Health

Who Else Is Paying Your Doctor?
From The New York Times
Published: January 20, 2012
A version of this editorial appeared in print on January 21, 2012, on page A22 of the New York edition with the headline: Who Else Is Paying Your Doctor?
Editorial
It took longer than expected, but the Obama administration is finally poised to enact badly needed regulations requiring that the manufacturers of drugs, medical devices and medical supplies disclose all payments they make to doctors or teaching hospitals. The information, which would be posted on a government Web site, will allow patients to decide whether they need to worry about any possible conflicts of interest.

Such payments can be for legitimate research and consulting. But there is also a lot of cash being spread around to pay for doctors’ travel and entertainment or for gifts or modest meals for a prescribing doctor’s staff.

As Robert Pear reported in The Times this week, some prominent doctors and researchers receive hundreds of thousands or even millions of dollars a year in exchange for providing advice to a company or giving lectures on its behalf. About a quarter of all doctors take some cash payments from drug or device makers and nearly two-thirds accept meals or food gifts. Analysts contend that even seemingly trivial gifts can influence doctors to prescribe expensive drugs that may not be best for a patient’s health or pocketbook.

The new rules were championed by Senator Charles Grassley, a Republican, and Senator Herb Kohl, a Democrat, and incorporated into the health care reforms enacted in 2010. The reform law required the Department of Health and Human Services to establish reporting procedures by Oct. 1, 2011, and required manufacturers to start collecting the relevant data by Jan. 1, 2012. The proposed rules were finally issued on Dec. 14 and are subject to comment until Feb. 17, after which they will be revised and issued in final form.

The Centers for Medicare and Medicaid Services will publish the disclosure data on a public Web site that the law says must be searchable and understandable so that patients and advocacy groups can see which doctors are being paid and how much. Manufacturers could be fined up to $150,000 a year for failing to report payments and up to $1 million a year for “knowingly” failing to report.

The new rules should give a welcome boost to otherwise spotty efforts by some companies, medical centers, scientific journals, states and ethical codes to eliminate, minimize or at least disclose financial interests that might cloud medical judgments. The existence of the Web site could deter some questionable payments. And it could help patients decide which doctors to rely on.

Popping Pills
The older one gets, the more likely it is that they will require medications of some kind. It is just a reality of the ageing process. Some people can avoid prescription drugs well into old age, but most sooner or later end up taking at least one pill every day. Prescription drugs can be a life saver, but
they also create their share of problems. Therefore, it is important for you to be an informed participant when discussing medications with your physician. Here are a few hints on how to be an effective drug captain.

When It Comes To Drugs
The Physician Is Your Consultant
 Not Your Manager

Let the physician know that you are an adult consumer who doesn't want to be treated as a helpless victim. Make it clear that you have every intention of  taking an active role in planning your drug therapy. This is an important declaration. It helps to prepare the consulting physician for some pointed
questions regarding his/her prescribing intentions. Remember, an assertive  patient does not have to be an obnoxious one. You can be open and straightforward with most physicians and still maintain a good relationship.  The tone of delivery is usually as important as the message. You may say
something like this:

      Dr. Zorba, I am the sort of person who gets very concerned
      over the kind of chemicals I put into my body.
     I want to feel comfortable asking questions about any drugs
     you prescribe for me.
    So please bear with me, and be patient with my questioning.
    I want to be an educated consumer so I can properly look
    after my best interest.

You may find it difficult to get your little speech out without being interrupted by the physician. Please appreciate.....people rarely talk to physicians in a self-assured manner, so they may have their guard up at the start. Don't give up if their initial response is somewhat aloof and blunt. A little persistence mixed with patience, understanding and good humour usually brings them onside. Once you make your wishes clear, most will try to accommodate them. Indeed, given the green light, some will even encourage your active participation.

Never enter into a conversation regarding prescription drugs without a pen and paper because the first step is to make sure that you get the correct spelling of  the drug. The correct spelling of the drug offers you the opportunity to research it later, and it also puts you in the position of being able to check the name on the label of the bottle once you receive the drug from the pharmacy. The physician will often just say, "Here, you should get this," while handing you a prescription slip. There is no point in relying on the prescription slip because many physicians don't write in a legible fashion. It is part of the mystique.

You owe it to yourself to make sure your temporary vulnerabilities do not turn  you into an ignorant victim. If  you plan to take a prescribed drug, you should know what the medication will do to you. Ask! What is this drug supposed to do to me? Is it supposed to thin the blood, stop headaches, open
the bowels, prevent pain, stabilize blood pressure, relax me, or do any other number of things to my body? Be sure you know the expected outcome. You also want to be clear about the side effects of any drug you intend to take. Simply say, "Please explain in detail what is likely to happen to me
when I take this medication."All prescription drugs have side effects of some sort. They may be minimal, but you should still be aware of them.

