Yes, there are some shocking behaviors being noted in great numbers of doctor’s offices. It’s an ongoing problem and these ethical lapses could impact your care and, most certainly, your pocketbook.
This contributor happened upon an AP article about drug and medical device companies paying off doctors to use their products. NOOOOOO! REALLY???? And the Associated Press has just now been made aware of a fact that has been at the core of an embarrassing number of medical practices since, h’mmm, drugs and medical devices were created and invented? Yes, kindly old Doc Fixemup has been on the take since his third year out of med school.
The story names research grants and travel junkets among many sweeteners to get practitioners to prescribe a certain drug that may be way down the chain in effectiveness for what ails you. The favorite reward of drug company influence-peddlers still appears to be the old reliable cash under the table, another way for the wealthy to avoid taxes. In-kind gifts and services are also identified in the write-up.
The AP uncovered the sleaze as part of an “Open Payments” initiative required by The Patient Protection and Affordable Care Act (ACA). The ‘dirty money’ total the government came up with was the $3.5 billion siphon off the top of the medical care heap by no fewer than 546,000 doctors and 1,360 teaching hospitals. With the Henry J. Kaiser Foundation count of just under 900,000 practicing physicians in the U.S., that’s an extraordinary number for a supposedly ethical industry. And that $3.5 billion represents a mere five-month collection of numbers, not to mention what have to be guesstimates of the brown-enveloped cash. I’d put the yearly total at close to $12-15 billion.
Most doctors take a form of The Hippocratic Oath that’s supposed to make them behave themselves. The oath dates back to the 5th century BC. It is an interesting moral and ethical imperative. Written by somebody (scholars can’t agree), the original oath, a current modern-day shadow in its endless variations, had something for everybody. It is also mostly ignored by the modern-day medical community, especially in the area of euthanasia.
The recently deceased comedian Joan Rivers is but the latest example of docs technically violating the oath when permitting the family to call for the end of life support. It’s perfectly legal but antithetical to the words of the oath, “Nor shall any man’s entreaty prevail upon me to administer poison to anyone, neither will I counsel any man to do so. Humor me and allow me to call ‘cutting off all paths to continuing existence’ the parallel to “administering poison.”
Doctors will deny this, but cutting off life support, whether mechanical or continued life-extending treatment, has been an integral part of their professional regimen for many, many decades, oft-times without family involvement. It would take the speediest of computers to count the number of times end-of-life decisions have been made when that life could have continued for perhaps weeks or even months longer. There might also be a question as to whether another tenant of the oath was violated in the River’s case: “I will take care that they suffer no hurt or damage.” Authorities are still looking into this one.
Politically, there’s something for the conservative side of the ledger in the original and updated oaths. For the anti-abortion adherents from 5BC, “Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.” This was later upgraded to “utmost respect for human life from its beginning.” Different translations of the oath yield slightly different wording from different sources, but the meanings are the same.
Then there’s the original oath’s tacit permission to join the top 1%: “If I faithfully observe this oath, may I thrive and prosper in my fortune and profession.” Forbes says 22% of docs are already members of that ultra-exclusive one percentile club.
Apparently, the high-powered pharmaceuticals and medical device makers had not yet begun their docs’ door prowling back in 5BC. There’s very little that directly addresses trips to Cabo or an extra 50 thou a year for serving as a “consultant” contributing little to no consulting other than the phony title.
There’s one other factor to take into account. I think I’ve mentioned this before, but visit any state capital or Congress and see how many staffers in the offices of male representatives and senators are young women. The same holds true in the pharmaceutical and medical device sales industries. Young women abound, and it would appear, as a sad fact, that if you don’t have at least a Miss Armadillo, 2006, on your resume, your chances of catching on with a biggie drug company are lessened.
Purty girls! Business sexism or a cold business calculation? I’m guessing mostly the latter, as the bosses do the math that just getting in the door can be a challenge and that, once inside, Dr. Fixemup will see an attractive young lady as more difficult to say ‘no’ to, than an older, slightly paunchy bald guy, 160 IQ notwithstanding. Make no mistake, these comely young ladies have to have some pretty pronounced smarts as well. Talking advanced drugs and devices takes a fair amount of technical medical knowledge. I’m just sayin’!
