patrick.net

Patrick seems to have lost his free market chops when it comes to paying his doctor's bill. Take it from me, watching people who can't pay their doctor's bill is as much fun as watching people who can't pay their mortgage. Losers.

There's no free market in medical care anyway. You shop around when you're bleeding?

Not that I would deny anyone the right to choose doctors or pay for private insurance. Only that our current system is _worse_ than a single-payer system.

"....pb3030 Says: All of you people in favor of national health care need to carefully think about how the system REALLY works in Canada, Great Britain, and the rest of Europe. There are many, many horror stories."

Wow. OK, how about health car rationed by insurance companies and poverty. Horrible enough? Well, then there's the old one of people turned away from emergency rooms because they didn't have insurance.

Look, the bottom line is, almost every other advanced country in the world somehow manages to provide national health care. Are you telling me that the USA is somehow too stupid or too poor to afford this?

Yes, single-payer health care is not a panacea. There is none. It's just better than the greedhead, unregulated every-man-for-himself free-for-all that we've got now.

Does anyone have examples of what they pay for insurance?

I am under Tricare so I only pay $114 per quarter. So far I have paid nothing out of pocket for daughters birth (including sonograms), 2 colonoscopies (ancestor med history had me get probed much earlier than normal), any meds, annual physicals (including MRIs) and lots of blood labwork. I am in very good health, I can't imagine what they put a sick fellow through.

My English Grandma bought trip medical insurance before coming to USA for a visit. She cought pneumonia on the flight and ended up in the hospital for a week. No out of pocket expence for her private room, meds, and care.

My mom was in a nasty car wreck last year that broke some ribs. She had a private room in a local hospital for a few days, hooked up to what reminds me of the Star Trek sick bay instrumentation, where a screen shows heartbeat, ph0 and a few other visual graphs. Ambulance trip was paid by county, emergency treatment was covered, and medicare paid for
the remaining treatment.

I paid medical insurance for my nephew up until a few months ago. The cost was $238/mo.

Even if we do not get a NHS style coverage, I wonder how many Americans could accomplish the same by choosing a less expensive house and/or more practical car and use the savings to buy insurance. Emergency room care is already free.

Headset,

We pay around $200 a month for (2) empty-nesters ( 46 and 50 y.o ) in decent health. BC/BS thru wife's emp.

Our problem is that we'd be better off going w/ LifeWise and just getting a catastrophic policy and recoup premiums off of Sched. C but it's difficult for people that have always been on an emp. based system to "just let go".

I'll be on Tricare @ 60 but I'm sure it will be different by then.

I pay around $500/month for wife and kid. Our premiums are little higher than that, our employer is covering that amount right now. My insurance is covered by employer. My wife started work around 6 months back and she started to get coverage from her work. They didn't do her paper work correctly and she only got her paper work a month back. Weird thing is, they put effective date as 2 months back. I go to my HR to cancel my wife's insurance and they ask for document of her coverage from her work initiated in last 30 days. Now, I got to wait till june for the changes.

No wonder, i love this system so much.

An example of medical costs: Trip to primary doctor, think only 15 min. May have gotten billed for 30min because we covered two topics? Got a referral and some advice.

Billing description:

Ov Est PT Level 4 Joe The Doctor MD $255.00
I paid 10.00, insurance the rest.
(California.)

MeanGreen, I can agree that nurses are overpaid, again using teachers as the yard stick.

Headset, my insurance is $431/month (this is the full cost) for one person, as of May. This is an HMO with the 10/10/100 copay/prescription/ER structure.

DinOr, sa, justme,

Those costs sound reasonable. Did you ever have trouble getting the care you needed? Long lines? Good quality?

justme says:

Got a referral and some advice

It took willpower for me not to take advantage of a straight line like that. Just think of the quips that would apply! I am sure everyone here can come up with a good one.

Headset,

I really wish I 'could' respond to that? It's a constantly moving target. Of late we're paying on an 80/20 and the deductible is $500 per person per year. The... copays vary depending on whether the HC providers are in or "out" of Network and we have to regularly end relationships if they are dropped or the company changes the insurance provider.

We 'were' w/ CIGNA forever. Then they decided to go w/ BC/BS and you start to wonder if these changes aren't made to keep people off balance? By keeping the shell game it's almost impossible to plan ahead. IMHO.

Headset.

I must be dense, I do not see the potential for quips. Enlighten me.

