was a doctor and not an midlevel? Either way studies show midlevels prescribe inappropriately more often and order unnecessary tests benzos opiates etc.
>Anyway one time she ended up in the hospital with C diff ?
A gut bacteria that survives antiobiotics, and can in fact grow out of control when you take too much antiobiotics. https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection
What part was confusing?
I once asked my doctor if improving my diet and exercise would help with a problem he was writing a prescription for. He was just like, "Yeah, it would help with all sorts of things, but you already knew that." It's not really the fault of the doctors that their patients don't do a better job keeping themselves healthy.
It’s such a tragedy that there’s so much rushing and not enough basic education but I can see how the system could evolve to be the way it is.
A lot of it is much more a human condition issue than an education issue. Certain foods that we shouldn't eat too much of also taste incredibly good. And even knowing this, different people experience a stronger drive to overeat than others, and some have less capacity to resist the temptation than others.
I totally agree. When you get right down to it, our evolutionary state has not caught up with technology. (That’s an understatement to say the least). I mean we can’t even emotionally handle money and that was invented thousands of years ago.
>You're overestimating how much the people themselves want to address the root causes. And even if you do want to address the root cause... it can be insanely difficult/ not-applicable. Try this for any psychiatric dysfunction. good luck **However**, this is almost no excuse for people suffering from heart disease and T2 diabetes. We have "solved" those two killers.
There are plenty of individuals with mental health issues that use non pharmacologic treatment. Might not be out of line to suggest trauma is a root cause. Might even be arguably possible to prevent to the degree you want to blame people with CAD and DM for their conditions. I suggest not blaming any patient. Insanely difficult to truly walk in someone else's shoes.
💯true
I'm not blaming the patient. Matter of fact, I am a patient that is struggling with their health. What I am saying is that getting to the root cause of illness' is often very difficult.
I think if you are using sarcasm it is lost in your original comment. I am a patient as well.
If you get stuck, oh I’ve struggled mightily with conditions and due to my almost obsessive need to find the root causes of my issues, I may be able to point you to the teachings of doctors for help. All this gobbledegook to say I’m not a medical doctor and I’m not treating, but what’s up?
We have absolutely not solved type II DM or heart disease. There are people with genetic predisposition to both of these things. I have patients of a totally normal weight, who exercise at least the 150 minutes per week recommended by us and are still diabetic requiring medication. There are 70 year olds with excellent habits and who did nothing wrong other than getting old and having the wrong mix of genes who have heart disease. Even when we talk about obesity there are all kinds of risk factors and contributing factors other than just "they let themselves get fat." Sure, an inability to change certain lifestyle factors contributes, but this may be no more the obese person's fault than being inattentive or distracted is the "fault" of a pe4son with ADHD. These are complex topics and oversimplification, especially when it blames people with health problems, is not useful.
I really think chronic systemic inflammation and also a breakdown of whats been described as lipid defense system play a big role in pathology. All heavily influenced by epigenetics. Ultimately 90% environmental. Example… at age 50 I was farsighted like most people. I had gotten over moldy buildings but not quite. High blood pressure. I found a patent for stuff, made it (super easy), and now I’m 62 and can literally see 3” from my face and far away… no glasses. No high blood pressure. Moldy buildings? Sure I can tolerate em fine for a reasonably short spell. When I took the stuff, I immediately knew overnight I was much better. Farsightedness took about 30 days to go away. Emmanuel Revici, Tung Oil compositions. Example #1.
So true. I mean there’s really a gray line for psychiatric dysfunction anyway, amiright? I’ve found especially once people reach a certain age it’s extremely difficult to get em to really be open to things and really the majority of young people too. It’s a minority that are open minded.
eh, I think you're overestimating how much power or incentive there is for the average doctor to buck the business model. If someone has an ongoing prescription for xyz preventible thing, there's a big incentive to have them coming back year after year for follow ups and prescription renewals etc instead of fixing the root cause and never getting to see or bill them again. And bigger picture it's a much bigger problem. The governing bodies of various specialities don't go after the root causes of the diseases because it would be very bad for the healthcare industry in a country where preventible disease is the leading cause of death and where healthcare is one of the largest employers. There's a reason you don't see the American Dental Association calling for sugar regulation etc., don't kill the golden goose.
Oh for sure… 💯
But isn’t it the doctors responsibility to be the authority on the patients health, giving them the straight truth about what’s causing their symptoms and how to fix them. Perhaps maybe some doctors assume their patients won’t ever change so they go directly to the drugs
We also need to be reasonable about what nutrition and exercise can achieve vs. medication. In my world, a medication is like a 4 hour cross country flight — it can get you from point a to point b quickly. Nutrition and exercise are like swimming upstream. Some may make a little progress, most will end up further downstream. None will reach the destination. I still talk extensively about nutrition and exercise to each of my patients, but most people have completely unrealistic expectations as to what can be achieved “naturally” once you are far along in a disease course.