There’s little about ethics in the Hippocratic Oath of long ago. The closest would probably be, “Further, I will comport myself and use my knowledge in a godly manner.” I would assume that would include ethical behavior, though ‘godly manner’ has been assigned a whole new definition by one of the major political parties of today.
The most modern version of the oath appears to be from the year 1964. Perhaps I’m missing something, here’s where you can find it and read it for yourself. I read it several times and looked in vain for any references to money under the table, Cabo and buying off a doctor. Maybe there’s some subtle symbolism in the wording. If so, let me know.
There is also the “Declaration of Geneva” oath created in 1948 by the World Medical Association in response to Nazi atrocities. The following pledge could be construed as having an ethical component: “I will maintain by all the means in my power, the honor and the noble traditions of the medical profession.”
Bottom line, about half the docs can be had. And the mischief goes beyond the AP topic du jour. Physicians, whether individually or as a group will buy sophisticated diagnostic equipment and then insist you need the device for further testing. That may or may not be true, but the doc prospers either way.
Shocking!
Raised rural & small town, then lived in N.Y., Chicago & LA. Widely traveled. Returned from world wandering to pursue media life of anchorman/reporter and major, medium and small market talk radio. Highly active in politics. Once worked as orderly & security in Mens Lock Ward for the Criminally Insane at a state institution. Much more rational population than current Teapublicans. Great concern for country run by and for the extreme wealthy. The inhumane current running through this country has no precedent in modern history.
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And then there’s shock-reporters, who try to roll legitimate info on the corruption big pharma has brought into doctors’ administration of care in with topics like euthanasia and abortion, and claim it’s all disgraceful. I understand that if you very rigidly interpret the Hippocratic Oath these practices seem to violate it; however, just as money under the table for drugs didn’t exist back then, neither did our current understanding of bio-science and the extreme methods used to keep a body functioning. Perhaps the Oath needs modifying, yes; but to insist on rigid literal following in those areas is like insisting you should dig a hole and crap in your yard as the Bible says, as though nothing has changed since then in sanitary practices.
Hey its the free market. The only way to curb these abuses is Medicare for all.
I am in the VA system and from my experience they don’t push expensive drugs on you to line their pockets because they are on salary. Maybe that’s why the AMA oppose any socialized medical care
You’ve mixed up a lot of good with a lot of bad, and threw it out there like its all bad, all corrupt, all the time. That is an astoundingly naive attitude to take. Big Pharma is a case study all its own, agreed, but they also do a lot of good for a lot of people. Those ‘free’ drug samples are often saved for the people who can’t afford to get them any other way. In addition, most of these companies have hotlines/programs to get the meds to the poor.
You’ve described ‘pulling the plug’ as a violation of the Hippocratic oath, but say nothing of the massive violation of the Hippocratic oath when these people were assaulted with drugs/equipment to artificially sustain a ‘life’ that is already gone. Unless you’ve cared for people in this extremity or seen a loved one go through this, you can’t understand just how horrific this is.
Your flippant, juvenile approach to this is jarringly insulting, and betrays a total and willful lack of understanding about any of this.
Even in private practice, the patient’s insurance plan dictates which drug can be prescribed.
NPR did a bit on this Monday, that was factual and not hype like this article.
DJ,
My husband has the most attentive and caring MD in the world through Nashville VA. The fact that this physician is a USMC Colonel and a native of Canada may have something to do with it – he hates the American HC system due to the prices and general mismanagement, but he is constantly on the Hill lobbying for VA dollars. This doctor treats my husband as though he is a family member; even emailing him when he goes overseas to treat people in war torn countries. It is about the patient and medicine with him. He works tirelessly and is brilliant with his chemistry in prescribing medication, ever conscious or the price of medication. This doctor retired from Vanderbilt recently to devote all of time to the VA patients. Nashville VA and Vanderbilt are next door to one another in Nashville.
