Medical Forum / General / General / September 2005
online cash for docs
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fresh~horses - 21 Sep 2005 21:26 GMT http://www2.epocrates.com/index.html
Check the "Honors" box on the left.
Howard McCollister - 22 Sep 2005 00:24 GMT > http://www2.epocrates.com/index.html > > Check the "Honors" box on the left. epocrates is generally small potatoes for honoraria, as are most of the online offers. I, and most doctors I know, get such invitations by email and regular mail at least a couple of times every week - fill out a survey by phone or mail and get $100. Drug companies mostly, but some equipment manufacturers and some marketing firms. Then, there are various other consulting agreements, usually involving money plus travel expenses, honoraria for speaking engagements....stuff like that. It's nothing new...been going on for many years now.
HMc
Sbharris[atsign]ix.netcom.com - 22 Sep 2005 02:15 GMT > > http://www2.epocrates.com/index.html > > [quoted text clipped - 10 lines] > > HMc COMMENT:
What?? They've been offering ME only $35-- stuff in that range. I just got one today in the mail. And for half an hour of my time, I've been too lazy to do it. I might, for $100.
I'm trying to figure out how having somebody pay me to tell them how much of their advertising I listen to, causes harm to the world.
I suppose I could make a long complicated reasoned argument for a causal chain, but at the end I wouldn't really believe it. No, the answer is, I really am that lazy.
Back when I was an intern making $17,000 a year (which dates me, because for a LONG time before that interns made quite a lot less, and very shortly thereafter quite a lot more), some of these doctor opinion thingies came with a $5 check enclosed. So then the moral problem was do you cash the check and NOT do the survey? They did make it clear it was on the honor system, and I had no obligation to do the survey (and of course no legal one either-- if somebody sends you a check in the mail, it's yours).
Dilemas, dilemas. And of course doctors aren't the only people paid to fill out marketting surveys. We just get paid a little more. ($100?? Really? That's obscene. Must be a surgical instrument deal).
SBH
PS. Hey, Howard, did you make your contribution to the Red Cross Katrina fund, yet? Good for you. Feel any better? Me, neither.
On future 1040's, it seems I'm due to make a major contribution to "The War on Terror." But I can't seem to find anybody in Washington who doesn't understand that this is not the same as "The War on Iraq." Anyway, they seem to have spent all the money earmarked for the one, on the other, instead. Not surprisingly, it doesn't seem to have worked very well. If anything, a lot of people find the US just as terrifying as ever. More so. So this is all very frustrating, too.
S.
fresh~horses - 22 Sep 2005 03:16 GMT > > > http://www2.epocrates.com/index.html > > > [quoted text clipped - 51 lines] > > S. You directed this latter to Howard...
You think only docs make donations?
Howard McCollister - 22 Sep 2005 06:31 GMT >> > http://www2.epocrates.com/index.html >> > [quoted text clipped - 52 lines] > > S. Yeh, surgical instruments are big. The technology moves so fast that early adopters are often sought for preceptorships. My partner and I teach courses in advanced laparoscopic techniques for 4 different companies. Or maybe it's 4 different divisions of the same company, or some combination in between. I can never remember. The drug company stuff I just pitch....just too much trouble. I've declared a personal moratorium on surveys. I carried it too far when I didn't fill out the ubiquitous medical manpower survey the state sends out with its medical license renewal forms and they held up my license renewal until I did.
Yes. Thanks. No. Sigh...I volunteered to do medical support for Katrina refugees at a military base close to here when they were going to send 5000 people. Then it was 3000, then it was 500. As it turns out, nobody is coming to Minnesota from New Orleans. I can't figure out why so many Minnesotans are surprised at that.... I also volunteered to go to Louisiana to do coroner stuff (I'm Assistant County Coroner and death investigator here), but Paul Brown didn't want me either. War on Terror, Katrina, now Rita...I agree, very frustrating.
But hey!...at least we aren't living and practicing in Canada...
just kidding....really...
HMc
fresh~horses - 22 Sep 2005 03:14 GMT > > http://www2.epocrates.com/index.html > > [quoted text clipped - 10 lines] > > HMc It's nothing new been going on for years now...
That makes it ok?
Howard McCollister - 22 Sep 2005 06:32 GMT >> > http://www2.epocrates.com/index.html >> > [quoted text clipped - 15 lines] > > That makes it ok? No, that doesn't make it OK. I think it's intrinsically OK, all by itself.