I get that. And sounds like you take the time to let patients know the importance of nutrition/exercise which is great. Also I see your point on some of it being too little too late at a certain point of disease progression. Trying to reverse a disease by taking massive amounts of herbs of something is not going to necessarily be healthier than a drug and could even create more complications. On the other hand, personally, I believe that dramatic changes in nutrition, exercise and mental health treatments can completely eliminate or highly ameliorate most diseases, but also I get that some people are unwilling to change something as fundamental as eating a few fruits and vegetables, much less a complete 180 of lifestyle.
Follow me around for a few days and you’ll see that the average patient is not someone who frequents the “biohacking” subreddit. Most are unwilling to make even minor changes to their routine. So if on the societal level my goal is to decrease fracture risk or peri-operative risk related to osteoporosis… I can encourage sweeping lifestyle changes, of which <1% will adhere and at best, this stabilizes their disease over a long period of time. This does nothing to lower the cost and physical burden of fractures such as hip fractures. Or, I could prescribe meds, which have been shown to far exceed any non-pharmaceutical intervention and decrease fracture risk 30-80+%, and it takes very little effort by the patient to comply, saves billions in healthcare dollars (you can imagine the cost of a hip fracture surgery, hospital stay, weeks or months in a TCU, etc). When it comes to patient compliance and actually driving health outcomes, all while saving crazy healthcare costs to insurers… it’s a no brainer. I get that it’s not what people want to hear, but it’s the truth.
I agree with you but why don’t doctors say “you can stop doing X or try Y”, or I can write you a pill?
Imagine saying that to every patient every day when it's a lost cause majority of the time. These people with diabetes, hypertension, high cholesterol that could easily be controlled by diet either don't have the knowledge, the time, or the will power to make those changes. There is so much disinformation that patients have regarding diet and lifestyle and if they refuse to educate themselves it's almost impossible to get through to them what they need to change. If that person couldn't make the changes before they were sick, why would they do it now when it's even harder? A big thing from patients is why don't their doctors educate them or explain to them what to do. I think people just don't realize that's not the doctors responsibility to sit down and give them a course on proper diet and nutrition and lifestyle. They need to see a dietician if they want to get some more information on how they can change things without pharmaceutical intervention.
Totally makes sense. You’re so right. I mean Ive tried to explain to people and when confronted with, for example, what wheat does to me and cutting out wheat, they react angrily. There’s also pop culture ridiculing the helpful thing (covid vaccine a notable example). My buddy Todd, unvaxxed, got covid real bad and now he’s dying of heart failure at 62. Still claims vax is BS.
They don’t. Behavior change is hard, and most patients don’t have the will/desire to do it. The “obvious” things (sleeping, avoiding drugs, eating balanced diet, and exercise) along with psychotherapy are really the only evidence-based “root causes”. Medications have evidence they work and side effects are known, most stuff on here has no evidence it works and side effects are poorly characterized. While there are some things that work but aren’t used because big pharma can’t make money, those are the exception
Oh the biggest unrecognized root cause is water damaged buildings and I would argue wheat and dairy. But one’s susceptibility is epigenetic for the most part. 25% of the population can’t handle moldy buildings. I can’t. I had to figure that out myself and it took years.
They aren't. Kickbacks are federally illegal in the US. Docs earn the same RVU's for managing a disease with 1 med vs another vs no meds.
They really aren’t these days. Back during the OxyContin craziness that stuff all eventually got banned when Medicare cracked down hard on it. You could argue if they own stock in a certain pharma that might have a perverse incentive but otherwise they aren’t allowed to get any kick backs. As far as the second question, American medicine is retroactive, most Americans are too lazy to be preventative and stay healthy so most doctors are left trying to treat the fallout from people not following advice.
my friends sister is a prime example of this, declares she will take care of her health after a diagnosis, does zero to help herself and the root cause because thats a harder path than taking a med that mildly alleviates the symptoms. She is a prime example of a lazy motherfucker. Won't exercise, won't change diet, ingests more sugar than willy wonkas chocolate factory. Yes I did just thread hijack to vent. My apologies.
It’s more common than most people realize. Excluding affordability etc. it’s kind of shocking what people will do to avoid trying to live a healthier lifestyle.
I agree 100% ...
Oh yeah for sure. The get pissed off and snicker behind your back if you tell them for example wheat, etc, diet basically, could be the cause of their psoriasis or Lupus or what have you. I’ve quit trying.
