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Physicians and bribery: a closer look at this common medical industry practice

Thursday, July 07, 2005 by: Dani Veracity

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In 2001, 2.8 billion prescriptions were filled in the United States for an average of 9.9 prescriptions per person. This statistic taken from Ultraprevention, by Drs. Mark Hyman and Mark Liponis, certainly supports their point that "drug industry prescriptions have gotten far out of hand." The overabundance of prescriptions isn't because of a rise in illnesses or the availability of new drugs that effectively and safely treat chronic diseases; rather, it is because of the corruption of mainstream medicine. The philanthropy that was once present in modern medicine has been replaced by a love of money, which gave rise to an elaborate system of bribery, conflict of interest and deception.

How does your doctor decide which medications to prescribe? Is the decision based on the first-hand testimonies of other patients? Is the decision made after a careful and thorough research of medical journals? Usually not. As Michael T. Murray explains in Natural Alternatives to Drugs, your doctor's decision has nothing to do with medicine: "Most physicians do not make decisions about which drug to use on the basis of scientific research or cost. They base their decision almost entirely on which drug is the most popular choice of their colleagues.

What determines popularity? The effectiveness of the drug company's marketing and advertising efforts. In essence, doctors are often bribed or lied to so that they will prescribe certain medications." Bribery is a danger in any business sector. In medicine, bribes can prove downright deadly; nevertheless, they are shockingly common.

How would you like a bonus of $100,000 per year on top of your already outrageously high salary? Wow, that sounds like a dream, doesn't it? Well, for many doctors, obtaining a bonus of that amount is a reality. These days, the majority of doctors have dived right into the "deep waters of entrepreneurship, where there is always the danger of conflict of interest between patient care and making a buck," as Martin. L. Gross phrases it in The Medical Racket. Entrepreneurship has turned the medical industry into a giant game, where patients serve as the chips, their lives the bets, and jackpots are won by doctors, hospitals and pharmaceutical companies.

At times, the bribes are obvious, such as when pharmaceutical companies send physicians on exotic vacations in exchange for listening to lectures about the companies' drugs for a few hours of the day, while the rest of the day is quite literally a day at the beach (or the golf course). The ways in which some hospitals bribe physicians are especially sickening, according to Professor Ann Blake Tracy in Prozac: Panacea or Pandora: "Did you know that some hospitals offer special incentive deals that give doctors valuable gifts like fax machines and car phones, if they schedule surgeries when the hospitals are hurting for business?" Incentives belong in car dealerships, not in doctors' offices.

Sometimes the corruption is not as conspicuous; it could be a matter concerning conflicts of interest. "Conflicts of interest are institutional weeds. They take root below the surface and become pervasive problems often long before they show their ugliness," Dr. Jerome P. Kassirer quotes an "observer" as having stated in his book, On the Take. Now, what are these conflicts of interest, and are doctors really so susceptible? Dr. Kassirer asks a few questions in order to determine the severity of this subtle corruption: "Have the fees that physicians charge given them an incentive to bring patients back to their offices too often, or to order too many tests that aren't needed? Or have they skimped on tests if ordering too many shrinks their paycheck? Are they more inclined to order certain expensive drugs or promote certain products because of personal financial relations with some of the drug companies, contrary to patients' best interests?" The answer to all these questions is, unfortunately, yes, which signals the existence of a pervasive level of corruption.

Now you know why doctors' prescriptions follow trends and why the whole world seems to be on the same drug at the same time. Now you know why so few doctors prescribe alternative medicines for their patients: Nature doesn’t offer bribes.

One big question, however, remains unanswered: How can doctors accept these bribes and look in the mirror afterward? According to Dr. Kassirer, it's all a matter of self-deception: "Physicians know that pharmaceutical companies don't provide these services simply out of altruistic motives, yet they are eager to believe that they can preserve their integrity in the face of such bribes. How then, do they cope with the gross discrepancies between the knowledge that they are being bought and their need to believe that they cannot be bought? Disavowal probably explains much of the mechanism of self-deception. Whereas avowal is a capacity to identify one's true thoughts and motives, disavowal aids self-deception by evading these motives." In other words, corrupt doctors actively try not to question themselves about it, thereby perpetuating their state of self-deception.

Physicians may not overly concern themselves about the bribery they allow to take place, but we as consumers must. Gross asks, "What could be better than stopping the waste of $100 billion (at the very least) in medical, dental and pharmaceutical fraud, and using the money for any good purpose, including lower federal taxes for all? And in the process, cleansing the stain that dishonest doctors have cast on the profession and, by extension, on their honest colleagues?"

