the week in review

Doctors are generally altruistic creatures, but as anyone who’s been around the medical profession knows, money and privilege can corrupt even those with the best intentions. This week was a particularly rough one in that department. A St. Louis orthopedic surgeon was accused of fabricating study data on a bone repair product; as a former Army doctor, he used the product to treat injured soldiers, and the data he faked makes the stuff look practically bulletproof. Turns out he’s on the payroll of the company that manufactures this stuff — the company paid him nearly $800K over the past eight years — so the press attention has not been flattering.

He isn’t the first to pull a stunt like this and he won’t be the last. Doctors are human and ergo, ought to be as susceptible to financial incentives as anybody else. Yet it seems the only folks who really believe this are pharmaceutical and device manufacturers, all of whom offer aggressive incentives to encourage doctors to use and endorse their products.

Which is neither good nor bad; it’s simply what corporations do since their legal, fiduciary duty to their owners is to maximize profit.

My opinion is that moral judgments aren’t terribly useful here. What we really need to do instead is to look at financial incentives that pervade the business of health care, and increase their transparency to the public. And we need to recognize that when there’s money on the table, most doctors will behave in the same fashion as anybody else.

Along those lines, this week the state of Vermont mandated that all gifts and income from pharmaceutical and device companies to doctors be publicly reported. The law passed with 65% of Vermont doctors voting in support and introduces much-needed transparency into a lucrative sideline for many physicians, one that may subtly influence their practice habits. (Incredibly, many physicians believe they personally aren’t swayed by drug salesmen, in spite of overwhelming evidence that the opposite is true.) Let’s hope it’s a step towards serious change in the opaque world of health care incentives.


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