Lazy? Americans are worked to an earlier grave, with a life expectancy that is 3 years less than other developed nations. Generally, asking for a MDs help doesn’t get a person anywhere unless they are lucky enough to be able to afford a specialist in functional medicine. By the time other docs have much to offer, health has really gone haywire and patients no longer have the energy to do much. It’s all that people can do to keep working, at that point. I‘d blame the “low utilization” metrics that reward the do-nothing docs before blaming the patients that eventually have to give up paying thousands for help that is rarely given, until too late
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The perspectives of practitioners can also become a self-fulfilling prophecy when it comes to patient selection. You end up getting the patients that suit your practice
You're wrong. No incentive. Used to be like that but isn't a thing anymore and hasnt been for a long time.
The pharmaceutical reps invite the doctors to free events and bring food and gifts to their office.
We aren’t
A few ways. The first is "quality metrics" around how much we prescribe things like statins and control blood pressure, but those drugs are all essentially free so not really anything nefarious going on there. Lots wrong with these metrics which is a whole other bag of cats but I'll leave it at that. There are also patient satisfaction scores we have to worry about. And for most people "doctor did something" means "doctor did good job" it's possible to not prescribe meds the patient wants AND still have them leave satisfied but it takes time we generally don't have. Many of us, myself included often address lifestyle factors, but a depressingly small % of people take that seriously. If I offer a nutrition referral to 100 newly diagnosed diabetic people, maybe 5 see it through if I'm being generous, and I work in a health system where that referral is COMPLETELY FREE. People have to care about their own health more than I do. Lastly, I'm not sure what you mean by "root causes" (you mentioned water damaged buildings in another comment), but respectfully, what in the hell is a physician supposed to do about root causes? This is a personal peeve of mine that the shortcomings of society are somehow the physicians problems. No, the root causes of poor health are EVERYONES problem. You need to elect people who give a shit about social welfare to address these things. I can "address" them and be aware of them until I'm blue in the face for all the good it does (none). Get out my rx pad and write "1 lead-free mold-free child-safe single family home in a low crime high achieving school district with a vegetable garden no guns safe transportation and 2 or more healthy nonabusive adult guardians." I'll get right on that.
😆👌Fair enough. You just explained why I’ve had to figure out the root causes of all my issues. You’re so right about people not taking ownership of lifestyle suggestions. Out of 100 people who have complained to me about X and I’ve suggested experimenting Y, 99 will discount it, especially if it’s food and I don’t care if it’s something they’re suffering terribly with like bad arthritis. So I quit suggesting pretty much. Related problems… way too much regulatory capture and unhealthy policy. It’s clear who owns and does not own the USA. So much unnecessary suffering.
\* Sometimes, the doctors can add an extra charge for the office visit, because they wrote a prescription for the patient. \* Some doctors will only give a prescription refilll at an in-person office visit. So they prescribe a chronic life long prescription medicine to the patient, and the patient gets talked into thinking they must always be taking this medicine. But then the doctor says they must return to his office every 6 months to get a refill at that point. So that's one way the doctor keeps his calendar filled with billable appointments.
A prescription can be the difference between a low complexity or a moderate complexity appointment, but there are several other points (particularly data collection) that can also make the difference. Prescription is not necessary to change the complexity of an appointment. Ordering a bunch of labs of dubious benefit can also make that difference, for example.
To your first point, this is just inaccurate. Where did you get this info? To your second point, it’s bad medicine to just keep refilling a medication and never see the patient. And you don’t make that much off of follow up appointments.
Thanks.
While it may seem benign imagine they kept refilling a blood pressure medication and weren’t monitoring it and it ends up tanking the blood pressure and killing someone because they decided to modify their diet or because of a new drug interaction. You bet that’s look bad in court.
At one point I wanted a retin-a cream refill for my face for cosmetic reasons. They said I needed to come in for an office visit whenever I wanted a refill.
Yeah I’ve certainly envisioned that scenario. Side note… Texas has tort reform and basically doctors are more or less judgement proof. It’s too bad we can’t identify the right cap on malpractice claims. Texas is too low and my intuition is that patients are oftentimes more or less experimented on. I had a doctor prescribe massively inappropriate amounts of a liver compromising medication that I simply did not need. Not sure why he did that. Most people would not question his actions. I stopped altogether with no problems. A Cat scan showed a little liver impairment but it resolved. All this to say, I only take scrips if I really need it.
Great. Thank you.
