This article covers all of the bases in one simple, sad story.

It begins with a ghastly trend — charging patients before they are treated. And goes downhill from there, including such swell tactics as:

• Charging the uninsured many-fold times what insurance companies reimburse for the same services
• Stopping therapy until the payment office gets a check
• Considering a billing administrator part “of the health care team”
• $20 for latex gloves?! Is the patient allowed to bring her own next time?

Apparently, hospitals have decided to take up the motto of the highway robbers of old: “You money or your life.”

AAMC has finally put out some guidelines regarding industry gifts, etc at med schools – simply its to pretty much ban all gifts. However, I think it could still be stronger in that it doesnt require the ban of industry representatives from campuses/hospitals – they’ve just written out more restrictions – i.e. they should not be in pt care areas for example and also recommending more regulation for drug samples vs. doing away with it (we and pt’s dont really need this – its only that we’ve come to believe the fallacy that there is no other way to get free drugs to patients who need them!). You can see the full report at: AAMC Task Force on Industry Funding of Medical Education

Today’s NY Times has a good piece on it:

Ban Urged on Gifts at Medical Schools

By GARDINER HARRIS
Published: April 28, 2008

Drug and medical device companies should be banned from offering free food, gifts, travel and ghost-writing services to doctors, staff and students in all 129 of the nation’s medical colleges, an influential college association has concluded.”

A spectre is haunting Medicine —the spectre of Pharma. Powers of good old Integrity have entered into an alliance to exorcise this spectre: the National Physicians Alliance, Prescription Project and NLARx, Families USA and (even) the legislature. Very little can be added to NPA member Joseph Ross’ piece in JAMA on ghostwriting- noted previously here, in the press and by other bloggers – other than maybe “you don’t think it’s only Merck doing this, do ya?”

Today, JAMA is publishing a series of articles related to the marketing of Vioxx by Merck. One of the articles, co-written by NPA member Joe Ross, details how articles published under the names of academic physicians were actually written by employees of the drug company.
This is just one of several ways that Merck corrupted the scientific process in order to promote its medication.

And patients died because of it.

These new details of the way drug companies infiltrate and undermine our scientific evidence are disturbing. They certainly deserve headlines in the Washington Post and New York Times.
But we should remember that, in the end, it is physicians who have the power to stop this erosion of the foundation of medicine — we must create a separation between what is done for the benefit of our patients, and what is done for the pursuit of profit. As physicians, our oath unambiguously states our allegiance to our patients. Not to shareholders, a Board of Trustees or the “right” to have an all-expense paid vacation to Hawaii as a “consultant”.
The Vioxx scandal will continue to be a black mark on the practice of medicine until we are able to demonstrate to our patients that we are “Unbranded Doctors” who are free from the entanglement of drug companies and other interests seeking to influence the decisions we make for patients on a daily basis.

Earlier this week, I discharged a patient after a 45 day hospitalization. She had been through a lot – a viral infection caused her immune system to go wild, she had a fungal infection, her kidneys failed – but she pulled through and recovered so quickly that we discharged her to home rather than to a nursing home as originally planned.

Today, I called to see how she was doing. It’s a long, slow haul after a month and a half in the hospital, but she’s doing better each day.

Her husband then mentioned that his next biggest task was to get her insurance coverage continued. You see, since she had been hospitalized for so long, and ill before then, she hasn’t been working. And since she hasn’t been working, her employer-sponsored health insurance will soon lapse. She’ll have to enroll in a COBRA plan (and pay the full cost of the insurance), but if her coverage every lapses, she’ll never get insurance again due to her “pre-existing condition.”

Doesn’t her husband have enough things to do? Shouldn’t he be spending time helping her get stronger, rather than fighting the insurance company to fulfill their promise to pay for her medical care? They were sure happy to take her money for years, but now that she needs coverage …

Sadly, this is all to common. For her, it’s the catch-22 that you can’t work if you are sick, and you can’t get insurance if you can’t work. For other patients, it’s the policy ceiling that allows insurers to walk away after paying out a set amount (which is all-to-easy to reach when you have a 45-day hospitalization).

Is there any morality in a system that fails those just when they need it the most?

