This worry anyone else? <i>Facing an Enron-style scandal among doctors By SEBASTIAN MALLABY Washington Post The Enron scandal features trusted professionals -- auditors -- who turn out to be corrupt, damaging the whole economy. Meanwhile, in what ought to be recognized as the national health scandal, we have trusted professionals -- doctors -- who are likewise corrupt, with even more expensive consequences. Doctors are supposed to advise patients on their health. But doctors face financial incentives to be less than objective. Last year pharmaceutical companies spent $7 billion on sending gift-laden salesmen to woo doctors and another $2 billion on events for them. Doctors' coffee cups, stethoscopes and pens all are adorned with pharmaceutical logos. Their expenses-paid seminars in the Caribbean are conveniently invisible. This is only the tip of the scandal. Doctors accept money from drug firms to serve as "consultants," and sometimes there's a direct financial incentive to push certain treatments. A blood-testing lab may pay doctors a percentage on the business they pass on; a pharmaceutical company may provide drugs to doctors at a discount so that they can be sold to patients at a nifty profit. The Medicare system -- meaning taxpayers -- loses several hundred million dollars a year to this sort of scamming. Hence, Part I of the Enron parallel: professional conflicts of interest. Auditors are supposed to watch over corporate management, but managers corrupt auditors' judgment with lucrative consulting contracts. Doctors are supposed to advise patients on which drugs they need, but drug firms corrupt their judgment with assorted blandishments. Corrupt auditors sign off on dubious financial statements which, when later corrected, can cost shareholders their shirts. Corrupt doctors sign dubious prescriptions that cost patients multimillions. How many millions? Consider one simple calculation. In 2000, according to the Kaiser Family Foundation, Americans paid for 45 million prescriptions of the anti-inflammatory drugs Celebrex and Vioxx, even though nearly all patients could be treated just as well with over-the-counter ibuprofen. The Celebrex and Vioxx cost $3.7 billion, whereas 45 million bottles of ibuprofen at $3.99 a shot would have cost $180 million. In other words, dumb prescriptions for just two drugs cost the economy more than $3 billion. Those examples are not alone. Of the 20 most frequently prescribed drugs, 15 (including the inflammatory culprits above) are under patent. Several could be partially replaced by generic drugs. But doctors stick with the expensive branded drugs that company salesmen press on them. This is the triumph of the Caribbean seminar. And this is why the price of the average prescription jumped 10 percent last year, despite a general inflation rate of about 1 percent. The Enron analogy goes on. Just as the corruption of individual auditors is reinforced by the cozy oligopoly of audit firms, so collusion increasingly pervades doctoring. Hospital companies have been on a merger binge; in several cities now, one or two chains control more than half the hospital capacity. In Cleveland, Ohio, for example, two systems control two-thirds of local beds; in Richmond, Va., one firm controls two-fifths of them. Naturally, the hospital oligopolists are shoving prices up. In Richmond the average fee for treating chest pain shot up 47 percent between 1996 and 2000, according to The Wall Street Journal. Finally, there's politics. When government agencies tried to rein in auditor conflicts of interest in the past, the firms lobbied them into submission. Anyone who messes with the doctor-industrial complex risks the same treatment. The Food and Drug Administration has preached the benefits of cheap generic drugs, but many doctors only shrug. State governments have tried to impose a list of cost-effective medicines for use by Medicaid, but the pharmaceutical lobby is now suing them. In different ways, Bill Clinton and Newt Gingrich tried to rein in health costs. Both fell victim to shameless medagoguery. The Enron factor in health care explains why costs are going through the roof, with nasty consequences for everybody. Insurance premiums are shooting up; firms will respond by holding down wages or cutting insurance coverage to stay even; the ranks of the uninsured will swell beyond their already shameful numbers. Containing this problem will take a national campaign, and happily the first signs of one are visible. A new coalition of businesses and state governments is pushing the cause of cheap generic drugs, and the American Association of Retired Persons has thrown its considerable weight behind this effort. Without reform, the health-care system is "like Venice, sinking into the sea," says William Novelli, the AARP's boss. Perhaps sensing the coming groundswell of outrage, the drug industry has cooked up a voluntary code that may perhaps temper the worst of its marketing abuses.</i>
I remember when I was a kid, it seemed like every pen and notepad in our house had some prescription drug logo on it. I recall my father being invited on junkets by drug companies, but I never recall him going. Of course, it's a little simplistic to say that doctors are prescribing Celebrex or Vioxx instead of recommending over-the-counter ibruprofen simply because of drug marketing or what-have-you. I know that Celebrex was supposed to be an anti-inflammatory medicine that also reduced gastric problems that are not uncommon with aspirin and inbruprofen (since in blocking inflammatory enzymes, they also block enzymes that protect the stomach lining and can cause stomach irritation, internal bleeding and ulcers). I'm not saying that there isn't something "shady" going on, but I don't think we can say that one drug is necessarily a direct substitute for the other. I'm just saying that a doctor could actually believe that prescribing Celebrex or Vioxx is the proper course of treatment regardless of drug company marketing. But I don't know. It's not so much my field of expertise. If anything, this shows how we as patients should try to be more educated. We should ask questions of our physicians and our course of treatment. We certainly have plenty of access to information these days. I know that if I were prescribed Celebrex tomorrow, I'd at least ask why that instead of ibruprofen. There may be a good reason, or there may not be one. But I'm certainly a very interested party in my own health care. So, it's on my shoulders to provide some checks and balances, as well.
Thanks for posting that Jeff. The HMOs catch h*ll, yet there is no organized, widespread examples of greed that border on corruption like what we see on the delivery system. Rx cost inflation continues to outpace all other segments of health care costs. Even though generics are molecularly identical to brand names, physician groups have been fairly successful at fighting generic purchasing rules laid down by health carriers to control costs - one of those arguments about 'clerks' restricting the doctors' decisions. Time to: 1) outlaw carribbean trips (etc.) for med school students and doctors; 2) allow Americans (with prescriptions) unihibited imports of overseas pharmaceuticals; 3) penalize any company that charges us 10 times more for the same drug than what is charged in another country. Go AARP!