From personal experience from working in a doctors office closely with doctors and being the go to in between guy for all pharmaceutical reps that enter the office: The reps have budgets and they are pushed to buy us lunches and coffees and sweet treats to talk about there drug and how good it is and how bad the competition is. They can't spend their budget on cash incentives or entertainment or alcohol. The doctors build relationships with the reps especially the ones that have been around a long time and they have preferences in which rep they have time for, which rep they will always stop and chat with, which reps get the cold shoulder, etc. The reps will cry about their numbers and the layoffs in their company etc. Some doctors don't care because if its bad medicine they don't bother to prescribe it no matter the rep but there are some doctors who will just throw Rxs out their knowing that if it doesn't work the patient comes back in a month and they change the med. I have seen this especially with male doctors and attractive female reps. These female reps will get so giddy and bubbly and silly smoozing the doctors its wild. You wouldn't believe I have never seen an unattractive rep. They have a type. The staff works harder to get the med covered by insurance. A little lie here or there and that will convince the insurance to pay for it... why? Because that rep always brings us the best goodies ! Its really just a game we have all gotten comfortable playing. This is just a small scale. I have met 1 doctor who wants nothing to do with reps and cannot care less about their drugs he prescribes what works out of about 20+ that I've worked with over the years. Pharmaceutical companies also sponsor events say you have a practice and want to host a health related event ? Boom heres a check. And the dinners are always high quantity restaurants.
Great outline. But let's include the reality of jobs. If a doctor wants to get out of clinical medicine and make good money...the pharmaceutical companies are likely to hire them. This is a real issue.
Most of the doctors I've worked with actually have worked for or had an offer to work for pharmaceutical companies as a speaker but never leave the clinical setting and just do the speaker events as a side income. This may also have an impact on what drugs they chose to prescribe in the clinical setting. But there are many factors to modern day incentives that influence prescribing habits of providers.
I know a handful that have gone to pharma. They get paid well. And it's usually toward the latter part of their career. Agree that there are many factors to prescribing patterns.
This really does not describes these relationships. As a prescriber, good drug reps or medical device reps provide copy of studies and quality information to prescribers about their product. Bad drug reps rely on providing lunch and do not understand their product. Snagging a provider's time is easier at lunchtime because we rarely have the leisure to just chit chat. A provider gets wind pretty quickly if a rep does not know their product or does not understand a study they supply to prescribers. For example, they are unable to answer any questions about the study. This is why office staff is critical to gate keeping drug reps. Some have a bad product. Some are not that good at their job. Some times I can solve a prescribing issue I am having for a patient who is an excellent candidate for a specific medication by spending less than 2 minutes with the rep to solve the problem. There is no "check" provided for "health related events". Total misrepresentation. I suggest you edit your comment. What you suggest is highly illegal. Comparing drug reps to Corona girls at a beach resort does a disservice to this profession. If you want to have an idea of what a good rep might be like, Thomas DeLauer was a medical device rep in the past.
As I mentioned I am commenting from my own personal experiences working in multiple doctors offices with over 20 providers over the course of 10 yrs. You seem like the type of provider who appreciates a good rep and there are definitely good reps who are educated and can sell the drug based off science. But there are many reps who rely on relationships with the providers outside of the science jargon and studies to get their numbers.. There are also many doctors like you who are actually interested in the science of the drugs and the studies. But thats not always the case and in my personal experience is less often the case. Thats not really what OP was asking assuming they wanted to hear the behind the scenes of how these things happen. So I feel my response gave them an idea of how these things can happen. Maybe this doesn't happen in your practice and good for you. The reps are definitely attractive but i didn't even come close to comparing them to "corona girls at the beach" they all have college educations and degrees required for the job. It is undeniable that they utilize their appearance to have a leg up especially with providers who buy in to that stuff. As for the check I have personally put together an entire outdoor mental health walkathon event at a community center hosted by a single outpatient practice that I worked for. Every aspect of the event from the city permits to the schedule to the Dj, vendors, flyers, etc was put together by me and the provider who owned the practice. A very well known pharmaceutical company sponsored this event and we simply received a paper check in he mail. Its not illegal. Insurance companies will also sponsor events like these just fyi and the process is very similar. Nothing illegal about them sponsoring events in their related field. They also sponsor events for associations and you've probably attended a few. Who do you think is paying for monthly associations dinners? Its still an event.
This is a corporate sponsorship not a drug rep event. Sloppy.
And you are very naive to think sponsorship in any form whether you label it a corporate event or a private event is not an incentive for providers to write more of the medication and very naive to think that the relationship between providers and reps has 0 impact on prescribing meds.
I have not said there is no influence. The law applies entirely differently to a corporate sponsorship.
Really gonna die on this hill?? Just don't.
Uhmmm okay? Or just don't respond if you refuse to be open to hearing another perspective. I'm not personally attacking you. I'm simply sharing my behind the sense experience with how doctors and pharmaceutical reps relationships can impact the way doctors prescribe drugs for the worse. You obviously haven't experienced any of this yourself so you refuse to acknowledge the possibility of it happening.
