Here is a very important post from Dr. Catey Shanahan documenting direct bribes from drug dealers to clinics who can attract more doctors by paying them more as long as they pledge to get every patient’s LDL below 100. Without major dietary change, counseling for which takes a lot of unpaid time of the doctor, this can only be done by prescibing statins, already the most prescribed drugs in the world. When will the physician licensing bodies stop this corruption of the medical profession and forbid any financial connection of practicing doctors with any industry associated with medical practice?
Unlike Dr. Shanahan, I do blame the doctors. This sort of behavior is highly unprofessional. If no doctor went along with this highly unethical practice, contrary to the Hippocratic oath, it wouldn’t exist.
It seems insurance companies are so occupied with getting $zillions from drug dealers that they can’t be bothered to look at the data. Here are some from the ALLHAT-LLT study. In spite of a large reduction in LDL, bad blood cholesterol, there was no effect on mortality or morbidity in this group of very high risk people including diabetics, all of which the insurance company says should be give statins. Where a bar crosses the vertical line there is no significant effect in that sub-group.
And look at the baseline characteristics of the participants in ALLHAT-LLT: all overweight, 43% obese, 23% smoking, 35% diabetic. Is it not highly unethical to perform a drug study for lifestyle diseases in such a group with obviously atherogenic lifestyles BEFORE optimizing the lifestyles of all participants?
Many of the comments on the NYT and other articles on the new recommendations for pediatricians and family doctors to put children on brain-damaging statins are expressing outrange that drug companies are taking over the minds of doctors. Don’t blame doctors. We’re being threatened by insurance companies. If we don’t do exactly what drug companies want, we’ll be paid less. In some cases, some of us might loose our jobs. (OKay, we do deserve some blame for not standing up for ourselves!)
I went for a job interview in Portland and in a conversation with the medical director of a large group there, I was told that if I failed to get my patients LDL levels down to 100 “someone will sit down and talk with you.” This particular group was able to offer a better starting salary than average. I had assumed that the reason they could offer more was through efficiencies. During the interview, I learned there was more to it than that. They had special arrangements with drug companies called ‘incentive programs.’ The medical director told me with absolute glee “we keep asking them [meaning drug companies] for money and they keep giving it to us.” He sounded like a kid at Christmas!
This group’s policy is to get everyone’s LDL under 100, regardless of risk factors. Stratifying risk is “too complicated.” So they make it simple for their docs. How convenient for the drug companies. I suspect that because this organization has such an aggressive general policy, the drug companies reward them handsomely for taking such a progressive position. They can offer about $50,000 more per year than doctors working in their own, independent offices.
HMSA is Hawaii’s largest medical insurance company. They are paying me to prescribe statins to people who have had heart attacks. Next year, they will pay me to prescribe statins to every single one of my diabetic patients. If I don’t I may loose about $20,000 and my entire group will be penalized financially as well.
If any of this disturbs you, please write to John Berthiaume MD, HMSA Vice President/Medical Director. 818 Keeaumoku Street, Honolulu, HI 96814. Or, you can write to the medical director of your own insurance company and let them know what you think about your payments going into programs that force doctors to write bad prescriptions or loose money!