Addiction is a catchy word. Everyone knows the US is ‘addicted’ to oil. When we think of ‘addicts’, some movie scene with a skinny, disheveled criminal may come to mind. Thankfully, not many physicians have a narcotics problem. Or at least I hope that is the case, there seems to be a paucity of data out there. A study in New South Wales from the 1990′s suggested at least 0.4%. In US Anesthesiologists, it may be as high as 1.6%.
However, if you are about to cancel your upcoming surgery, here is a scary fact: your doctor may be addicted to hand outs from the pharma industry, sometimes called a “pharma whore“. Those are not my words, this is a term some doctors, jokingly acknowledging somewhat inappropriate behavior, describe themselves (it also is used to describe industry friendly politicians who take pharma money). I may have used it to describe myself a few years ago, when during my fellowship I was Chief (Pharma) Fellow, in charge of making a call schedule and the premium champion of arraging dinners for my colleagues and me at Seattle’s premier restaurants like Shiro’s. Even according to guidelines by the AMA and PhRMA, such meals are not OK:

“What do the guidelines say?
In short, the AMA guidelines state physicians should accept only gifts that entail a benefit to patients and that are of modest value. Individual gifts related to the physician’s work, such as pens and notepads are also acceptable. And no gift should be accepted if there are strings attached.” (from AMA FAQ’s).

I ran into a friend yesterday who stated that a few of my former colleagues went out 3 nights in a row at the ACC, to the best steak houses, including one with a 7 course tasting meal. Modest? From experience I can say that a good steak, sides and some wine is at least $100 a head. I my hotel you only needed to go down to the lobby around 7:30 PM to see such dinner parties leaving – always a few salivating docs surrounding a cheerful sales rep.
I arrived at the ACC conference this past weekend, for the whole shebang. Saturday morning I attended a CME course for Cardiac CT, run by The Johns Hopkins University, with support by Toshiba. Now granted, no one expect to hear from such a CME activity that one should NOT use cardiac CT, although the benefit of the test is not undisputed. One can also not expect that the CME activity would be unbiased – the faculty basically admitted it was to demonstrated to possibilities of Toshiba’s new 320 slice CT scanner, Johns Hopkins being the first medical center in the US to have it installed (one speaker made mention of a Siemens product). The other goal of the course was to demonstrate the result of the Core64 trial – needless to say that was Toshiba sponsored, too. This activity is part of an ‘unofficial’ program at the ACC, such satellite symposiums are usually sponsored by Pharma, feature prominent speakers and despite their ‘unofficial-ness’ are featured in the proper ACC meeting brochures.
That night, I returned to my room and found that someone had left some trash in front of my door. It was a white plastic bag that contained 32 glossy promotional fliers (one was a mouse pad; the next day I received 16, then 3) that invited me to visit various pharmaceutical companies booths at the “Exhibition” the next day. Now if you have never been to one of these conferences, this you got to see. The Exhibition is an area that could probably accommodate a few football fields where pharmaceutical and device vendors have set up their displays. Now, in principal, that is not a bad thing. For example, I wanted to learn more about my hospitals radiology software, what features the new update of the software had etc., and I went and talked to the sales reps, who did a great job of answering all my questions.

But the main goal of these companies is to sell their product (a legitimate reason). Their booths are colorful, brightly lighted constructions. The way they do this is by luring you in with some kid of relatively cheap trinket, like a travel mug, a low end USB drive, or the like. To obtain this, one usually has to give out one’s contact information (by swiping a plastic card) and talk to a rep, sometimes answer some questions or fill out a survey. Now imagine 30,000 cardiologists swarming that hall. One would be surprised that people making an average of $300,000 a year (and sometimes much much more), would care to get these plastic gimmicks. When I was a fellow (making far less than the above amount), I did it, been there. I once lined up to get a wooden pen engraved with my name – there must have been a line of 20 to 30 doctors and it took probably 15 min. I have sipped cold Starbucks Coffee at the Pharma trough. I have answered marketing surveys, only to receive a cheap pair of sunglasses….. this year I celebrated my independence by treating myself to a fountain pen which will probably last me a lifetime.

Furthermore, when you pick up your ACC program for the conference, you are handed an impressive array of gifts:

- a black bag prominently displaying the name of a high selling cholesterol drug
- a neck strap for the name tag, with the same label
- a water bottle, featuring a new anti-angina medication
- a clip board with a blood pressure medicine written all over
- a business card holder wit drug company AND ACC label (you can get in engraved at the company booth)
- several glossy brochures
- a pen, labeled with an anti-platelet drug (it’s NOT aspirin)
- a bookmark with incorporated loupe (for those older cardiologists – or is it for the fine print on the medication packet), of course it’s branded

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