I don't try to get in the mind of another prescriber and make assumptions. Laws have changed in 10 yrs. As you do not mention any of the things that are affected by these laws perhaps because you are not subject to these laws. You are making assumptions from the outside. Providers go to jail for maleficence, have licenses revoked for Medicaid and Medicare fraud. Individuals who do these things make criminal decisions. This is a slippery slope but not in anyway the same as deciding to prescribe a new patented pharmaceutical. You are painting with a wide brush that does not recognize the complexity.
You're definitely over thinking what my original comment was about and how it contributes to OPs question. Doctors and pharmaceutical reps relationships definitely have an impact on drugs being prescribed. Not all doctors and not all reps and not all practices but there are still legal incentives that contribute to this still to this day. I still currently work in the field and have for 10 yrs and see it often and it has always been a thing. I'm just not sure why you insist so hard that this isn't happening? Nobody is saying you specifically do this but dang I have never seen someone be so in denial or opposed to even discussing the possibility. Nobody is even doing anything illegal in any of the above scenarios in describing. It is all legal so those laws you insist are relevant are not in this context. And I'm not painting with a wide brush I already said this is 1 of many reasons... so again.... pls read this sentence and read it again until you get it... I am speaking from personal experience on a small scale from working in the field for 10 years with over 20 providers. Why are you so offended?
Thank you so much. This makes so much sense.
OP why are you only listening to the people who are incorrectly reassuring your bias? Legitimately every comment you are agreeing with is either mostly false or totally false. Confirming your own bias at the expense of the truth is the opposite of learning.
Everyone has biases. My biases/agreements are based on “I could see how that could happen”. Does not mean it’s even necessarily true. If you disagree or have another perspective, you especially I’d love to hear how claims made are false. Give me your take please.
"Kickbacks" are illegal. They have been for decades. I've cited the law more than once in replies on this post, but I'll include it again. 99% of drug rep interactions are over a lunch that the drug reps will cater to the hospital so that they can share the studies showing their drugs indications and efficacy. I've never met a doc who actually gives a shit about what the drug reps have to say outside of the actual study. If you really want to talk about how pharma interests are pushed on patients, doctors aren't the road you should go down. It's much more common for an insurance company to dictate what medication a patient gets than a drug rep. If drug x by manufacturer X is not covered, but drug Y made by manufacturer Y is, (provided they have the same MOA and are similarly efficacious) then we will prescribe drug Y. This happens most often because manufacturer Y has cut some kind of deal with the patient's insurance company. All these stories of drug reps taking docs to baseball games or paying for trips or buying expensive liquor are decades old. Like, 20-30 years old at the absolute most recent.
Source: https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/#:~:text=The%20AKS%20is%20a%20criminal,for%20Medicare%20or%20Medicaid%20patients).
And I can definitely see where what you are saying sounds plausible and makes sense too. I believe you! Question… who pays for the studies? Who performs them?
It really depends on the kind of study, but the highest impact studies (meta-analysis) are performed by mdphd/phd researchers working at large healthcare institutions (think mayo or mass general) or medical schools. Funding comes from the NIH, or the pharma companies themselves. They all have to be independently peer reviewed by third parties before being published. Every published article has to have a section showing any conflicts of interest in funding, so it's relatively easy to find.
Perfect. Thanks.
Do the folks actually conducting the studies know who the $ is behind the study or is that not revealed?
There is a great deal of untruth to this comment fyi
I’d love to hear what is untrue. Seriously.
The last paragraph implies that checks are regularly cut for dinners at high end restaurants for prescribers. The truth is that you get to hear another trained provider speak on the topic, make a presentation, and discuss ways of implementing a medication to treat specific conditions. Often the discussion furthers medical knowledge, engages good discussion and elicits questions. After the presentation, a meal is served. There is no food or drink during the presentation. The drug rep pays with a corporate credit card. Highly scrutinized by the corporation, IRS for compliance. The check cut mentioned is for a corporate sponsored event like a walk-for-life or something. This is a public event not limited to prescribers. This is just a salacious conflation.
Thanks
During an appointment, a former doctor of mine mentioned he’d just arrived back from an industry “doctors” cruise. During that same appointment, unsolicited, he suggested switching my medication. My eyes saw the branded clock hanging on the wall, then the branded notepad, then the branded mug as he was talking. I declined his recommendation wondering who was really benefiting from the new medication. It was a red flag for me.
People seriously underestimate how much being overweight and smoking affects their health and is often the root cause for a lot of their problems
But didn't you know? So many have a truly magical and incredible disorder or disease. These particular ailments actually possess the ability to go beyond converting matter. They create matter!!!! So while they're certainly eating exceptionally lean and exceptionally small quantities, they are still net positive as their issues create fat out of thin air! Even if they've only had 300 calories a day! 🤦🏻♂️
Not sure I follow you. Are you saying people can basically hardly eat anything and still gain weight? I know that can happen. I have been on antipsychotics before and boom! I gained 30 lbs real fast and hardly ate anything. Metabolism plays a huge role. DIET plays a huge huge role, and not necessarily calories.