DinOr,

I presume that you can plan a yearly physical, get care for any sudden illness, and get meds like the high dose niacin they push on anyone over 50. Just that you can never can determine in advance what the costs will be? Or perhaps where to go for treatment?

justme,

I doubt that you are dense, just politically misguided. :-)

Perhaps I am a bit sophomoric, and assumed others were as well. When you write of a doctor giving "referral" and "advice," the quip that immediately comes to mind is:

Referred to the local "clinic" and advised to wear a condom next time.

Like the fellow who has something to say to a group that is gathering up to leave an event. The fellow blurts out "Mine's real short" in an effort to get the group to pause an listen. Of course that line also evokes an obvious quip, along the line of "Your poor wife!" Nothing mean or personal, just taking advantage of an opportunity.

Bingo! Patrick, the real problem is limited supply! Government license requirement in cahoots with AMA! If anyone and everyone is allowed to practice medicine, prices will come down.

The 31% administrative cost is peanuts when compared to the 87% administrative cost in government-run single-payer welfare. Only 13 cents out of every dollar allocated to welfare budget actually reach the intended recipient. What residual competition there is among insurance companies and among hospitals (for those who pay their own bills, especially for things like dentistry, which is usually not covered in most plans now) is what's keeping administrative cost down to 31%. Without competition, an industry would be almost entirely taken up by administrative cost, just like government-run single-payer welfare industry. Comes to think of it, under a single-payer medical system, medicine will indeed be like welfare: from each according to ability (i.e. tax on ability to earn), to each according to need . . . i.e. the presumption of perfect knowledge in resource distribution without any cost associated with acquiring such knowledge. In real life, every single piece of knowledge on where resource is most urgently needed comes at a cost; market price signals are what transmit those pieces of knowledge.

If you want to see how much health insurance will cost you, go to http://www.ehealthinsurance.com/ Just enter your gender, zip code and birth date.

Health insurance is relatively affordable here in CA, but really expensive in NY , NJ and MA because of guaranteed issue.

1. The health care system of a nation is a product of its culture. Imagine the case of two hypothetical countries:

Country A
- People are health conscious and try to take good care of themselves.
- People don't like going to the doctor unless they have to.
- People do not see prolonging life at all costs to always be the best decision.
- People are willing to pay out-of-pocket for visits to their doctor to take care of minor health problems.
- People do not consider the co-existence of a private and a public health care system to be unfair.

vs.

Country B
- People are not as health conscious.
- People go to their doctor for every little problem and expect to be cured.
- People regard prolonging life at all costs to be an inalienable right.
- People see health care as an entitlement and want it to be 'free' or provided at a low cost that may not be realistic.
- People see a two-tiered private/public health care system as a product of class discrimination.

It would not be unreasonable to conclude that Country A would likely have a health care system with lower overall cost.

2. People will pay for what they consider worthwhile.
Consider the amount of money that people are willing to pay out-of-pocket to have beautiful teeth, bigger boobs, smoother skin, etc., not to mention McMansions, granite counter tops, SUV's and big screen TV's.

3. One size cannot fit all.
As a Canadian, I have access to essentially free 'universal' health care at the following costs:
- Big Brother keeps over half of what I make
- Mediocre health services due to chronic underfunding and bureaucratic waste and inefficiency
- A lack of choice - If I wanted and was willing to pay for better service or essential service that was not available where I live, I would have to look for it in another country. Note that this could be a matter of life and death.
- Long wait times because of inefficiency and a lack of incentive for health care personnel to work hard, thanks to the pervasive union mentality. I like Michael Moore's films in general but I can tell you that his depiction of the Canadian system in Sicko is biased.

4. The pragmatic system
- Coexistence of an appropriately regulated private, for profit system and a public health network
- Allow free market mechanics to work to lower costs (for those who argue that this has not worked in the US, note that it is the corrupt political system and crony capitalism that is in the way of a truly free market)
- Encourage citizens to utilize the private system, especially for primary health care and elective procedures
- Encourage citizens to save up for their health care needs through tax incentives, etc.
- Use the public health network as the system of last resort so nobody dies on the street and that the poor will have access to basic care (think soup kitchen - it keeps people alive but ain't no five star gourmet buffet)

5. Two guiding principles
- Let (force) people to make the best choice for themselves but also make them suffer the consequences of their unwise choices
- If you want to be a chooser, make every effort not to become a beggar

It's interesting to compare and contrast systems internationally, so I'll post thoughts as they occur to me.

