Wednesday, January 30, 2008

The Bu$ine$$ of Medicine

Here are two articles about doctors profiting from their patients. In both, the doctors appear to be basing their treatment decisions on how much money they can make, rather than what is best for the patient.

The first is from the New York Times, and discusses how an artificial disk for the spine called Prodisk made it through all the testing that these things need:

In a study of nearly 240 patients with lower back pain, the doctors said that the Prodisc, an artificial spinal disk, had worked much better than conventional surgery in which patients’ vertebrae were fused.

“As a surgeon, it is gratifying to see patients recover function more quickly than after fusion and return to their normal activities more easily,” Dr. Jack E. Zigler, a well-known spine specialist and one of the study’s lead researchers, said in a 2006 news release announcing the latest results of the Prodisc clinical trial.

As it turns out, Dr. Zigler had more than a medical interest in the outcome. So did doctors at about half of the 17 research centers involved in the study. They stood to profit financially if the Prodisc succeeded, according to confidential information from a patient’s lawsuit settled last year.

The other article is from NBC News Chief Science and Health Correspondent Robert Bazell who talks about cardiologists doing much the same thing.

Some very smart doctors believe that the vast majority of the 1.6 million Americans who get these procedures in any year may never need the expensive and potentially dangerous interventions, or at the very least, they don't need them yet.

But we don’t hear much about option No. 3 because it is drowned in the tsunami of profits made with the procedures, especially angioplasty with stents.

Let me be clear, the vast majority of interventional cardiologists — the doctors who perform angioplasties — are honest and caring physicians. But I remember standing in scrubs outside a procedure room in Miami when the other doctors (who mistook me for a colleague) were bragging about how many “normals” they had done angioplasties on. That’s right, people came in complaining of shortness of breath or chest pain, so the doctors put them into the cauterization lab and examined their vessels, then told these patients they needed an angioplasty and did it knowing full well it was unnecessary.

For many doctors and hospitals, angioplasty has been the mother lode. I’ve had young interventional cardiologists brag to me of their multi-million dollar signing bonuses to change hospitals.

This specialty faces a mine field of potential conflicts because so much of it is based on self-referral.

What ever happened to Marcus Welby, M.D.?

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