HMc
fresh~horses - 22 Sep 2005 06:49 GMT > >> > http://www2.epocrates.com/index.html > >> > [quoted text clipped - 19 lines] > > HMc A couple questions related to a comment in your post to Harris ie) "early adopters".
What does that mean?
And preceptorships...what does that mean?
And when you say teach ... do you mean teach for the pharma device manufacturing company? Or teach for your surgery colleageus at Cayuna?
Zee
Howard McCollister - 23 Sep 2005 01:52 GMT >> >> > http://www2.epocrates.com/index.html >> >> > [quoted text clipped - 33 lines] > And when you say teach ... do you mean teach for the pharma device > manufacturing company? Or teach for your surgery colleageus at Cayuna? Surgery these days is increasingly technology-driven. In many cases, a particular operation can't be done using minimally invasive techniques until someone invents a tool make if safer, or to make it possible at all. The days of being able to do modern surgery using the same tools that Halsted/Halstead used are long gone, as of 1989, the day that Eddie Joe Reddick did the first laparoscopic cholecystectomy in the US. There are all kinds of technologies being invented, studied, FDA-approved, and then they make their way into the medical market. Those companies then have to sell the technology to surgeons.
My partners and I are committed laparoendoscopic surgeons. We tend to stay at the leading edge of advanced laparoendoscopic technique and as such, there are a number of operations we do that very few other surgeons around our part of the country are doing. We evaluate the technologies that are out there in order to find a better or safer way for us to do a particular operation, and in some cases we participate in the development of those technologies with a variety of different companies. We get paid for sharing our expertise with those design teams. In cases where we have greater experience with a particular operation than other surgeons, those surgeons may come to our hospital and we will teach them (preceptorship). Most of these companies have several other such teaching arrangements. In other cases, we may be invited to speakand/or teach at other such training courses. As I type this, I have my feet up on the balcony of a very nice hotel overlooking the Hollywood hills in LA. I drove up this morning from San Diego. Dinner at Spago tomorrow night.
Bear in mind that these companies with whom we have consulting agreements have sought us out because we are already using their equipment - we didn't start using their equipment because they gave us money. As an example, we have a consulting agreement with one particular device company that makes surgical staplers, and we teach surgeons how to do advanced laparoscopic operations using those staplers. That same company makes an ultrasonic scalpel and they would dearly love for us to buy it and use it in those teaching courses. We don't, and use a competing company's ultrasonic scalpel because we think it's better. It's a sore point with the first company, and it creates a fair amount of friction in our relationship.
HMc
fresh~horses - 23 Sep 2005 03:19 GMT > >> >> > http://www2.epocrates.com/index.html > >> >> > [quoted text clipped - 72 lines] > > HMc I'm going to read this over, think about it carefully, and ponder on how I can tell you why I disagree with you, in as unemotional a way as possible. However, if I think *that* isn't possible...
...and it's been a couple days and I still haven't repsonded; send for the Mounties.
<<sitting here with my feet up on a stool cause I have to be in flexion to stop muscle spasms caused by the pedicle screws put in my spine without my authorization; by a hotshot show-off who knew those screws weren't ok'd for use in the spine at that time.>>
Butter tarts & espresso at the Farmers' Market tomorrow...
I hope you have a great weekend Howard. Truly I do.
Howard McCollister - 23 Sep 2005 08:15 GMT > I'm going to read this over, think about it carefully, and ponder on > how I can tell you why I disagree with you, in as unemotional a way as > possible. However, if I think *that* isn't possible... No offense meant, but I can't imagine that you understand the landscape and the situation well enough to possibly be able to provide a meaningful rebuttal to the concept.
HMc
fresh~horses - 23 Sep 2005 14:13 GMT > > I'm going to read this over, think about it carefully, and ponder on > > how I can tell you why I disagree with you, in as unemotional a way as [quoted text clipped - 5 lines] > > HMc If you think meaningful rebuttal can only come from your colleagues, then you're right Howard.
Zee
Howard McCollister - 23 Sep 2005 08:22 GMT > I'm going to read this over, think about it carefully, and ponder on > how I can tell you why I disagree with you, in as unemotional a way as > possible. However, if I think *that* isn't possible... Hey Zee, you don't need to think about it - your arguments will certainly be contained within this article:
http://www.nytimes.com/2005/09/22/business/22devices.html?pagewanted=4
HMc
fresh~horses - 23 Sep 2005 14:47 GMT > > I'm going to read this over, think about it carefully, and ponder on > > how I can tell you why I disagree with you, in as unemotional a way as [quoted text clipped - 6 lines] > > HMc Yes, some of my arguments may be there.
