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OT: is your doctors advice altered by conflict of interest?

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Posted 4/23/2018 11:57 AM (GMT -5)
I hope they are not. Some interesting thoughts from some physicians:

/nutritionfacts.org/2018/04/19/find-out-if-your-doctor-is-on-the-take-with-just-two-clicks/?utm_source=NutritionFacts.org&utm_campaign=4f5ffbe608-RSS_BLOG_WEEKLY&utm_medium=email&utm_term=0_40f9e497d1-4f5ffbe608-23982641&mc_cid=4f5ffbe608&mc_eid=620cd771e1
Posted 4/23/2018 1:28 PM (GMT -5)
It doesn't appear to me to be a huge problem...it looks to me like most doctors are ethical. (Those figures are sum totals for a 2 1/2 year period of time). I don't believe docs are gonna change their course of action for a grand spread out over two and a half years. Color me naive.

I've never seen a sales drug rep what wasn't (vert) pretty. I don't believe that's a coincidence.
Posted 4/23/2018 3:38 PM (GMT -5)

island time said...
It doesn't appear to me to be a huge problem...it looks to me like most doctors are ethical. (Those figures are sum totals for a 2 1/2 year period of time). I don't believe docs are gonna change their course of action for a grand spread out over two and a half years. Color me naive.

I've never seen a sales drug rep what wasn't (vert) pretty. I don't believe that's a coincidence.

I agree, the pharmaceutical reps do tend to be young and pretty, more so every year before I retired.

I went to this link from the article and checked my RP surgeon up at Vanderbilt, and he was only down for some small change, $112:
/projects.propublica.org/docdollars/

Then I just typed in my town and checked out the local docs. Most of the surgeons and anesthesiologists I worked with were down for any where to $100 to a couple of thousand thousand at the most, over 2 or 3 years. But some of the ortho surgeons, allergy and especially cardiologists and some others were down for 40-70K.

I did a search for Nashville, where I had my RP, and it didn't take long to find an Ophthalmologist paid over 100K, a diabetes doc at 97K(right beside an infectious disease doc paid $26! ), a Urologist paid 122K, a surgeon(does not say what kind, just surgeon) at 150K.

Hey, a guy or gal has got to make a living. I just hope these payments from drug and equipment companies do not influence which studies they believe and most of all their advice to their patients.
Posted 4/23/2018 4:18 PM (GMT -5)

BillyBob@388 said...

island time said...
It doesn't appear to me to be a huge problem...it looks to me like most doctors are ethical. (Those figures are sum totals for a 2 1/2 year period of time). I don't believe docs are gonna change their course of action for a grand spread out over two and a half years. Color me naive.

I've never seen a sales drug rep what wasn't (vert) pretty. I don't believe that's a coincidence.

I agree, the pharmaceutical reps do tend to be young and pretty, more so every year before I retired.

I went to this link from the article and checked my RP surgeon up at Vanderbilt, and he was only down for some small change, $112:
/projects.propublica.org/docdollars/

I did a search for Nashville, where I had my RP, and it didn't take long to find an Ophthalmologist paid over 100K, a diabetes doc at 97K(right beside an infectious disease doc paid $26! ), a Urologist paid 122K, a surgeon(does not say what kind, just surgeon) at 150K.

Hey, a guy or gal has got to make a living. I just hope these payments from drug and equipment companies do not influence which studies they believe and most of all their advice to their patients.

Well where I come from.... 6 figures buys things. I should have played with more. My surgeon made 24 grand and I thought that to be alot of money. Never knew this went on. Good education.....
Posted 4/23/2018 6:10 PM (GMT -5)
At university labs I worked with many med students and I worked directly for an MD for three years. I feel that they were amongst the most self absorbed people I have ever met. They may believe that they deserve even more money than they make. Subconsciously altering ones advice for financial gain isn’t hard to do. They send in drug reps because it pays to do so.

