Can doctors be bought?

As recently published in The New York Times, Dr. Charles Nemeroff from Emory University has been accepting millions of dollars of income from pharmaceutical companies and device manufacturers without accurate disclosure. In other words, he’s taking money from the companies whose products he is endorsing and supporting through published articles, speaking engagements, and research. Lots of money, and he’s been doing it for years.

Dr. Nemeroff is no ordinary psychiatrist. He’s published hundreds of papers, and has served on dozens of corporate boards. Until recently, he was the editor of the very influential journal Neuropsychopharmacology—and is said to have been driven from this position after an outcry over a positive editorial over a medical device made by a company with which Dr. Nemeroff had financial ties. Again, no disclosure was made of this at the time.

This case is far from isolated. Earlier this year it was widely reported that Dr. Joseph Biederman of Harvard University was caught in a similar scandal. He was recommending and endorsing an ever-increasing use of certain medications while taking millions of dollars from their manufacturers. In this case, Dr. Biederman was most closely associated with a trend towards diagnosing and treating bipolar illness in children with powerful antipsychotic drugs that had never been approved for this use by the FDA.

Although these scandals have involved prominent and influential psychiatrists, episodes like this occur on a smaller scale every day. Many physicians serve on “speaker’s bureaus” or as “consultants” to pharmaceutical industries, collecting substantial fees. I’ve been offered thousands of dollars to travel to physicians’ offices, reviewing company-written material in support of a new, expensive antibiotic. The understanding here is not only that the speaker convince other physicians to prescribe particular medicine, but also that the speaker increases his own prescribing habits. Doctors are reluctant to admit it, but we are not immune to these marketing efforts.

So what can we do about it? Certainly, government efforts to require transparency should be supported. Universities that tolerate this sort of thing should be shunned, and should risk losing government grant support. The individuals who egregiously ignore reporting rules should not be allowed to keep their prestigious tenured positions, and the drug companies that are complicit in these shenanigans should face genuine, substantial penalties. Reforms like these will take time to change habits and entrenched marketing strategies, but in the long run are going to be necessary to re-establish the public trust in academic physicians.

For now, the best way to prevent your family from being exploited for profit is to avoid using expensive, brand-name drugs. There are seldom any advantages to newer medications—and the advantages that are talked about are usually only the over-blown talking points of a marketing weasel. Talk with your physician frankly about choices of prescription medications. If you stick with older, generic products, they’ll not only save you money, but they’re more likely be safer because they have a longer track record. You’ll also know that the medicine is being used only to help your child, not because a salesperson flattered your physician or brought a lunch. Here’s a list of some fancy, newer medicines, along with a generic substitute that is just about equivalent in safety and effectiveness:

Fancy and Expensive

Just about equivalent

Rhinocort, Veramyst, Nasonex

fluticasone (generic Flonase)

Nexium, Protonix

omeprazole (generic prilosec)

Xopenex

albuterol

Zyxal, Clarinex

loratidine (genetic Claritin)

(This is not meant to be an exhaustive list; it’s just for illustration. Don’t make any changes in your prescription medicines without discussing it with your doctor.)

There are certainly times where there is a genuine advantage to a newer medication, for which no good alternative exists. But believe me, this doesn’t happen often. If your physician suggests an expensive, new medication, discuss the specific advantages that it might have before shelling out your money.

Disclosure: I do not accept, and have never accepted, any money or any substantial gifts from any pharmaceutical company. I get no kickbacks or any other compensation from any prescription that I have ever written.

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One Comment on “Can doctors be bought?”

  1. Holly M Says:

    Thanks Dr. Roy — it is posts like this that make me grateful to have you as our pediatrician. Thank you for all you do for the wellness of children.

    Holly

    Like


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