Faith Based Medicine

From "The drugs don't work: a modern medical scandal," in The Guardian, Friday September 21, 2012, by Ben Goldacre, author of "Bad Pharma."

Doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it's not in anyone's financial interest to conduct any trials at all.

Unfortunately, that ad hoc method is how they choose most of the care they recommend for patients.

Higher Doses for Higher Profit

From Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease, by Ajay K. Singh, M.B., B.S., and others for the CHOIR Investigators, in The New England Journal of Medicine, Volume 355:2085-2098 November 16, 2006 Number 20

Among the world's best selling prescription medications are those prescribed to patients who suffer anemia as a result of kidney problems. The most profitable part of treating them is selling them drugs. Some independent scientists believe that, in part, is why patients are receiving doses that are too high, because dialysis clinics maker bigger profits for higher doses. The higher doses do not improve quality of life in any way but do result in high blood pressure and strokes and heart attacks in patients who at lower doses do not have those problems.

Treatment of Anemia Questioned, by Alex Berenson, New York Times, November 30, 2006

 

The Spine as a Profit Center

From "The Spine as a Profit Center," by Reed Abelson, an article in the New York Times on Saturday, December 30, 2006

Most of the companies making devices for spines are private so the relationships between them and the spine surgeons who invest in them are not publicly disclosed. Usually there is no way for patients to understand the doctor's financial interests.

Doctors who use the products of companies in which they invest say they do not let financial interest influence their medical judgment. If a city council member awarded a city contract to a company in which he/she owned an interest, would we accept that? If a school principal awarded contracts to a firm in which he/she owns an interest, his/her job could be lost. The fact that doctors believe and expect us to believe that they are selfless and objective and beyond reproach to this extent shows how much the opposite is true. If they are no better judges of themselves than that, then they simply cannot be trusted with our wellbeing.

Allez Spine in Irvine, California has the 120 doctors who invested in it serve as its customer base. The spinal screws it makes cost under $100 to make but sell for $950. A normal operation needs 6 of them as well as other parts costing $7,000 to $8,000 per operation. There is a lot of money to be made in devices. Allez says all their relationships are disclosed to patients, but how many patients are sophisticated enough to see the problem with this? Especially when they are sick and being told they will be healed by the doctor with the questionable financial interest?

About these financial relationships, Dr. Charles D. Rosen, a spine surgeon at the University of California at Irvine, and president of the Association of Ethical Spine Surgeons, says, "These are, I believe, unethical and bias the doctors' choice for what is best for the patient."