My MO despises drug companies, but he’s probably still affected by their marketing.
Posted 4/23/2018 7:18 PM (GMT -5)
I do not consider nutritionfacts.org to be a reputable source of medical information.
Posted 4/23/2018 11:16 PM (GMT -5)
I rest my case on every thing I have ever uttered on this forum...and ya know this is not a recent phenomenon...same old story...fight for love and glory...a case of do or die...Tim G we will take that under consideration as we de liberately de liberate...our de liberatsheons...tribute to adam sandler...Cajun Man....GFMPH...Nawlins
Posted 4/23/2018 11:56 PM (GMT -5)

Tim G said...
I do not consider nutritionfacts.org to be a reputable source of medical information.

Well, maybe not, though he is an MD. Regardless, the info I posted in last post was not from him, it was from the links. Apparently since Obama Care the gov has required companies to spell this stuff out. The Sunshine Act, by Senator Chuck Grassley? I got my info from the more user friendly web site, here is the link to government web site:
/openpaymentsdata.cms.gov/search/physicians/by-name-and-location

I rechecked the first 40K doc that came up locally on the 2nd web site, and it showed $71.7K for 2016.

I think some of this money is other than outright gifts, rather for services rendered, such as speaking fees at a drug seminar, that sort of thing. Still, considering some of these takes are more than a lot educated folks make for an entire year, I'm just hoping that somehow it does not influence their opinions and decisions regarding our treatment. It is obviously not illegal. I would not be surprised if such considerations (EDIT: I left out the "do not" ) also enter into many of the studies that we, and our docs, read.

Post Edited (BillyBob@388) : 4/24/2018 9:02:52 AM (GMT-6)

Posted 4/24/2018 12:21 AM (GMT -5)

BillyBob@388 said...

Tim G said...
I do not consider nutritionfacts.org to be a reputable source of medical information.

Well, maybe not, though he is an MD. Regardless, the info I posted in last post was not from him, it was from the links. Apparently since Obama Care the gov has required companies to spell this stuff out. The Sunshine Act, by Senator Chuck Grassley? I got my info from the more user friendly web site, here is the link to government web site:
/openpaymentsdata.cms.gov/search/physicians/by-name-and-location

I rechecked the first 40K doc that came up locally on the 2nd web site, and it showed $71.7K for 2016.

I think some of this money is other than outright gifts, rather for services rendered, such as speaking fees at a drug seminar, that sort of thing. Still, considering some of these takes are more than a lot educated folks make for an entire year, I'm just hoping that somehow it does not influence their opinions and decisions regarding our treatment. It is obviously not illegal. I would not be surprised if such considerations also enter into many of the studies that we, and our docs, read.

That's a very reliable website for information.
Posted 4/24/2018 12:25 AM (GMT -5)

logoslidat said...
I rest my case on every thing I have ever uttered on this forum...and ya know this is not a recent phenomenon...same old story...fight for love and glory...a case of do or die...Tim G we will take that under consideration as we de liberately de liberate...our de liberatsheons...tribute to adam sandler...Cajun Man....GFMPH...Nawlins

Doubletalk
Posted 4/24/2018 2:10 AM (GMT -5)
I'm not sure what to make of all this. I've searched for a couple dozen top PCa docs, and the results are all over the place. In 2015, some took just $100-$200 in food & beverage, some took tens of thousands in promotional fees. The highest fees generally seem to be to MOs to promote, you guessed it, drugs. One RO had a stake in a medical systems company. Surgeons promote mainly surgical tools and, of course, DaVinci.

The main question, for me, is duty to disclose. If I needed chemo and it was a close call between two different drugs, I'd appreciate it if the MO disclosed any substantial financial benefit s/he received from the company that makes the drug s/he was recommending to me. I think that would be pertinent information, and it would be much better for the MO to be upfront about the conflict than for me to find out about it behind her/his back.
Posted 4/24/2018 6:48 AM (GMT -5)

Saipan Paradise said...


The main question, for me, is duty to disclose. If I needed chemo and it was a close call between two different drugs, I'd appreciate it if the MO disclosed any substantial financial benefit s/he received from the company that makes the drug s/he was recommending to me. I think that would be pertinent information, and it would be much better for the MO to be upfront about the conflict than for me to find out about it behind her/his back.