I have thought about it Howard. From your perspective now too, but for some time as one who carries a device deployed in me in off-label use by a surgeon who thought there was no need to ask my permission or tell me I was part of an experiment.
Howard McCollister - 24 Sep 2005 07:26 GMT >> > I'm going to read this over, think about it carefully, and ponder on >> > how I can tell you why I disagree with you, in as unemotional a way as [quoted text clipped - 14 lines] > by a surgeon who thought there was no need to ask my permission or tell > me I was part of an experiment. Your situtation doesn't apply, Zee. I'm certainly not talking about off-label use of ANY of these technologies.
HMc
Howard McCollister - 24 Sep 2005 07:26 GMT >> > I'm going to read this over, think about it carefully, and ponder on >> > how I can tell you why I disagree with you, in as unemotional a way as [quoted text clipped - 14 lines] > by a surgeon who thought there was no need to ask my permission or tell > me I was part of an experiment. Sbharris[atsign]ix.netcom.com - 22 Sep 2005 21:11 GMT > > It's nothing new been going on for years now... > > [quoted text clipped - 3 lines] > > HMc COMMENT:
Agree. One of the great reasons for decentralization of decision-making is that it removes much of the incentive for bribery. This is as true in politics as economics. One of the less-talked about bad things about socialism and command economies isn't just that the commissars aren't smart enough to decide how many widgets will be needed where, and when (the sorts of horrors you saw with Katrina), but also there's the fact that when decisions are made by a few on behalf of the many, there's always corruption. That's bad enough even in Western-style democracies. Republics are mandatory thing from the demands of information processing, and if you have a republic, you will have junketing politicos getting private donations for their private projects (presidential libraries, whatever) who make doctors (ANY doctors) and even many business people look more pure than Ceasar's wife.
What I don't understand is why anybody wants a system which encourages this. Sure, somebody's always going to be doing complicated surgery that nobody else can do. But there's really no reason to have many drugs available only by prescription. Remember how long it took to get Clariten and Prilosec over the counter? This kind of thing is what lead directly to drug company pressure on the few, when it could (and would) be better diffused into the many. And thereby somewhat detoxified. Who cares about direct to consumer advertising? If the doctors aren't too biased, the intelligent consumer can always consult them first.
I've long argued that the only drugs which should require a prescription are those which are intrinsically destructive to society, like some particularly nasty form of pollution. The only ones I can think of in that category are antibiotics. Most of the narcotics are no worse on their total effect on society than is alcohol. We deal with alcohol without requiring it to be prescribed by doctors.
There are cases were people's lives are destroyed by drugs-- indeed by alcohol. But in those cases, the decision of what to do about it should not be left in the hands of doctors. That's a social decision. If you're destroying your own life with alcohol or seem likely to destroy somebody else's by your use of it, the judge or jury might decide in such cases not to make alcohol illegal for everybody, but instead illegal for YOU PERSONALLY for the next 5 years. Or the rest of your life. But again, such decisions are so personal and decentralized that corruption would seem to be unlikely to be much of a problem. The beer-makers might care if beer were outlawed altogether, but would not give a fig if beer were outlawed for Joe Blow who wrecked his pickup truck after drinking 2 six-packs after work on the way home. Indeed, it's Joe who gives beer a bad name. Even the beer companies would prefer he not partake.
Can doctors be bribed? Sure. Can juries be bribed? Sure. But fix the system a little, and there's really no reason why the one shouldn't be as rare as the other.
SBH
Frankie - 23 Sep 2005 18:24 GMT Who cares about direct to consumer advertising? If the doctors aren't too biased, the intelligent consumer can always consult them first.
Sorry to butt in, but this struck a chord with me.
Re: Who cares about direct to consumer advertising? It's unbalanced. The sun is shining, everyone is smiling but the drug advertised has serious side effects, sometimes life threatening and none of this is mentioned or is in fine print that cannot be read on a TV screen.
Re: If the doctors aren't too biased... That is a BIG "if"... many doctors are very biased. Our doctor completely denied that Lipitor can cause cognitive side effects, when there is clear evidence that it can. In fact he was pretty darn snotty about it. Walked out of the room in a huff, sent in the nurse to give the in-office memory test, which my husband promptly failed. Hubby's memory is much improved since off of statins for over a year now.