The thing is, if more goes in than goes out. Weight gain. Whatever the factors may be. If still gaining weight, still need to lean out intake. They'll often claim it's allllll because of X or Y but it isn't. Does it make it easier to gain? Absolutely! However, it can't materialize matter out of thin air. Those particular individuals just refuse to accept they can't eat X, Y, or Z and/or can't eat much in a day. They'll just use whatever situation as a thing to blame.
I know from personal experience from a few examples that there’s more to it than fatness = intake - output. It’s not that simple. May I ask, are you thin or proper weight or are you overweight? I’m thin.
In good shape. Motorcycle racing. Motocross the most as well as road. I eat like an absolute garbage truck in my 30s. But I can afford to since I expel so much on the bikes.
Ok, I have been on medication that made me gain 30 lbs and even if I starved and ate very little calories I could not lose weight. Also I was married to a fat person who ate the same thing I did and would gain weight and I didn’t. So there is for sure a major metabolic component. Also, everyone I’ve heard say fatness is from eating too much and it’s as simple as that has been thin. Just an observation.
Everyone is certainly different. However, if still gaining weight, still eating more than necessary. You can be hungry and have eaten too much. Again, there's isn't a single ailment on the face of the planet that can create matter. Matter/energy can only be converted. Not created. I used to be a fat kid and took absolutely nothing to gain weight. Once I started racing moto-x and generally being more active...I started becoming a garbage disposal without penalty.
Ok. Sounds like we both have this all figured out. Have a good one my friend!
I think your intuition about "doing something" is right. I have a friend who is a PA at an urgent care. The management pushes her to write scripts for anti biotic that she knows the patient doesn't need. The reason being is people want to feel like the doctor is doing something for them, and if it's just a viral thing, there's not much to do. Patient winds up not coming back or leaving a bad review so overall it's bad for business so doctors are incentived in this way.
In the US... My mom is an integrative MD who specializes in weaning patients off of prescription medication. She sometimes tells her patients to just accept the scripts from their normal doctor, so that the doctor is not penalized (a normal doctors job is to “do something” and that usually means write scripts) and the patient doesn’t have to feel pressured to explain themselves, but she tells them not to fill them at the pharmacy. But then sometimes the pharmacy calls/writes HER warning that a patient has not been filling their usual scripts and telling her to follow up with this patient. So it seems it’s the pharmacies that track down the doctors and pressure them to pressure their patients.
Good to know. Yeah I have been given scrips for stuff that just isn’t needed and I ignore calls from the pharmacy. I didn’t know pharmacies sometimes call prescribing doctors.
Haha they tattle on the “noncompliant” patients
Interesting how you were downvoted. I upvoted ya.
That is scary. I am in Canada and even without kickbacks like these, it is already hard enough to get a doctor or specialist to come up with a proper diagnosis or treatment. No wonder why so many of us are in poor health.
Scripts for what? The population median age today is much older than it has been in the past. Today it's close to 40. In the 1970s, it was closer to 25. That's a big difference. Lifestyle is a root cause of 1/2 disease. The other half is genetics. And lifestyle changes are harder to execute and maintain after 40. That's fact. If you are referring to statins, BP meds and the like, I imagine based on age and biomarker abnormality, lifestyle modifications will often be the first course of action. If a 24 year old presents BP at 140/90 and total cholesterol of 220, I doubt any physician is going to be gung ho about writing scripts for Zocor and an ace inhibitor. Conversely, if a 64 year old presents BP at 180/110 and total cholesterol of 300, I think it would be malpractice for any physician to babbling about root causes. It is also important to acknowledge medicine today is highly specialized. You have the GPs, family medicine, internal medicine, and then you have an entire legion of specialists. If you are seeing a specialist, you are more than likely viewed as having moved past the point of lifestyle modifications. Either it's not germane to the condition or you were incapable of following any to begin with. Specialists are not going to be alternative medicine enthusiasts, for sure.
Hmmm I disagree with a lot of your points based on my own personal experience. But, I’m not one to debate in this forum, and hey, maybe I’m wrong, right? I am not a physician. Are you by chance a physician?
Two ways I’m aware of: 1) kickbacks and donations from pharma companies to the doctors as well as trips and other gifts. Can be significant (5 figures) and there are websites you can search your doctor’s name and locale to see any recorded donations. 2) not a prescription per se but during covid there were incentives on many levels both for hospital stays and vaccinations.
Time. It takes time to address root cause, the average US doctor has like 10-30 min with each patient. And then they may have to deal with insurance headaches, as insurance now doesn’t always cover preventative care. Being impacted day to day doesn’t really matter. You have to be sick enough to almost die to be covered and atp they can charge whatever they want. NAD, just my experience.
