Monday, January 8, 2007

Getting Screwed

The New York Times reported on December 30th, 2006, that one screw used for spinal fusion costs $1,000. By the time they put in the plates and other hardware, the average cost of this type of surgery gets close to $10,000. The "getting screwed" part gets worse when you find that a significant number of doctors performing these surgeries have stocks, or commercial interests in the companies making the screws, and all the other stuff.

The problem "sickens" when we consider that these type of surgeries, and back surgeries in general have been repeatedly shown to be no better that physical therapy, or rehabilitation for low back pain. And rehab is more cost effective (Annual Meeting of the North American Spine Society, Chicago 2005. J. Family Practice News, January 1st, 2005; British Medical Journal 2005;330:1233)

Chiropractors have been saying this for many years; yet, they are often ignored as "quacks."

Let me tell you one more piece of information before I "braindrop" any more about this point:

Surgeons profiting from these hardware deals are going to be investigated under the umbrella of "conflicts of interests," thus joining some Oncologists, who tend to overprescribe expensive experimental chemotherapy treatments in the last three months of patients' lives (American Society of Clinical Oncology, Atlanta 2006.) In my opinion, it is better to get patient's into hospice care for comfort and dignity in passing, not financial ruin for surviving relatives, and a death full of false hopes and overly aggressive interventions in hospitals hell-bent on pushing futile treatments.

So, why are some chiropractors ignored (many reasons, but, let me stick to this line of thought,) and what do they have in common with some Oncologists, and some Orthopedic surgeons, and a rising number of medical doctors selling nutritionals supplements, herbs, and some jungle juice that is going to cure everything?

They are selling products for medical conditions they themselves diagnosed in their patients.I believe this is unethical. No one is above the temptation to allow our own financial interests to cloud our judgement, and that includes me.

The AMA fails to understand that, allowing these ethically compromised behavior to happen in health care. The AMA feels that it is OK to sell stuff, like vitamins, etc, if there is no mark-up, and the patient is not able to get the product in question elsewhere. As you can imagine, these conditions are often violated, with no policing taking place.

Some Chiropractors and other non-MDs engage in the same type of behavior. Ultimately, the patient suffers by getting stuff sold to them that only help the financial considerations of the care provider they trust to be acting in the patient's best interest.

Academic medicine, or researchers hired to study a given product are also being looked at. Often, their results are influenced, if they stand to gain from the company that hires them. Some researchers are even given stocks in these companies.

In my opinion, physicians, and all care givers, would do best to abandon these questionable practices.By the way, I sell nothing. I do work as an independent contractor at a clinic with a store within the facility. I see no profits from such practice, which I have recommended against, since it may be interpreted as a conflict of interest by patients who come to see me there. I do on ocassion receive a stipend for speaking about nutrition from several companies involved in sales of nutritional products. I do not own stocks in any of them, nor do I plan to do so in the future.

Speaking engagements are costumary in the medical profession, and sanctioned, as long as such activity is known to the patient. I have also stopped eating lunches provided by pharmaceutical companies, and attending their educational seminaries, or classes. If I could, I would refuse their drug samples as well, but, again, I do not own the clinic I work at.

I realize I may be pontificating here. But, then, these are just "braindroppings..."

Hugo Rodier, M.D.