I don't think it's necessarily 'single payer' that's the solution to high healthcare costs, altho just about every single payer country costs about half of the US system per capita, according to one analysis I've seen. It's probably also worth separating the primary care MD visit/script/pharmacy experience vs going into hospital or outpatients as 2 very different sorts of cost bases.

US medical salaries seem quite high, most nurses in Oz are paid $50-70K only (which has roughly equivalent buying power domestically to USD), and there are very few NPs, almost non-existent, so there's no career path there for nurses, and PAs don't exist at all. Many nurses have to work nights just for the shift penalty loading of say 10% to make ends meet. No wonder it's one of the most abandoned careers going in this country.

Drs in hospitals in their intern years are on a $45K p.a. salary, and choose to work 16 hour shifts to compensate for it!

GPs that I've quizzed only make $70-90K in private practice generally after overheads are paid. The govt rebate for a 10 minute consultation is not very high, compared with that $255 bill above -- I think it's about $30 only, and many practices do not charge patients any more than that (a potential 'gap' amount). That means if they can manage 6 patients an hour, shovelling them through, that GP is grossing only $180 per hour, out of which they have to pay receptionists, their own superannuation, practice overheads and ongoing training, etc. Hence why they end up with $80K a year or similar.

Even top surgeons make no more than $300K p.a. in this country which is a very comfortable living but nowhere near US pay rates. And it takes many years of specialisation study and some pretty expensive exams to qualify.

There is an extra tax in Oz called the 'Medicare levy' which is an extra 1.5% of income at tax time -- this was added a while back once pollies realised they really couldn't continue to pay out of general income tax revenue. There was some stuff (tax changes) in the last govt to encourage movement to private health insurers a la the US model, but it's been mostly a failure, and the govt actually paid 1/3 of the premium to encourage people to join! and put in some penalties for not joining. The new Labor govt may well undo a lot of it tho.

In terms of 'free market' approaches and alternatives, I understand NSW Health (responsible for the running of public hospitals at a state level) is really over-administered and micro-managed by too many bureaucrats, but I could suggest a number of models to try to deal with that -- particularly selective outsourcing of functions to the private sector to manage staffing etc. This would not change the 'single payer' model at the Federal level at all though, simply improve the running of hospitals. I happen to work for a company that specialises in taking on outsourced govt contracts of any type at all, and it's very clear to me efficiencies can be made without absolving govt of accountability and responsibility. So reported 'inefficiency' in such systems does not mean the death knell of single payer or a guarantee of universal health care -- it just means some of the bureacratic bloat could be dealt with one way or another. All the state govts here are now meant to be broke as a result of the GFC and reduced revenues, and I know they are looking increasingly to cheaper outsourced options as a solution to their woes.

EBGuy Says:

April 29th, 2009 at 10:18 am
Just sos youse all know - yes, I’m looking at you, EBGuy.
DS, Let’s put it this way, I was in the room with two female doctors in a social situation. One educated and licensed in California, the other, educated in Europe and trying to become licensed in California. The practicing doctor personally apologized about the US system and how onerous it was for foreigners educated and licensed abroad to become licensed in California.

No, I don't disagree, the point was that it is not the AMA that controls places or licenses drs -- it's the state medical board, as indicated above -- the AMA are simply like a union for doctors, they lobby and grandstand, and not all doctors are even members. It's the same with the Oz AMA and the BMA. There's some confusion in general out there.

Interestingly, Oz is very interested in poaching drs trained overseas, but require that they work in an area of shortage (meaning rural/regional/remote) for a solid 10 years to get a visa! So you now have multitudes of overseas drs in every small town. They often like to live on the edge of the nearest large city and commute also, so they don't really assimilate into the local community. Some of them are sociopaths and poorly trained or next to useless. As I noted, there are some 2,000 domestic graduates and 4,000 imports every year as the source of supply. This strikes me as a Federal govt not willing to pay for local uni places.

So base supply comes from graduates and o/s arrivals. Also, the Fed govt issues 'provider numbers' for the single payer system that entitles drs to Medicare rebates, as per my preceding post (when it comes out of approval). You can practice medicine privately without a provider no, but no-one in their right mind would try, because you would get very few patients. Restricting the issue of these provider nos allows the Fed govt to keep more drs locked into the hospitals, and out of private practice, thus propping up the public hospital system. Sneaky.