Ask yourself that same question. There is no downside to stopping medical corruption right here, right now.

The experts speak on physicians and medical corruption:

"Physicians: Dishonesty"

The competition was fierce, and the hardest-fought battles took place in India's largest cities, where physicians practicing all traditions of health care went after the hearts, minds, and rupees of the growing middle class. By 1994 it was glamorous to be an antigovernment physician who decried the stupidities and corruption of state and federal authorities. It was fashionable to declare as lies most government public health declarations. And intra-physician competition often echoed this antiestablishment theme, making the most outrageous of "physicians" chic among the middle and upper castes.
Betrayal Of Trust By Laurie Garrett, page 32

Analyzing why there is so much medical error Leape acknowledged the lack of reporting. Unlike a jumbo-jet crash, which gets instant media coverage, hospital errors are spread out over the country in thousands of different locations. They are also perceived as isolated and unusual events. However, the most important reason that medical error is unrecognized and growing, according to Leape, was, and still is, that doctors and nurses are unequipped to deal with human error, due to the culture of medical training and practice. doctors are taught that mistakes are unacceptable. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. We can see how a great deal of sweeping under the rug takes place since nobody is taught what to do when medical error does occur. Leape cited Mclntyre and Popper who said the "infallibility model" of medicine leads to intellectual dishonesty with a need to cover up mistakes rather than admit them. There are no Grand Rounds on medical errors, no sharing of failures among doctors and no one to support them emotionally when their error harms a patient.
Death By Medicine by Gary Null PhD, page 10

Despite what many doctors think, vitamins and minerals are not something invented by the health food industry; they are part of our biological system. Without them all life stops and you die. Vitamin and mineral deficiencies can often lead to disease, and you do not have to be embarrassed about taking vitamin and mineral supplements. The medical and scientific literature supporting nutritional supplements is extensive and goes back over a hundred years. I know many doctors who religiously take supplements themselves but will not recommend them to their patients because of fear of being ridiculed by their colleagues. This is intellectually and morally dishonest.
Health And Nutrition Secrets by Russell L Blaylock MD, page 36

I am not implying that those who review manuscripts are corrupt or even conscious of their bias. Nevertheless, doctors and scientists who are interested in nutritional medicine almost invariably complain about how difficult it is to have their work published in "peer-reviewed" medical journals.
Preventing And Reversing Osteoporosis By Alan R Gaby MD, page 250

Despite the obvious corruption of the drug company/doctor marketing connection, I don't blame the drug companies, the detail men, the government agencies which are supposed to police these activities, or the patients who badger their doctors for drugs. doctors have enough facts in their possession to know what's going on. Even where the drug is fully tested and the side
The Aids War by John Lauritsen, page 272

"Physicians: Corruption"

After all, I am not talking about overt corruption such as fraud, bribes, office-buying, or kickbacks. Yet what we are concerned about is equally problematic, far subtler, and largely hidden from sight. One observer commented: "Conflicts of interest are institutional weeds. They take root below the surface and become pervasive problems often long before they show their ugliness." The weeds in this case expose physicians to powerful temptations to make money at the expense of their patients' welfare. Aside from harm to patients, conflicts of interest may be subconscious and as such can undermine judgment and integrity and lead to self-deception.
On The Take by Jerome P Kassirer M.D., page 52

...he and his colleagues receive funds that allow them to spread their educational message to thousands of physicians. Dr. Libby believes that despite the drug-company support of these efforts, strict adherence to published guidelines in creating the content of the sites, multiple layers of peer review by experts, and assessment by his audiences preserves the objectivity of these programs. By disclosing all his financial conflicts of interest and by being involved with so many companies, Dr. Libby believes he can maintain his independence, objectivity, and reputation as an opinion leader in his field.45 The involvement of these high-level academics in such ventures is open to various interpretations. Dr. Libby asserts that they simply exploit a corrupt system in a way that benefits patients. Nonetheless, to me these relationships between the academics and the companies (which may include providing advice about drug marketing) are too close, too collaborative, and too cozy. They generate income for some of the participants and thus induce some obligation to advocate for the company in unseen ways.
On The Take by Jerome P Kassirer M.D., page 104

If Dr. Horowitz is correct, then allopathic physicians in this century knowingly participated in an unarguably evil enterprise of medicalized killing that is not much different from the corrupt heart-rendering Mexican Mysteries of an older, equally sinister America.
Physician by Richard Leviton, page 524