Paternalistic physicians may gloss over the side effects fearing you will fall victim to the power of  suggestion if they place too much emphasis on the downside. That is, they refrain from focusing on  the possible side effects because they fear the mere suggestion will cause you to imagine they are
present. There is some validity to this concern, but it doesn't take precedence over your right to know. It is also wise for you to ask the physician what conditions must exist to eliminate the need for taking the drug. Is the prescription a life sentence or is there a way to monitor progress with the hope
of stopping use of the drug? You should also know what is likely to happen should you decide not to take the drug. You may get a brusque response to such a query, but it is still an area worth probing. Obviously, if the physician genuinely believes you will be dead in a month if you don't take the
drug, that will strongly influence your decision about what to do.

You also have a right to know if  the physician has done any independent  reading about the drug he is prescribing, or is he totally dependent  on  the  information  provided by the drug manufacturer. Many physicians depend on the drug industry's representatives for much of the knowledge they acquire about the drugs they are recommending for your use. If the physician claims to know little about the drug other than what has been communicated by the drug salesperson, then you may wish to consult someone else to get more information. Don't forget, your local pharmacist is probably the best source for getting information on drugs. In most instances, the pharmacist has a more in-depth understanding of the chemicals on the market than does the practicing physician. Conversely, if the physician indicates he has read material, you may ask for a copy of one of the research reports.

There is no reason to be snarky, impolite or impatient in attempting to engage the physician in this dialogue. And don't forget, it is always wise to end
helps physicians adapt to adult- to-helper relationships, rather than victim-to-helper ones, when they receive positive feedback for trying to interact in an adult fashion. Besides, trying to leave the visit on a good note is important because you will likely be seeing the physician again.

Most people lack confidence when it comes to deciding on prescription drugs. That is why so many completely submit to the wishes of  their physician. Being well informed helps you avoid excessive dependence on the prescribing physician. You, like the physician, are unlikely to become an expert on all drugs. However, you must be prepared to interact with the physician as a responsible
adult consumer rather than as a vulnerable child. Make no assumptions about your physician's level of  expertise on drugs. There are literally thousands of  drugs on the market. To get some idea of the number and variety, go to your local library and scan a copy of the Compendium of  Pharmaceuticals and Specialties published by the Canadian Pharmaceutical Association (2009). Just a quick glance at this drug encyclopaedia will explain why no individual could possibly have even limited knowledge of all the drugs on the market. The sheer volume renders it impossible for any practising physician to devote the time required to acquire such knowledge. Even the drug sales people must confine themselves to areas of specialization, and they devote their entire working life to promoting and selling prescription drugs. So who do the physicians rely upon for information about the drugs? The drug companies' sales representatives. That's right! The sales representatives along with advertising material and publications such as the Compendium of Pharmaceuticals and Specialties, which include advertisements from drug companies, are the busy physicians' main sources for information on drugs. There are also the professional journals, but most of them are supported by advertisements from drug companies. In other words, it is near impossible for the physician to escape the onslaught of  advertising and  promotion generated by the pharmaceutical industry.

No doubt the above comments have created some concern for you regarding prescription  drugs. Good! It is in your best interest to be well informed regarding any substances you are putting into your body. I urge you to use caution. I know medications can play a very useful, and at times life-saving, role in people's lives. However, it is to be emphasized that prescription drugs do not offer any cut and dried solutions. Never fall into the role of victim and leave all responsibility for your well-being with the physician. That would not be fair to the physician or right for you. It is essential for you to pursue a responsible dialogue with the physician when you are trying to determine which prescription drugs to use. You need sound information to make a responsible decision. Neither you nor the physician can work as the lone ranger if you wish to maximize the benefits of medication. It takes a team effort even though some physicians may believe they know what is best for you. In fact, your best interest is rarely served when the physician tries to subtly exclude you from the decision-making process. Do not allow it to happen.

So the message is rather simple. Take an extremely active role in planning the drug regime that you intend to follow. Obviously, the physician is a crucial participant in the decision-making process, but you must never forget that you are an equally important participant. Ultimately the decision as
to whether or not you use a prescribed drug is yours, not the physician's. Therefore, it is crucial for you to take the time to think through the pros and cons. As with most important matters, you want to strike a balance. It would be unwise to be so mesmerized by the drug industry's propaganda that
you accept any drug put before you. Alternatively, I would not want to see you in the position where your fear of drugs leads you to harm yourself or go through unnecessary misery because of an unrealistic commitment to abstinence.

Enlightened Choice

 Comes With Education

The above is an excerpt from Cardiac Champs by Dr. Larry McConnell
Copyright © Dr. Larry McConnell. All Rights Reserved.