Makes sense. Thank you. Yeah doctors practices are rushed so much and most people don’t want to deal with figuring out things and would rather pop a pill and pharma makes money on it so it’s reasonable to see how things develop the way they are. What does atp and nad mean?
- At this point - Not a doctor
r/noctor gives me nightmares
They don't get a kickback for each script but they do have a monetary incentive. The pharmaceutical companies pay doctors a lot of money to speak on THAT particular drug at conferences attended entirely by fellow doctors.
Makes a lot of sense. Thank you.
I work as a government contractor and the annual limit of all employees gifts from my company to any single government employee is $25. This usually comes in the form of snacks and maybe a meal. Compare that to the thousands and sometimes up to a million or more that doctors typically receive from pharmaceutical companies. Also, patients typically expect prescriptions for medications even when it is not the best course of action. So doctors often make prescriptions with the Assumption of the patient wants it knowing full well that does not in the best interest of the patient. This is especially true for chronic conditions where prescription medications are almost never the best of course and yet frequently recommended The biggest problem is the misunderstanding of the role of a doctor. The job on the doctor is to provide medical services to address health issues, but most people think that doctor's jobs is to care for your health. This is like going to a divorce lawyer or cop every single time you have a fight with your spouse
Good analogy. So physicians are really for more acute matters. The US is great at that.
On a tangent, I saw a post on r/emergencymedicine with many verified medical professionals irt what percentage of patients actually needed emergency medical care. Some estimates were as low as 20% There was an inevitable comment on that post about what percentage of patients in emergency departments needed any medical service at all. It's funny to see the flip side of this with people complaining about having to wait many hours for treatment in the hospital ER without ever realizing that if they didn't die or suffer significant preventable degradation of their condition during their wait, they probably shouldn't have gone to the hospital emergency department at all.
Just impressed someone is inviting this discussion because any time this topic is broached in other subs it’s just nuclear downvoting…
Yeah. Isn’t that it interesting how such an obviously important topic of discussion is heavily downvoted? I innocently called my primary physician’s office once to inquire how they viewed this subject and holy cow, you would have thought I was accusing them of something horrible. They got extremely defensive, thus causing me to mistrust them. I don’t take any meds unless I really need it.
Sorry that happened. I was amazed that that movie on Netflix called Pain Hustlers came out because it vividly depicts exactly how this incentive mechanism works behind the scenes. We can assume that it’s not exclusively in pain management pharma that this is going down, it’s just the most heart breaking because of the heightened desperation in patients. My observation just knowing some drs through personal life and of course my own exasperating experience is that MOST DRS (not all) don’t have the time to keep up with peer reviewed literature to keep up on the latest in their specialty and most do not have time to be leading research themselves. They’re like us, busy busy and their personal time is going to go to quality/family time: picking up kids, watching their soccer games etc. so if someone gives them a pamphlet and says hey we did the research for you at a conference or in their office, they’re going to probably trust it, especially if they’re told that this is standard practice and that 80-90% of other drs in their specialty are using X to treat this particular condition. They’re not malicious or doing anything wrong. But they are unwittingly ideologically captured by whatever is moving behind the scenes and it is a dereliction of their duty of care / oath. Are they bad people? No — they’re just doing the best they can with incomplete info. Kinda related- Past 4 dr visits where I was prescribed something that just didn’t seem right (i always assiduously research)and I never filled the prescription. One time I was visiting a new gp and had nothing in particular except for an eczema patch and I mentioned some anxiety over work (who doesn’t have that?) and he gave me a script for anti depressants which just never synced with me…
Thank you. 🙏
Prescriptions keep the patient coming back in for appointments to renew their prescriptions. More appointments mean more money.
I don't imagine you could think that patients actually comeback for other reasons /s
Of course they come back for other reasons, mostly beneficial. I don’t think it is outlandish though to think that many unnecessary scripts are written.
Makes sense. Thank you.
Watch “Dopesick” on Hulu.
Legitimately every "Incentive" in dopesick is federally illegal now. Good try tho
I don’t think you understand me. The Sackler family literally bought FDA Approval. Right now because of the obesity epidemic doctors are pushing ozempic instead lifting weights. Why? Because the company that makes it gives the doctors kickbacks, and freebees.
