Doctor knows best.
I believed this in my younger years. Now, it’s the most ridiculous thing I’ve ever heard about health—doctor’s do not always know what’s best. Oh, and when I say doctor I mean physicians, not surgeons who do know how best to perform surgical procedures. I am also making very deep generalizations here.
The danger in assuming your doctor knows what’s best for you is that you may not receive proper care or you may receive care you don’t need. Why? Why in the world would a doctor do that to you? Well, unfortunately, in the current environment of our healthcare system, some doctors do not serve the interests of their patients but rather the lining of their pockets or practice. There are two primary reasons for this, and to help explain I found a few articles, with links to them in the footnotes.
1. Fee-For Service
The habit of assuming the doctor knows best has created a system where huge numbers of patients aren’t getting the treatment they would have chosen if they were fully informed.
… doctors and institutions get paid based on some form of fee-for-service, meaning they take in more money when they do more procedures. 1
This article from The Atlantic also says they are rewarded for “doing more, rather than doing good.”
I also came across an example of someone’s Mom who had a minor procedure performed on her toe. It took about an hour and a local anesthetic was used. The bill Medicare paid was more than $13,000.
… the fee-for-service model provides powerful incentives to pad bills or even commit fraud. 2
… in the pharmaceutical industry… aggressively promoting drugs to doctors for uses not officially approved — including inducing other doctors to praise the drugs to colleagues at meetings — has quickly turned numerous drugs from mediocre sellers into blockbusters, with more than $1 billion in annual sales. 3
Doctors sometimes ask for sponsorship to go to international meetings, which they argue they need to attend to keep up with developments in their field. Their hospitals cannot afford to pay their flights and hotel bills, they say. 4
In my opinion, this practice is a severe conflict of interest and does nothing to ensure patients are receiving the best care possible. I suspected the treatment options the neurologist presented me, a binder for one of three different drugs (three binders in total), may have had something to do with this. He was not at all interested in discussing alternative treatments.
Looking up information on kickbacks led me to a brief chat OPB had with the reporters behind ProPublica’s Dollars for Docs tool. So I looked him up on Dollars for Docs and it shows that he does accept money for meals from different companies. While most of the dollar amounts are less than $30, one company (Allergan) paid him between $250 and $1,000; once in 2010 and another in 2011. Those are some pretty expensive meals! Allergan is the maker of BOTOX®(onabotulinumtoxinA). According to their website, it can be used to treat urinary incontinence and upper limb spasticity associated with neurological conditions, such as Multiple Sclerosis (MS).
Say what? It seems to me that Allergan is trying to make their product serve a myriad of purposes in order to get the most $$ out of it. Botox for MS?
Oh, well looky here:
American pharmaceutical manufacturer Allergan Inc. has agreed to plead guilty and pay $600 million to resolve its criminal and civil liability arising from the company’s unlawful promotion of its biological product, Botox® Therapeutic, for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Justice Department announced today. The resolution includes a criminal fine and forfeiture totaling $375 million and a civil settlement with the federal government and the states of $225 million. 5
And from WebMD:
Despite the fact that the drugs are used for a variety of medical problems, the FDA, as of this date, has not yet approved the use of these treatments for MS-related spasticity. 6
I don’t know if the neurologist that diagnosed me was involved in this at all, but it is an interesting coincidence. He certainly did not recommend Botox as one of the three drug modifying therapies I could choose, but I do know many with MS take other drugs to treat the multitude of symptoms they experience and Botox may have helped many MSers with incontinence and spasticity.
So, yeah, patients can’t trust doctors to know what is best for them. Unless of course you are blessed to have a doctor who does not use fee-for-service for billing and is not listed on Dollars for Docs. I hope to one day find such a mythical creature.
I should probably start looking.
1. The Cost of Assuming Doctors Know Best, The Atlantic – September 28, 2012
2. Is Fee-for-Service What Ails America’s Health Care System, dailyfinance.com – January 18, 2010
3. Drug giant Glaxo pleads guilty, fined $3B for drug marketing, USA Today – July 2, 2012
4. Drug companies pay doctors £40m for travel and expenses, The Guardian – April 5, 2013
5. Allergan Agrees to Plead Guilty and Pay $600 Million to Resolve Allegations of Off-Label Promotion of Botox®, Department of Justice – September 1, 2010
6. Treating MS With Botulinum Toxin, WebMD – May 23, 2012 (date last reviewed)