Finally, the Colleges of specialisation control the numbers entering specialisations, simply by only passing so many people a year.

Headset,

We rarely go to a doctor, even if we go it's for simple things. We are forced to take yearly check ups (which is not bad) but got screwed last year (It was our HR screw up).

From what I see, our costs wouldn't be more than $1500/year without insurance. If we let free market, it would be less than $1000/year. We as a family are paying around $11000/year.

My other main concern is, existing system doesn't incentivise people to get healthy. We are paying for a lot of inefficiencies in the system. Lot of unwanted people in the middle.

Headset,

Right, not knowing who'll be on their coveted PPO List from qtr. to qtr., costs but most importantly, billing procedures.

Earlier, some d!ckhead ( who apparently hadn't read the WSJ interview w/ Patrick and his modest oak table ) called everyone that "can't pay their mortgage" loosers. You needn't "lose your market chops" to not know WHO is billing you, WHAT they did ( if anything? ) HOW they even got your address or WAS their involvement even necessary?!?

Not to mention all of the double and even TRIPLE billing! The other thing that hasn't been brought up is all the monthly publications and "feel good" pulp that gets snail mailed out to you on a regular basis.

"It's cold and flu season! Are you ready?"

Ahem, some putz is getting paid and paid well to do all this promo cr@p and I'm sure they have a staff complete w/ graphic arts designer etc. You're PAYING for that glossy cr@p and the only 'use' "I" have gotten out of it is for puppy training and bird cage lining.

ian807 says

"Look, the bottom line is, almost every other advanced country in the world somehow manages to provide national health care. Are you telling me that the USA is somehow too stupid or too poor to afford this?"
and
"Yes, single-payer health care is not a panacea. There is none. It’s just better than the greedhead, unregulated every-man-for-himself free-for-all that we’ve got now."

Not a single fact mentioned in your retort. Your specious arguments are an example of what's wrong with political dialog today.

1) Other countries do it. -- Other countries do lots of things we don't want to do and other countries are going bankrupt. Check your facts.

2) USA is somehow too stupid or too poor ... -- Plain old mudslinging. What's the point of saying stuff like this? Does it move anybody's agenda forward?

Here's the question to consider: Is it, or is it not desirable to have national health insurance. What form should it take? How do we motivate people to take care of themselves? How do we keep the system from bankrupting us? These are relevant questions to which I would like relevant answers.

As a country, we have to speak to each other respectfully, and think over the facts. I don't know where we will end up if we do not.

Headset,

;-)

Well, better to be considered misguided than dense. I'll take that any day.

Realty,

>>The 31% administrative cost is peanuts when compared to the 87% administrative cost in government-run single-payer welfare.

I severely doubt this (87%) number. Please provide a reputable reference.

Medical service and product are limited resources universally, period. No country can afford to have everybody prolong life at all costs. What is unfair in this country is, why do the 65+ group get the right to prolong life at all costs while those of us who are working our ass off to pay their bills, do not get the same right?? If we lose our jobs, our COBRA easily goes in the thousands per month for equivalent coverage. On top of this, private insurance is not guaranteed for everyone, you can easily get turned down for pre-existing issues.

That's why it makes more sense that we all have a lifetime maximum, which is what our current private insurance system does anyway. My group and private insurance has a lifetime max of $6-7M, why should the government be any different? If you are on government dough, shouldn't you fall under rationing system anyway? Hey, I am a taxpayer, and I don't like the idea of my $$$ going to support a 90-yr old for another 3 months of bed bound life (while I do not get the same option from government). If he has enough resources to buy his own life extension, all power to him, but if he doesn't, he's just a leech on taxpayer dollars, making him no different from employees of AIG, so we as taxpayers do have the right to examine whether we should throw resources to keep him alive.

Lifetime max will also incentivize people to take better care of themselves. This obesity laden country will have lots of people who fortunately or unfortunately won't drop dead after a heart attack by 55, but live on with diabetes, triple bypass, stroke etc and under the current medical system, no dollar will be spared to keep them alive for many years, because the single biggest area of medical R&D dollar is spent on heart, and there are lots of expensive ways to keep a very unhealthy person "alive" with extremely high social costs. This is again unfair to those of use who expend our own resources to keep ourselves fit and healthy, why should I be paying taxes for those who don't really care about their own health? So there should be punitive insurance premium for those who smoke, do drugs, are grossly overweight, etc. Or they should be denied from the insurance system until they clean up their own acts.