Many doctors are paid by Eli Lilly and other drug companies to do drug studies for them or they are affiliated with a university or hospital which do these studies. The "don't bite the hand that feeds you" philosophy plays a major role in their defending the safety of Prozac. Are the incentives being offered to them by Lilly to prescribe this drug so great that they feel it is worth "selling out" their own patients? What is it? Have they become totally irrational themselves from their own personal use of Prozac? We are aware that doctors in general have on of the highest rates of prescription drug abuse. Just how serious is the abuse of these mind-altering drugs among the individuals we are trusting with our lives? Psychiatric nurse, Joyce Strom-Paikin, puts her license and credentials on the line to fight the "conspiracy of silence" that exists in the medical profession with the use of drugs by doctors and nurses in her book, MEDICAL TREASON. She feels this is a practice which "threatens to corrupt the profession and cost lives of many patients." In defence of physicians it should be stated again that they receive very little training in medical school on the use of drugs. Our entire system is in desperate need of revamping.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 176

Sometimes physician chicanery is the result of doctors entering the deep waters of entrepreneurship, where there is always the danger of conflict of interest between patient care and making a buck—too often a quick, dishonest buck.
The Medical Racket by Martin L Gross, page 112

Unscrupulous pharmaceutical companies, corrupt government officials, venal physicians, stupid and cowardly media people, incompetent and dishonest researchers — none of these things are new. They are business as usual. Where, then, does the buck stop? Who is responsible for pharmacogenocide?
The Aids War by John Lauritsen, page 272

But we couldn't disagree more. Good news? That more and more people are spending more and more of their money on drugs they don't need? In 2001,2.8 billion prescriptions were filled in the United States, or an average of 9.9 per person. We think that drug industry prescriptions have gotten far out of hand. Doctors have been bribed and brainwashed by pharmaceutical companies to prescribe new, expensive medications for every ailment—even when a
Ultraprevention by Mark Hyman MD and Mark Liponis MD, page 76

Of course, other professions don't police themselves so well either. How many unethical lawyers are disbarred? How many corrupt judges are removed from office? How many check-kiting legislators are impeached? And how many incompetent public school teachers are fired? There is a lot of room for more policing of the professions. Maybe methods used against doctors will be tried in your profession next.
Your doctor is Not In by Jane M Orient MD, page 193

The politically feasible course is to subject physicians, clinics, nursing homes, suppliers of medical equipment, and other providers to the same law that is used to wage war on drug dealers or Racketeer-Influenced Corrupt Organizations (RICO). The RICO law provides for civil forfeiture of property.
Your doctor is Not In by Jane M Orient MD, page 200

"Physicians: Bribery"

Most physicians do not make decisions about which drug to use on the basis of scientific research or cost. They base their decision almost entirely on which drug is the most popular choice of their colleagues. What determines popularity? The effectiveness of the drug company's marketing and advertising efforts. In essence, doctors are often bribed or lied to so that they will prescribe certain medications.
Natural Alternatives To Drugs by Michael T Murray ND, page 25

If the drug company didn't expect the gift to influence the doctor's decision, why would it give the gift? According to a 1992 article published in The New England Journal of Medicine written by Douglas Waud, M.D., the term gift should read bribe. A gift implies that no strings are attached. Dr. Waud criticized the American College of physicians' and AMA's guidelines because they seem to recommend that
Natural Alternatives To Drugs by Michael T Murray ND, page 25

When I was editor of the New England Journal of Medicine, I published an opinion piece by Dr. Douglas Waud, a University of Massachusetts professor of pharmacology entitled, "Pharmaceutical promotions.. a free lunch?" Waud asked: "So where does one draw the line? I suggest that we simply not be on the take, whatever the amount or context. I do not like the idea of a monetary limit on bribes (unless it is zero). Nor do I see the subsidization of education as appropriate. I believe that physicians can buy books and attend meetings without fear of landing in the poorhouse. I also don't buy the argument that asks, Would you be willing to have these arrangements generally known? My motivation comes from within, not from a fear that the Boston Globe may be looking over my shoulder."
On The Take by Jerome P Kassirer M.D., page 65

[The internist] noted that your .. presentation .. created an emotional response among the physicians greater than any he has seen in the past two decades. This doctor was insulted by the implication that physicians can be corrupted with trivial gifts or free meals. In fact, since the intent of the drug-sponsored dinner lecture is clear at the outset (i.e. pharmaceutical marketing), sitting through an obvious marketing lecture was considered by this physician as appropriate "payment" in kind for the meal. I thought that the most interesting of his remarks focused on the context of pharmaceutical marketing to physicians in the greater world of business practice in this country. This physician asks why we, as physicians, agonize so much about the ethics of what are standard business practices in other industries. Sky boxes at sports arenas, high-priced restaurants, and luxury hotels all survive as means for providing business to business perks. Even the IRS recognizes the validity of "business entertainment" as a standard part of doing business by allowing travel and entertainment as tax deductions. This physician asks whether fast-food advertising in elementary schools (to an unsophisticated audience) is any more ethical than giving medical students medical instruments. Since we, as physicians, are not being treated by payers as professionals but only as line "providers" of health care services, why should we hold ourselves to values different than any other businesses?
On The Take by Jerome P Kassirer M.D., page 66