Re: the intelligent consumer can always consult them (doctors) first. Consumers might be intelligent but most are ill informed and their doctors might be intelligent but many are ill informed as well. Doctors are too mono-focused on "take this pill and you will live a long health life".
Frankie
Sbharris[atsign]ix.netcom.com - 24 Sep 2005 05:17 GMT > Who cares about direct to consumer advertising? > If the doctors aren't too biased, [quoted text clipped - 25 lines] > > Frankie COMMENT:
Let me put it this way. It's a question of who is going to pay for information-processing.
Imagine that I was in the market for a car, and wanted a mid-sized sedan of some kind, painted red, and I wanted the best car I could get for under $25,000.
But I don't know anything about cars. So I ask Joe Greasemonkey, a mechanic and gearhead I know, to go buy me one. The "best" one. I offer him $500 to spend an afternoon shopping around, and with a phone consult or two, finally I get the thing.
And I don't like it much. I don't like the way it handles. I don't like the way it sounds. The switches are in the wrong place. I don't like the power ash-trays. Joe suggested I'd have done a lot better going with him to the dealers and listening some more about engines, but I'm not interested in that stuff. Why else do I hire the guy?
While I'm mulling over my potential lemon, I find out more distressing stuff, and it's becoming clear to be why I got the car I got. My bud the mechanic guy has had deals and dealings with all kinds of car manufacturers and parts makers for years, and he owns a couple of the same kind of cars he just bought me! Why, the very idea. I was paying for a totally unbiased opinion. If that's not bad enough, I realize that Joe spends half his time down at the local race track where everything that is capable of motion is plastered with sponsor stickers, and EVERYBODY developing everything has some connections with companies that make car-stuff. I mean, really. Disgusting. How can his mind not be totally polluted with spin and ad nonsense? Half of it's buzz, and I can't tell which half. Anyway, I want to know what place have Joe Greasemonkey's judgments and feelings about cars, which are his life and his passion and certainly not his sober academic career, got in this scientific issue of picking me out THE BEST CAR? The more I think about it, the angrier I get.
But if you think that's bad, a few years later it's worse. I need another car, having wrecked the first one (no fault of mine). But in the meantime, the business of picking cars has been mostly taken over by the government, which decided to remove all the commercialism and corruption from it. Okay, that's a start. The problem is Joe the mechanic has moved to some other country where they still actually have a commercially sponsored racecar culture. He couldn't take my money now, even if I wanted to pay him. So now I look around and realize I've got few choices left. I'm left with Fred Friendly's Chain of Government paid auto stores, instead, who get paid to pick my Best Car. They use my taxes. If I want a better job of car picking, I have to go out of the country for it. And the lines are pretty bad if I stay.
And you know what? Even paid by my taxes and with less commercialism, it's worse. At least Joe Greasemonkey knew his engines and was always taking apart something or building something, and had some idea about how the auto industry made progress. He could tell you WHY brand X was junk and company Y knew cars, and it wasn't just the stickers and sponsor ads (though I'm sure they had some effect on his opinions). But the Fred Friendly Government Guy seems to know only what they taught him in government auto school about the stats, and that doesn't seem to be much. It's just what opinions the government officially has about what is the best car. But I'm I'm wondering where THOSE come from? Are they cloned somewhere? Government race track tests don't just spit out the answer to what is the best car--- that's a value judgment. The government has to be paying somebody and getting info from somebody. And I know who. And I have the crawly feeling that some of the companies that sponsor stuff at the track have been telling officials somewhere about what cars are good and what cars are lemons. Not just the drivers and mechanics, who can see from themselves. But this time, it's all at a level where I can't even BEGIN to see the nuts and bolts of it. The racetrack is gone. My gearhead guy is gone. The auto developers have fled. I'm stuck in the government auto showroom with the government-appointed and approved and trained salesman, and I'm wondering about the nature of engineering. Where the hell DO good expert opinions come from, anyway? It's all very mysterious. The government should be doing it, is all I know. And they're not. The people who invent cars and play with cars somehow still control it, out there, somewhere. It's just not fair.
SBH
Frankie - 24 Sep 2005 06:36 GMT Re: Let me put it this way. It's a question of who is going to pay for information-processing.
Undoubtedly we all "pay for information-processing", but the information many times is grossly manipulated.
And yes, "It's just not fair", but it also sucks, big time!
Frankie
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