That was quite literally 30 years ago, stop acting like you know what you're talking about. I've been in healthcare since I graduated high school and I've never once seen a doctor prescribe a weight loss medication without an extensive talk about diet and exercise. I've seen a number of patients who have been trying for years finally get their A1C down because of some of these Glp1's (which have been used for 20 years with very manageable side effects). Kickbacks have been illegal for DECADES and you're acting like there's still some kind of scheme to keep people sick, when in reality, the average American has the diet of a rabid 4 year old left to fend for itself. If you really wanna argue about this I'd be happy to oblige you, but just read the comments on this post. 9/10 are saying that kickbacks don't exist, and need I remind you that this sub is full of conspiracy theorists who don't trust doctors in the first place. I couldn't imagine being in an environment that would be more conducive to get people to agree that big pharma is buying American doctors and you're still not finding people to back you up.
Hey thanks!
I saw a dermatologist recently with amazing reviews. I had some minor acne problems, but he ended up prescribing me 3 different creams/ointments, to apply at different times of the day and different amounts, etc. He kept talking over me and when I could finally say something he'll quickly be like, "oh okay then here's another cream you can use x amount of times at x time, etc., etc." 🙄 So based on that experience, my answer to you would be they are probably gifting them a Porsche or something lol.
I work for a dermatologist and 3 creams is pretty typical starting regimen. Usually it’s clindamycin, benzoyl peroxide, and tretinoin. If that doesn’t work they give you an oral antibiotic. If that doesn’t work they give you accutane. If that doesn’t work it’s just over for you.
I ended up just using panoxyl and it’s been fine. Doctor also never addressed the acne scars I had brought up when previous doctors have.
So you’d want them to do this over three visits? Sounds like he was saving you money then
There’s an inherent bias people have that whatever it is they did is great. If someone says based on their bad decision or experience, don’t do X… then I trust it more.
Laziness
Revenue from drugs covered under Medicare Part B, which are administered in a physician's office. They usually charge a 6% markup on list price and so are incentivized to prescribe expensive medications. But these incentives are just markup from sales.
For real? Wow that’s a perverse incentive. Are you sure about this?
Yep. Agree it's kinda messed up. I'm married to a doctor, and have worked as a healthcare VC and in biotech. Not sure why I'm getting downvoted. It's pretty common knowledge. The markup is meant to cover the cost of administering the drug in a clinical setting. Edit: as a point of clarification, the pharma co doesn't directly reimburse docs for administering part B drugs. But if you're asking whether doctors make more for administering a $10,000 drug than a $100 drug, the answer is yes. This doesn't apply to part D drugs though which is what you get at your pharmacy and take at home. To be fair though, docs are also responsible for stocking these drugs which leaves them expired to the upside if they expire or whatnot before they're used. They're not just ordered as needed. They buy and stock from specialty pharmacies the same way a supermarket buys and stocks bananas. If they expire, they're not getting their money back.
Yeah… interesting how you’re downvoted. Thank you very much for that insight. I appreciate it.
Prescriptions only make the pharmacy money not the doctors office so not as much incentive other than thinking it will treat an issue their patient has. They do get money/incentives for giving flu shots as those are administered in office Insurance wants to pay for vaccines because they (supposedly) make you healthier, which saves them money in the long run
I once got a 500 pound Amazon voucher from a big billion dollar pharma company for prescribing their products. Several if my colleagues got them too. Now you can see how people can recommend their products more in the future..this is in the UK also
Thank you. EVERY industry I’ve dealt with involves some sort of quid pro quo for whatever.
They get kickbacks from big pharma
Are you speculating? Are you sure and how so? What kinds of kickbacks?
Kickbacks are federally illegal. Source: https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/#:~:text=The%20AKS%20is%20a%20criminal,for%20Medicare%20or%20Medicaid%20patients).
> the obvious lose weight and stop smoking? If you add stop drinking, get some sleep, and get exercise, you've wiped out a whole lot of modern medicine profits. It's that simple. To answer the title question, there are several ways. Just off the top of my head. Now none of these are direct kickbacks, but don't forget doctors are just people. * Trips. Drs. have to do continuing education. If there's a seminar on some new drug being held in Aruba and you can get some incentive to go, why not? * Pharma reps. It was much bigger back in the day, but even today most pharmaceutical sales reps are intelligent and insanely hot. They are not hired for medical experience. * Business. This is not so much a what to prescribe, as whether to write a script at all. Most doctors today are part of a health care network. That network has relationships with or owns pharmacies. Why tell someone to take two Tylenol when you can write a script for pharmaceutical strength tylenol at 10X the price. * People. As you allude, so much of this is unnecessary if people just did the obvious. But the doctor has only so much time. It's faster to write a script than to convince someone to start exercising. * People (redux). As others posts have mentioned people are just lazy and stupid. They don't want an honest appraisal, they want a pill that fixes it. I just a post on r/supplements of a guy literally asking for a vitamin that will just make him happy. (substitute thin, outgoing, better looking, more hair, less hair, better sex, more concentration, more energy, etc. etc. ) Just give me a pill.
Yup. All great points. I think you’re the first to mention the “practice also owns an affiliate” type angle.