How Kickbacks Transform Doctors Into Drug Pushers
This article is a deeper dive into a subject long considered taboo: “Doctors receiving kickbacks for drugs or services provided.” You want to trust that your physician is always making the right choices for your health and well-being. And most of the time, this is absolutely true, as many doctors have professional conduct and commitment to patients.
Unfortunately, the pharmaceutical industry has influence on certain doctors. Pharmaceutical fraud is real, even if it’s frequently difficult to prove. The law says it’s not legal for a doctor to receive benefit for prescribing a certain drug.
But pharmaceutical companies often give doctors incentives such as free trips, meals, gifts, and other incentives to promote their products or attend sponsored events.
Even though doctors don’t receive a commission, you can see that they can still be rewarded handsomely for prescribing specific brand medications. Offering incentives to doctors may be lawful as long as they adhere to legal regulations and don’t influence the doctor's prescribing practices.
The situation becomes murky because, while this is not labeled as direct compensation for endorsing specific drugs, it does little to eliminate the potential to have a financial motivation to advocate for a particular medication.
And so kickbacks continue to be a troubling reality. Their pervasive influence can create conflicts of interest that lead to over-medication, unnecessary procedures, and potentially harmful drug interactions, all of which can have detrimental effects on patient well-being.
How Big Is The Problem?
Data indicates that almost two-thirds of eligible U.S. physicians received payments from drug or device makers from 2013 to 2022, with the total amount paid reaching $12.1 billion over nearly a decade (Medscape.com)
Breaking that down over about 56 million payments, data shows that more than 2,500 physicians received at least half a million dollars apiece from drugmakers and medical device companies between 2014-2018, a ProPublica analysis shows. And that doesn’t include money for research or royalties from inventions. More than 700 of those doctors received at least $1 million.
In addition to pharmaceutical companies, the medical device industry has also made significant payments to doctors. A study published in Health Affairs found that between 2014 and 2017, the medical device industry paid doctors consulting fees, lunches, lodging, and other incentive payments worth $904 million. This indicates that both pharmaceutical and medical device companies have been active in incentivizing doctors.
What kickbacks (payments) do is create medical drug pushers with massive conflicts of interest, at the expense of patients. Studies have confirmed what drug companies have long known: Industry cash influences how doctors treat their patients, meaning they prescribe more of a drug if they receive money from that drug’s manufacturer. And that unnecessary evil can’t be good for patients, especially in light of the current opioid crisis.
How Kickbacks Harm Your Health
It can’t be overstated enough. If you do see a doctor for a medical emergency, then you place a certain amount of trust in that individual to represent your best interests. No one likes it when a doctor is aggressively pushy with the prescription pad. It raises suspicion, and for good reasons.
A ProPublica analysis found that such behavior translated in prescribing almost all the most widely prescribed brand-name drugs in Medicare:
Those findings were repeated for drug after drug. In 2016, doctors who received payments related to Myrbetriq, which treats overactive bladder, wrote 64% more prescriptions for the drug than those who did not. For Restasis, used to treat chronic dry eye, doctors who received payments wrote 141% more prescriptions. The pattern holds true for 46 of the 50 drugs.
The medical community has argued that industry payments don’t harm patients; an absurd statement in the face of evidence. First, there is financial harm. A study in the United States found that a 10% increase in pharmaceutical industry payments to physicians is associated with a 1.3% increase in medical costs and a 1.8% increase in drug costs.
Second, there is physical harm. Many drug prescriptions can be considered both medicine and dope; producing both euphoria and dependency. In fact, most addictions are now directly or indirectly related to prescriptions. According to the statistics provided:
Prescription Drug Abuse: 16.3 million people misuse prescriptions annually, with 5.76% of Americans over the age of 12 falling into that category.
Types of Prescription Drugs Misused: The most commonly misused prescription drugs include painkillers (9.7 million annual abusers, 59.5% among Rx abusers), opioids (9.3 million, 57.1%), sedatives (5.9 million, 36.2%), stimulants (4.9 million, 30.1%), and benzodiazepines (4.8 million, 29.4%). All prescription drugs account for 16.3 million abusers, representing 100% of Rx abusers and 5.76% of Americans.