OO,

Right, the current system is designed to reward those that can limp into Medi-care age on a wing and prayer and we'll take it from there! See? You made it! You are now officially someone else's problem.

By implementing 'some' kind of a Lifetime Cap we could legally say, Dude.

Oh, that's "it". Just... Dude.

Not just a lifetime cap, but NHS style rationing?

http://www.telegraph.co.uk/health/2512639/Kidney-patients-denied-too-expensive-life-extending-drugs.html

Niiiice! So now I'm painted into the corner of "clubbing baby seals"?

I mean, why NOT?! Since I'm so f@ckin' good at it.

At 24,000 pounds a year ( that's like what 50k USD? ) what am I supposed to say? Screw 'em? O.k, let's try this, how many starving school kids will go *without* a second helping to make sure we can keep a 62 y.o alive for another year? ( While we're tugging on heartstrings? ) :)

24,000 quid is about $36,000, or about $3,000 per month.

Why does the cancer treatment drug cost so much? Can't they buy it from Canada and bypass the "big pharma" obscene markup?

NHS is doing the right thing.

In UK, you can easily purchase private insurance on top of NHS coverage, I know plenty who bought BUPA (their BC BS equivalent) to cover stuff that NHS doesn't cover.

Why should I shell out $3000 a month for someone else whose chance of living on is very thin anyways? He should be shelling out for himself if he desires to live on so much. As a taxpayer, I am more than willing to pay $3k for starving kids or kids' education because they will have a much better chance to better my future than dying patients.

I am completely fine with buying my own insurance on top of national coverage, and in fact I will never rely on national coverage alone. Life is not fair, people are born into different financial and social situations, or even different inherent health, and medicine is not invented to level such playing field. Socialized medicine is only put in place to give us best effort to save every member of the society, knowing that it is IMPOSSIBLE to save every single one, we have to make tough choices and constantly let someone go.

These kidney cancer patients should have bought BUPA when they were healthy. Why didn't they plan ahead?

Terminal cancer drugs are expensive, no matter where you buy them. They are expensive because of the R&D cost, and such drugs usually have very limited targeted customer segment, so if you amortize $100M over 1000 patients per year, the drugs have to be expensive to recoup the initial investment.

These drugs are also NOT that effective. Their marginal lifetime gain is minimal at best (usually less than 12 months), at the expense of quality of life. Many terminal cancer patients are better off NOT going through the expensive chemo and die with dignity. I have seen two terminal cancer patients who expressed regret in going though the painful process, if they could choose again, they would rather opt for a peaceful death.

It is a sickness of our society to pursue the length of "life" at all costs.

pb3030,

you fail to understand one thing. In the current medical US system, it is precisely the savers, those with sizable home equity and savings, that will lose the most when disaster strikes.

How? Easy. Do you know that for individual insurances, the rejection rate for age group 50+ is as high as 40%? Do you also know individual insurance policies have a much higher denial rate than group policies? They can reject coverage for very minor reasons, acne, psy. consultation session, anything. If you lose your job, particularly in this environment, and your COBRA runs out, and you are rejected by PPO policies, what do you do? Even when you have an individual insurance, you run a much higher risk of being rejected coverage because of "pre-existing" conditions.

Dirt poor Americans, aged Americans are in far better situations. If you are dirt poor, you are covered by Medicaid, from the day you are laid off. If you are 65+, Medicare takes care of all. Now if you are in your 40s, have a paid off house, saved up a few hundred grands, you'd better pray that you don't fall ill, because you are
1) not covered by any government entitlement programs (while there are lot of Americans are covered!)
2) medical bills can clean out your lifetime savings and home equity in a month - and you are completely liable for it if you have money.

So I know the government screws up. But the way it is right now, I am more screwed because lots of other Americans are covered by entitlement programs but I am not, and I have much more to lose should I get into the dire situations. So f*ck it, I am going to get my gravy train as well, let's all have entitlement programs and bankrupt this country together. I am not going to pay for other people's entitlement programs while I am not entitled to anything.

"let's all have entitlement programs and bankrupt this country together"

LOL! I suppose there is... something to be said for "togetherness" 'eh?

