In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.
I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the researchers did not determine if there was a cause-and-effect relationship between payments and prescribing.” To deny that perks have a causal effect on physician behavior invites improbable considerations.
In fact, the data suggests that doctors are particularly easy to manipulate. One of the researchers interviewed by Ornstein was “surprised that it took so little of a signal and such a low value meal [to influence doctors]” A Chick-fil-A is all that it takes!
We have @ChickfilA for Pharma-sponsored lunch today. Dang it. I’m hungry too. #coi cc @LisaRosenbaum17 @charlesornstein
— John Mandrola, MD (@drjohnm) June 17, 2016
On the other hand, Ornstein clarified,
…the researchers don’t think the meals themselves cause doctors to prescribe more of a drug, but rather the time they spend interacting with drug reps when they drop off those meals.
In other words, doctors are cheap dates for pharma. In response, “patients [should] talk to their doctors and ask ‘Is there a generic that’s just as good?'”
A better solution, of course, might be for the healthcare system to stop subsidizing pharma, i.e., to curtail patent laws, ease import prohibitions, and give up third-party purchasing of drugs. These factors are much more responsible for the high prices of drugs than the behavior of doctors. But proposals to remove subsidies are usually deemed unconscionable: How could an industry operate without government incentives and guarantees?!
Besides, as Margalit Gur-Alie has pointed out, much of this attention seems out of proportion to the actual economic effect:
.@marcsfz1 Agreed. Generic prescribing is close to 90%. These are blatant efforts to divert attention to inconsequential shiny things…
— Margalit Gur-Arie (@margalitgurarie) June 20, 2016
The diversion to shiny things, however, usually leads to some brilliant plan to protect Americans from the greedy and self-interested medical-pharmaceutical complex: more tinkering, more regulations, more prohibitions. That’s been the pattern for the last 100 years, a real success story for the doctrine of social progressivism, the political ideology at the root of the healthcare system. As Jeff Deist precisely put it:
Progressivism has been the overwhelming force in western politics for the last 100 years. Political progressives—defined not by their party, but by their desire to remake man into a more obedient political animal, absolutely dominated the 20th century.
The agitation about pharma-fed doctors, then, like all previous agitations, is simply motivated by that irresistible urge to shape fellow human beings to fit into a mold of behavior that will satisfy the rational and scientific norms that progressives favor above all else.
But progressives are humans as well, and ProPublica’s progressives somehow overlook that they, too, must be fed and are indeed fed by the familiar financial organs of progressivism: the Open Society Foundation, the Ford Foundation, the MacArthur Foundation, the Sandler Foundation and, most notably, the Carnegie Corporation which, as we saw previously, gifted us the Flexner reforms.
Should we cry “double standard” and ask for measures to restrict private funding of news outlets, which would ultimately restrict freedom of speech? Of course, not. We strongly believe that people ought to be free to pick and choose their source of information as they please. If ProPublica is not your cup of tea, you can go to Human Progress and be served Cato-style, courtesy of the Templeton Foundation. There are many other options, and one of my favorite is the Mises Institute’s website which, not coincidentally, is free of any dependence on big foundation money—whether from the left or the right.
Why, then, do we so easily accept restrictions against freedom in healthcare? The usual answer is that doctors must be held to a standard of objectivity that patients are too ignorant to enforce. According to progressives, only the government can ensure proper respect for the good of sick people and curtail the evil of private interests.
The real reason, however, is that healthcare progressivism operates by doling out perks and subsidies to everyone: doctors, hospitals, patients, pharma, industry, administrators, bureaucrats, lobbyists, voters…The whole 18 percent of GDP is corrupted by this boondoggle. We’ve all become hooked on the healthcare system, and there’s more influence in that dependence than anyone could ever stuff in a sandwich handed out to a hungry cardiologist.
Unfortunately, the unelected “experts” who rule over our healthcare system always hopelessly believe that just one more turn of the regulatory or meddling crank will do the trick. The great challenge seems to be that each new turn of the crank comes in the form of an impossible to read 900 page release written in such technical and obfuscatory language to force even the best intentioned and interested in the industry to throw up their hands and hire a consultant. MACRA/MIPS is just one of the latest examples on the trash heap of thousands of pages before.
Indeed!
Matt, you are quite right when you write-“The great challenge seems to be that each new turn of the crank comes in the form of an impossible to read 900 page release written in such technical and obfuscatory language to force even the best intentioned and interested in the industry to throw up their hands and hire a consultant.”
Everyone knows Santayana’s quote about history, but I think the corollary is more sobering: “The first thing we learn from history is that people don’t learn very much from history”.
We were warned of this nonsense of what has become the norm of thousands and thousands of pages of regulation, the “you have to pass the bill to see what is in the bill” mindset of present day politicians. Madison, in Federalist 62 states:
“It will be of little avail to the people that the laws are made by men of their own choice if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man who knows what the law is today can guess what it will be tomorrow”. And another; “what prudent merchant will hazard his fortunes in any new branch of commerce when he knows not but that his plans may be rendered unlawful before they can be executed?”.
Until the education system in this country begins to teach more of the Founders and less of Howard Zinn, we will continue down this Progressive road.
Michael–this is beautiful: “…healthcare progressivism operates by doling out perks and subsidies to everyone: doctors, hospitals, patients, pharma, industry, administrators, bureaucrats, lobbyists, voters…The whole 18 percent of GDP is corrupted by this boondoggle. We’ve all become hooked on the healthcare system…” Says it all! Thanks, Bob
Thanks, Bob!
The significance of the perks and subsidies is profound and cannot really be overstated. But there is another aspect of our dependence which is also of fundamental importance, the psychological dimension.
We have been persuaded to believe that they must rely on the health care system. Of course, I do not mean to suggest that there aren’t times when it is wise to consult a doctor, but self-care could be much greater than it is presently. We have been persuaded to believe that, if we didn’t have medical licensing and the licensing of drugs and medical equipment (i.e. the FDA), then we would have quack doctors and quack remedies running amok. We have been persuaded to believe that if we didn’t have the CDC vaccine schedule and mandates, then we’d all probably either be dead or suffering from debilitating diseases. In short, we have been conditioned to fear health freedom in many different ways, from childhood on.
Yes, I agree. Part of the problem, then, is that we allow those fears to take hold.