Bye Bye, Free Samples

“Doctors who are shutting the door to sales reps are cutting themselves off from a lot of valuable information,” said Scott Lassman, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, a trade association. “Sales reps can explain when it’s right to use a drug, when it’s not right to use the drug, which patients might benefit and which patients it might not work for.”
This was the quote that caught my eye in today’s NY Times article about the growing trend for physicians to stop giving free samples. In reading the above statement, I really feel like a doctor would be nuts to not talk to a sales rep.
But what is a sales rep, really? I’m sure some are very educated, but for the most part, these are people from diverse backgrounds, some college education, a science vocabulary and a huge marketing budget. Their job is to get a doctor to use their product. There are walking conflicts of interest.
I would feel a whole lot better if my DOCTOR didn’t have a need to learn from a sales rep, and could instead go learn for himself from government guidelines, peer reviewed journals, and continuing education formats.
Afterall, isn’t it the doctor’s job to know “when it’s right to use a drug, when it’s not right to use the drug, which patients might benefit and which patients it might not work for”?????

Sticker Shock

The above is a Graham Watson Photo.
A friend of mine recently suffered the most dreaded of all cycling injuries: the broken collarbone. Everything about this broken bone was ho-hum. It was not a severe fracture and the care to fix the bone was minimal: a sling, rest, some pain meds. However, the entire experience was valuable as a look into costs related to an Emergency Room visit.
As my friend was unlucky enough to not have health insurance, each bill received was painful, and we talked about it openly. For the most part, I can see the services as fair. Here is what was provided and charged for…give or take a few bucks:
1. Emergency Department Bill: $1050
2. Radioloist: $45
3. Follow-up Ortho visit: $125
4. Radiology: $400
5. ER Physician: $500

HOLD ON! Did you see that last charge? Per my friend, the total time spent in the presence of this ER doc was less than 10 minutes. Why so much? The extent of his intervention was to declare this injury non-emergent, refer to another care provider, and order a sling and pain meds. In other words…not much. In another context, why is his bill so much higher than a surgical consult? (Oh by the way, we’re leaving the fact that the ortho tried to talk my friend into an unnecessary procedure.)

For someone who has insurance, this bill would carry less weight. They will be apt to overlook the high cost and just shake their head as the insurance company pays the bill and passes the cost on to small business employers. Which is where this whole story turns ironic. My friend owns his own small business and cannot afford the absurdly high prices. Now, he’s being over-charged for medical care that is the root cause behind why he cannot afford insurance!
Here is another thought: Doing the math concerning his total bill (~$2000) we can easily see that even in light of a significant injury, the total outlay for medical care is still less than if he had paid $400 dollars for health insurance monthly for the past 16 month in which he sought no medical care, and would have still had a $500 deductible for an ER visit (~$6900).

Unsustainable economics for everyone.

Everyone except the insurance company and ER doc!

Comparative Visual Healthcare Spending

This is interesting: MSNBC did some calculations of the US budget and presented it in terms of a $1000 household budget. Most of your tax dollars go to finance healthcare. Personally disturbing for me, b/c I spent less than $400 on healthcare for myself last year!

For the picture, click here.

I wonder how much we could deduct off that amount if no needless MRI’s were performed. (see previous post)

Why Referal for Profit is Dangerous and Thoughts on Radiology

Yesterday, the journal, Health Affairs, published a study that investigated referral for profit in the context of advanced radiological imaging. Here is what they found:


Using data from a large insurer in California, we identified the self-referral status of providers who billed for advanced imaging in 2004. Nearly 33 percent of providers who submitted bills for magnetic resonance imaging (MRI) scans, 22 percent of those who submitted bills for computed tomography (CT) scans, and 17 percent of those who submitted bills for positron-emission tomography (PET) scans were classified as “self-referral.” Among them, 61 percent of those who billed for MRI and 64 percent of those who billed for CT did not own the imaging equipment. Rather, they were involved in lease or payment-per-scan referral arrangements that might violate federal and state laws. [Health Affairs 26, no. 3 (2007): w415-w424 (published online 17 April 2007; 10.1377/hlthaff.26.3.w415)]

In other words, and put less politely, 60% of doctors were illegally billing for imaging studies. As you know, MRI and CT scans are expensive, often over $1000. The ability of a doctor to be paid for a test like this is just way to fishy for me. I wonder if the patients sent for theses images have the ignorant good fortune to hear, “Good news, your MRI was negative!” more than those patients whose doctors were not getting illegal kickbacks.

The proper use of advanced imaging is to rule in/out a diagnosis. The overuse of these images is rampant, as many people just order the image to “see what’s going on in there” as opposed to performing a thorough and telling clinical exam.

Another excerpt from the article:

“Under federal law, it is generally illegal for a physician to refer Medicare or Medicaid patients for designated health services in which the physician has a financial interest. Nearly half of the states have similar prohibitions that apply to the privately insured. These bans on self-referral were enacted during the early 1990s in response to several empirical studies that found that the financial incentives inherent in physician self-referral arrangements resulted in increased use of services and higher payments from third-party payers.”
Ok, so my question now becomes two-fold:
  1. What is going to be done about this, because I’m sure there is a lot of needless expense in overuse of advanced imaging?
  2. Why is this referral for profit ban NOT inclusive of Physical Therapy? Why is it ok for a doctor to profit from self-referrals to his PT, but not from an MRI?

I guess this is just another bit of evidence for why we should, as a society, increase our skepticism of the medical profession. They are, after all, human. Check out the WSJ Health Blog on this subject.

Can Exercise Help Breast Cancer?

Perhaps not directly, but a recent BMJ article says it can help in improving physical function and quality of life measures in patients with early stage breast cancer. Some of the physical measures noted were a 12 minute walk test and a measurement of shoulder mobility. Interesting to note, the physical measures improved right away, but it took some time for the quality of life measures to show an intervention effect.

There have been a series of studies (and this one) recently dealing with the issue. I find the concept refreshing, as it really makes sense to get some supportive literature behind some good integrative care. Perhaps with enough of this type of literature, a woman diagnosed with breast cancer will be able to receive treatment not just for her cancer, but also for her receding quality of life and upper limb function…and have it reimbursed!