Medical Conflicts-of-Interest: A Thing of the Past
Recently I had been asked to give my opinion about a new “breakthrough” nutritional supplement that is being aggressively marketed through network marketing programs. As a physician who tries earnestly to be objective about what I see in the mainstream press, I have come to realize that the medical community no longer adheres to the high standards that not long ago were seen as a moral “high ground”. Now, I am seeing my physician “colleagues” becoming spokespersons for multibillion-dollar network marketing programs. Is there such thing as a conflict-of-interest anymore? This question is not rhetorical. Has our society completely embraced the idea that it is OK for a physician to prescribe a medicine or supplement that he himself is selling and getting profits from? Have we, as a society decided that there needs not be any distinction in moral conduct between a physician and any other salesman? It seems apparent to me that this is the case. One quick perusal of the “medicine and healing” isle at your local Barnes and Noble bookstore will demonstrate this. So why has this change taken place and what does it mean for people that are seeking the truth in medicine?
The Cause of the Moral Decline in Medicine:
First, 21st century physicians have to work harder and longer for less money. Due to the increasing amount of legal documentation that must accompany each patient encounter, fewer patients can be seen in any given day. I now spend approximately 2/3 of my time doing paperwork and 1/3 actually caring for patients. This has also affected the amount of time that can be spent with each patient. Also, insurance and medicare reimbursements are steadily decreasing. This, combined with skyrocketing malpractice premiums has resulted in a progressive decline in physician income over the past 20 years. I believe that this is one reason that physicians are looking at other opportunities to utilize their medical degree to make a living, and I can’t blame them for that.
Second, the American public has been so indoctrinated into our paternalistic medical system that they cannot conceive that a physician would actually abandon his oath to society and make recommendations to patients based on his own financial returns rather than on sound medical judgement. This “blind faith” has been appreciated by physicians over the centuries, but times have changed. Most physicians today are not the “public servants” of yesterday that would go out at all hours of the night to render aid to the sick and ailing. No, most of todays physicians are in groups and practice arrangements that are designed to limit their time commitment to their patients thus allowing them more family time. As a family man myself (married 22 years with 8 children), this has been a real struggle for me and was the main reason that I had to leave primary care to become an ER physician with no primary patients to be committed to. The oath that I took when I graduated from medical school (the oath of Geneva) clearly put my patient’s wellbeing ahead of my own or my family. This is a tough oath to take or to live by, but physicians over the generations have taken it. It is this dedication to patients that has created our extremely paternalistic medical environment. We tend to take whatever recommendation our physician gives as unadulterated, educated, and well thought through advice that could never be bought or sold for anything as immoral as financial gain.
If you therefore accept these two facts: first, physicians are making less money by traditional practice techniques, and second, physicians are still inherently trustworthy in the public eye, then it is no wonder that today’s physicians have a great opportunity to utilize this blind trust as a means to market medicine related products to a lay public. Then, as in a perfect storm, the “Dietary Supplement Health and Education Act of 1994” enacted by congress allowed nutritional supplements to be sold to the American public without any testing for efficacy or safety. This simply means that now physicians can utilize the trust that has been bestowed upon them to promote to unsuspecting customers (formerly referred to as patients) products that have not yet been shown to be effective or safe…and they are making millions doing it.
So what does this mean for the average American? Please be skeptical of any advice from anybody (and now this even includes medical doctors) promoting products that they are making money from. Look at the facts and get second opinions. After all, you don’t believe everything that is thrown at you by the plaid-jacketed used car salesman and now this applies to physicians as well. Before buying nutritional supplements or miracle remedies, you should always consult the opinion of your own personal physician that has your best interest in mind.
Joseph W. Kraft, MD
About the Author: Dr. Joseph Kraft, MD. Originally boarded in Internal Medicine and Pediatrics, Dr. Kraft is currently practicing full-time Adult and Pediatric Emergency Medicine at College Station Medical Center in College Station, Texas.