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The Pharma-Fed Doctor

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It's true that perks from pharma companies influence doctors. But pharma dollars are nothing compared to the subsidies doled out by governments.

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!

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:

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 20thcentury.

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, etc. 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.


Michel Accad, MD

Michel Accad, MD, practices cardiology and internal medicine in San Francisco, offering individualized care in a free-market setting. His blog about health care and medicine is AlertandOriented.com. He also co-hosts the Accad And Koa Report podcast.

Note: The views expressed on Mises.org are not necessarily those of the Mises Institute.
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