In short, my husband receives the VA care and treatment all Vets should receive and all Americans should receive, and I am certain he would smack anyone trying to give him a bribe.
Too bad mor…
Are you saying that doctors are also human beings and a vulnerable to the same faults of greed and power as anyone else? How shocking!
That’s not saying unethical behavior should be condoned. But to pretend this is a new thing would be using it to promote readership, hardly ethical in itself.
Sorry, Charlie, but pulling the plug is a lot better than having medical procedures that prolong your life at the expense of quality. I’ve had relatives drag their deaths out for months in pain, agony and empty savings accounts all to die in the end owing lots of cash to the medical profession.
By the way, no one pulls the plug unless they have a DNR or no extra methods to prolong their life directives.
I have a DNR and specific instructions to my family about end of life decisions and I expect the doctors to honor my wishes. You can call it a violation of their oath but it means to me that I can exert some control over my death and go out with some dignity.
My husband has been hospitalized frequently in the last 3 years.
Every time we hit the ER, the ‘doctors’ latch on to the amount of pain meds he has to take. He was held captive by drug lords during Iran-contra and abandoned by the government.
They ignore the problem in hand and gallop off to detox him from his PCM’s regime. They look at his hair and skin (Apache)and his occupation(blues musician) and assume he is addicted to his meds.
Typical scenario: He is currently in the hospital for complications following surgery on his foot.
The first they did was radically cut his pain meds because they were not helping relieve pain in the foot. They are not taken for post-surgical pain, but Hey! DEA rules! So he gets to go through involuntary detox while the cause of the foot pain is ignored.
McMedicine is killing him. McDs are tools of the McDEA. Medical neglect – it’s not just for the poor and women any more!
Our local hospital encourages people to prepare and submit DNR forms. I do not think that obliging the specific wishes of a dying person is a violation of any other person’s oath. It’s a greater violation to force a dying (or, an all-but-legally dead) person to be kept alive by machines at great expense against the person’s explicit wishes. And I don’t think that Joan Rivers’ daughter’s decision to abide by her mother’s wishes should be criticized. She did what I certainly hope any child of mine would do in a similar circumstance.
Sure got some folks stirred up. These are AP and ACA stats, not mine. Docs and pharma folks, writing in under nom de plumes, are welcome to call me any names they wish. Bottom line, the ‘plug’ has been pulled routinely for decades and if you read the story, you’ll note I called it “perfectly legal” in it’s current form.
Pharmas and med device makers gift docs with assorted “inducements” and that’s the nature of the business for a goodly number of practitioners. At least that’s what AP and the Obama administration claim.
Here’s the opening AP paragraph that set the stage for my story: “From research grants to travel junkets, drug and medical device companies paid docs and leading hospitals billions of dollars last year, the government disclosed Tuesday in a new effort to spotlight potential ethical conflicts in medicine.” That’s ABC News quoting the story.
The AMA needs to get more excited about this instead of intentionally limiting the number of med schools to keep earnings high.
FeddedUp, You are so correct about End of Life Care. The Hippocratic Oath has nothing to do with that, except for the fact that the measures to keep the “life” sustained are likened to torture until the stink of death sets in. As a retired RN, I can tell you that I have seen that happen many times. When a person is BRAIN DEAD, THEY ARE DEAD! Bodies on “life” support with no brain activity are sustained by machines and drugs that stimulate heart muscle. Stopping that, and ALLOWING the natural process of death to take place, often in minutes, is NOT euthanasia. There have been a number of instances where someone MIGHT have awakened, but you can bet your bottom dollar that there never was the SMELL OF DEATH emanating from that awakened one.
To clarify my previous posting…Euthanasia is the act of specifically causing a person to die, usually by some kind of substance which is ingested or injected. The difference in pulling the plug after brain death has been unequivocally established, is, the Person is dead already, and pulling the plug allows the rest of the body to finish dying. That is NOT euthanasia. Euthanasia=causing death. Pulling the plug=allowing the body to finish dying.