The ultimate drug company "bribery" is sending an M.D. on an exotic vacation and including CME courses along with it. The physician spends a few hours a day listening to lectures on how to prescribe the company's drugs and the rest of his time on the beach or golf course.
Prescription Alternatives by Earl Mindell RPh PhD and Virginia Hopkins MA, page 13

Doctors Borison and Diamond pleaded guilty to the theft, bribery, and racketeering charges brought against them by the Georgia Attorney General. They were each fined $125,000 and were sentenced to prison. At the time of their highly publicized indictment, Eli Lilly pulled all studies still in progress with Borison and Diamond, reassigning them to other centers. Regarding the many studies the pair had completed over the years for Lilly, however, a spokesperson said the company was confident that none of the data provided was compromised in any way. But Dr. David Hess, chief of neurology at the hospital where Borison was the chief of psychiatry, told investigators, "This whole thing was very dirty. It was basically a numbers game. These patients are purely used for the greed of the researchers.. [It] was very apparent to me what was going on." While some insist that the repeated exposes are not representative of the testing of psychiatric drugs, others note that many of the most disturbing practices highlighted in the exposes—such as the exorbitant sums of money involved, employing staff with little training or clinical experience to evaluate patients, and advertising for subjects rather than using real patients coming into doctors' offices seeking treatment—are not uncommon in psychiatric drug testing.
Prozac Backlash by Joseph Glenmullen MD, page 211

...shocked to discover that their doctor's advice could be colored by less than virtuous motives. You're supposed to believe that everyone in the medical community is in it purely for humanitarian reasons. If you believe that, just try to see a doctor or check into a hospital without flashing your insurance card!.Did you know that some hospitals offer special incentive deals that give doctors valuable gifts like fax machines and car phones if they schedule surgeries when the hospitals are hurting for business?.If your doctor is prescribing a certain drug for you, wouldn't it bother you to know that the makers of the drug may have offered him a free trip to New Orleans in return for his patronage? Drug companies regularly bribe doctors with free drugs, dinners, trips and even cash."
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 235

The Veterans Administration had been dispensing research money for several years as a sort of bribe to attract doctors despite the low pay in government service. The money from Washington was doled out by the most influential doctors on the staff, not necessarily the best researchers, but I still felt I had a good chance because the VA was having an especially hard time recruiting orthopedists. …
The Body Electric by Robert O Becker MD and Gary Selden, page 70

Kickback scams are omnipresent in medicine. Dishonest and ingenious doctors can take in sums much greater than $100,000 a year. In one case involving Caremark International, a Minneapolis-based home care company, a federal grand jury indicted them for paying astronomical kickbacks to one physician. How much? Caremark pleaded guilty to mail fraud and paid a fine of $161 million. Suprisingly, the doctor was convicted but that conviction was overturned on appeal; the charges against the executives were dismissed entirely.
The Medical Racket by Martin L Gross, page 115

"Physicians: Pressures on"

Increasingly, people are questioning the values and the presumptions of medicine, asking whether our way of caring for people is the best way. The administrative structure of medicine is being overhauled from top to bottom by governments, by market managers, by physician executives and health management consultants. At the same time, new advances in medical science promise a new era of biologic innovation, with everything from fetal surgery to gene therapy to treatments to prevent aging. Each innovation comes with a promise and a price, and the more we innovate, the more we are forced to question and compare and prioritize among interventions, populations, problems, and allocation schemes. The individualistic morality that sees virtue in the unencumbered and unswervingly loyal commitment of each doctor to each single patient seems to be crumbling under the assault. Medical societies agonize over the compromises that doctors are being forced to make. Journals are filled with soul-searching articles bemoaning the changes and looking for villains. We blame the corrupt government or the greedy managed care administrators or the heartless market.
Do We Still Need doctors by John D Lantos MD, page 98

How much suffering and death are the American people willing to take before they stand up to the bureaucracy? How many physicians must be put into prison before all physicians cry "enough!" to the increasing government control over their profession? How many Watergates do we need before we realize that mortal men are corrupted by power, and that the solutions to one's problems lie not in increasing the power of government but in decreasing it?
World Without Cancer by G Edward Griffin, page 330

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