If you politely ask physicians about these conflicts, they get offended. No only are many of them influenced by big $ handouts, so are hospitals and medical schools. To believe otherwise is naive, IMHO.
Posted 4/24/2018 3:59 PM (GMT -5)
Gary, I’ve never asked a doc about conflicts, but I can certainly believe you’re right about the usual reaction. Frankly, I’d be shy to ask. It would spoil the mood.
The website lists the teaching hospitals that receive the top payouts. They are among the best PCa centers.
Posted 4/24/2018 4:13 PM (GMT -5)
this thread = waste of time
Posted 4/24/2018 4:21 PM (GMT -5)
Here we go again. NK, if you feel that way it may have been better to move on instead of commenting.
Posted 4/24/2018 10:04 PM (GMT -5)
Tim its ok they all know that...it's ok...honest...let it be.... yeah
Posted 4/24/2018 10:49 PM (GMT -5)
Is my doctor's advice altered by conflict of interest?

no.

more often altered by lack of understanding my problem, not being trained in all specialities, and just being a fallible human, but not by being an evil money grubber.
Posted 4/24/2018 11:40 PM (GMT -5)
I'm not suggesting that a doctor is an "evil money grubber" for taking payment for services from a drug company or medical device manufacturer. The problem with conflicts in any profession isn't that they show malign intentions but that, each of us being a "fallible human," we're susceptible to develop biases in favor of those who show us favor. There are many published studies about medical conflicts of interest, how to manage them, when and what to disclose, and to whom -- it's a fair and important subject. E.g., from NCBI: Conflict of Interest in Medical Research, Education, and Practice, National Academies Press, 2009
We spill a lot of ink in this forum on biases for or against surgery or radiation that certain physicians have developed over the course of their medical training and socialization. Why should the subject of biases owing to financial interests be off limits?
Posted 4/25/2018 12:54 AM (GMT -5)

Saipan Paradise said...
I'm not suggesting that a doctor is an "evil money grubber" for taking payment for services from a drug company or medical device manufacturer......Why should the subject of biases owing to financial interests be off limits?

Excellent post, Richard!

Taking a valid topic, and putting some previously unstated "evil" tag on it, is unproductive, and what derails many conversations and debates. I hope we are better than that, here.
Posted 4/25/2018 1:13 AM (GMT -5)
Gary, thanks for the support.

Andrew, for the record, I don't have any problem with how you stated your view, it didn't cross the line as far as I'm concerned.

Also, I want to be clear that I'm not advocating "outing" doctors who take big speaking fees and I hope no one names names here. Aside from being not nice, I'm pretty sure it would shut the thread down.
Posted 4/25/2018 11:00 AM (GMT -5)
I don't understand why we are so fearful of "evil"...its all around us....always has been...it gets it power from fear...it is a part of every single one of us...there are no degrees to it...call it out...it is "evil" to use financial considerations as a part of any consideration...even financial decisions....Is it done...absolutely...always has...always will...this side of the divide...an OP calls my words double talk...another gibberish...knowing full well the "evil" with in themselves...when a member of a double minded species...forgets this{that they are double minded}...that member is pretending{matters not consciously or not}...again I can and do pretend to pretend...but I will not pretend...double minded? ...gibberish?...absolutely...

"the opposite of sin is not virtue...but faith" SK....."the true prodigal son is..lucifer" ME...think about it
Posted 4/25/2018 6:36 PM (GMT -5)
Some MDs with private offices participate in trials. I know my dermatologist and my retina specialist are doing this. about twenty years ago, my wife's endocrinologist participated in a bisphosphonate trial. I find that totally positive because they are trying to advance the state of the (medical) art.
I assume that they do get paid for participating (on top of getting the relevant drug, etc); if so, I find that kind of income 'above board'.

Post Edited (Sr Sailor) : 4/25/2018 5:42:31 PM (GMT-6)

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