Prescription Drugs as Illegal Substances: Prescription drugs are the third-most abused illegal substance after marijuana and cocaine. Prescriptions are the fifth-most abused substance after alcohol and tobacco products.
Commonly Abused Psychotherapeutic Prescriptions: Adderall, Ativan, Morphine, Oxycodone, Ritalin, Vicodin, and Xanax are among the most commonly abused psychotherapeutic prescriptions. These drugs are prescribed for various conditions but can be misused for their psychoactive effects.
Prescription Drug Abuse by Age: Prescription drug abuse is most common among 18- to 25-year-olds, with 14.4% of adults in this age group abusing prescription drugs annually. Older and elderly patients may be at heightened risk of misuse and addiction due to the number and variety of drugs they take for health reasons.
Source: DrugAbuseStatistics.org
These statistics highlight the significant issue of prescription drug abuse and addiction, which fall into four broad categories: sedatives, stimulants, painkillers, and anxiety medication, which when misused can lead to severe health consequences, including addiction and overdose.
Most physicians are aware that addictive pharmaceutical drugs eventually pose a risk comparable to illegal substances. Doctors who are motivated by kickbacks, essentially bribes from drug companies, are fully cognizant of the consequences. This awareness makes them accomplices in the outcomes, yet they often escape legal repercussions.
When a doctor prescribes ten different medications to a single patient, it's clear that their intentions are not purely therapeutic. This situation underscores the saying that for any pain eased by medicine, there's often a greater infliction of suffering mentally, physically, and financially. How much different is that from the drug dealer down on the street corner?
What About Canada?
Global News says Canada is also part of this unethical medical cabal. They ran a four-part series about the pharmaceutical industry and the hold it has on Canada’s health-care system — swaying doctors’ opinions, funding medical schools and, ultimately, affecting the type of drugs patients are prescribed.
The 10 largest pharmaceutical companies in Canada gave more than $151 million to doctors and hospitals across the country over the last two years. But unlike the U.S. and many European countries, Canada has no legislation compelling drug companies to reveal which health-care providers got money or what it was for.
Shelling out the most to Canadian physicians and hospitals was AbbVie with just over $13 million in total payments, followed by Novartis with just over $12 million and Amgen with around $11 million, according to the reports for 2018.
Open Pharma, a group of leading medical experts pushing for more transparency between the medical profession and pharmaceutical companies says, “There’s a real body of evidence that shows transfers of value have been associated with a higher likelihood of prescribing those drugs that may or may not be presented to them.”
When discussing the issue within the industry, there is a widespread denial of the problem. However, Global News has provided direct evidence that Canadian doctors are receiving lavish hospitality from pharmaceutical companies, aiming to boost their profits at the potential expense of patient health.
Studies show that even small gifts of less than $20 can influence a doctors decision. Doctors may resist the connection, but it all adds up to $150 million distributed by drug companies in just two years to continue the distribution of dangerous pharmaceuticals. Seeing this colossal amount of money to buy influence, it gives you a taste of the scope and extent of relationships between health professionals and industry.
Is Your Doctor On The Take?
There are some preventative laws out there, and on paper they seem to have teeth, but pharmaceutical companies are extremely sneaky and find lots of ways to get around these laws.
The Anti-Kickback Statute (AKS) is just such an example. Designed to keep medical treatment decisions free from the influence of potential monetary gain and from services they might not actually need, it doesn’t work as intended. Neither does the Stark Law, or the Physician Payment Sunshine Act. The illicit dollars just keep flowing as a whole range of activities can still be cleverly disguised as legitimate payments through loopholes in the law.
Remember, we said at the beginning of this article that currently, about half of all U.S. doctors are still accepting money or gifts from drug and device companies annually. That means about 50% of patients need to be concerned not only about their ailment, but also about the level of trust in medical services.
To find out if your doc is getting big money from certain drug makers, you can now run their name through the Dollars for Docs database.
In sum, it's a big deal that doctors are getting money from drug companies. It’s not only an unethical practice, but makes the doctor a criminal in the eyes of the law. The fact that so many doctors continue to be implicated in this unethical practice, albeit disguised through various activities, begs the question: Can patients place their trust in the ethical judgment of medical professionals drug dealers who knowingly participate in criminal behavior related to kickbacks?
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