I'm in no way saying that people can't make valuable contributions throughout their lives, but I think statistically OO is right. The lunchroom kids have a better liklihood of having a positive impact than an older poet, commentator ( or blogger for that matter? )

Any long time poster here will tell you that if "I" am diagnosed terminal I will make a beeline for TJ and get the most ridiculous sombrero I can find! Then I'll get a bottle of tequila' and a sleeping bag and "move in" to the bathroom! Hey, let's have some dignity here.

Probably been said, but, we are the only industrialized "western" country with no national health service.
Cowboys die alone.

Wow, quiet here today. Is everyone taking the International Worker's Day off?

4 bank failures recorded today ...

Single payer health care is a huge mistake. It is a true example of socialism. Socialism does not work. Why do people flock here for health care from countries that have national health care? It is because they can't get it in their countries. It is because of rationing or lack of services. How would you like to stand in a long line to see a specialist? Especially if you have a life threatening ailment that needs immediate treatment.

Single payer will work in the short term, but will be disastrous in the long run as it goes bankrupt (higher taxes, govt debt and money creation) and will be rationed due to great demand and limited number of doctors and facilities. It is about supply and demand. I heard that doctors are leaving the system in other countries. Who wants to be a slave or poor doctor after spending a tremendous amount of time and money training in med school and getting certified?

Medicare is in deep, deep trouble with tremendous future liabilities. I agree there is greed with insurance companies. I heard about a group of various doctors working outside the system (and medicare) offering their own clinic and services with very reasonable prices. Some doctors will offer charitable services and work with the poor and their ability to pay. That is what the free market is about.

I'm afraid that most of what you've written is just untrue and unsubstantiable, wcalleallegre.

Australians are more than happy with the way Medicare works, bar some tweaking around the edges. Such systems also seem inherently more efficient than the American system with its excessive administrative overhead and for-profit operators.

Rationing is generally not a problem except with the most expensive and exotic interventions. I have had 'free' consults, treatments, blood tests, even a CAT scan all for nothing over time in this system. Pharmaceuticals are automatically subsidised for all with no insurance required -- and some of the insurance schemes end up reimbursing the remaining low cost to $0. Pensioners pay $3 or even $0 for pharmaceuticals. It's mostly funded out of tax dollars in a '30% taxing' country, with a 1.5% Medicare levy top-up. I choose to have a minimal $150 p.a. health plan on top of this that reimburses for dental and optical, scripts, physio, and ambulance costs (none of which is covered by Medicare). You can end up breaking even on this.

A lot of British ex-pats in the US actually elect to return to the UK to get free medical treatment on the NHS rather than contend with the US system. That's a very common pattern.

The US health care system is ranked 37th in the world by WHO, with its low ranking largely due to 'denial of access to care to those who need it'.

Also, in the area of travel insurance, when you look at the zoning of premiums, it's interesting that Europe, Oz and even South America have much lower premiums than travel insurance in the US -- simply because of its dysfunctional billing regime and cost.

Slightly OT, something that just came to me from crikey.com on big pharma and medicos -- heavy US component. People will recognise the Sunshine Act etc. When you consider the extra 'perk' money that goes to doctors and other prescribers of the lavish hotels and meals and conferences and plastic pens going on to the cost of your pharmaceuticals, those little things in plain cardboard boxes in blister packs:

Time for MDs to get out of bed with drug companies
by Ray Moynihan

The powerful National Academies of Science in the United States released a report this week, calling for much greater distance between doctors and drug companies.

The report, written by the National Academies’ widely respected Institute of Medicine (IOM) — which advises America on health matters — calls for a ban on doctors accepting any gifts or meals from drug companies, a move which would have major changes for the diets of many medicos.

In Australia, according to figures from the drug industry, doctors, pharmacists and nurses are provided with free meals by drug companies at more than 30,000 events annually, many of them in fancy restaurants and at flash resorts.

The report calls on the United States congress to make laws requiring drug and biotech companies to disclose every single payment to every doctor, medical association, patient advocacy group and educational provider.

US Congress is currently considering the Sunshine Act, which would force companies to disclose some payments, but the new IOM report calls for more comprehensive disclosure.

The authors write that collaborations between doctors and drug and device makers can benefit society through discovery and development of new treatments, but financial ties “present the risk of undue influence” on doctors’ judgments and may “jeopardise” scientific integrity, patient care, public trust and the “objectivity of medical education”.

With doctors’ education, the IOM report urges the development of “a new system for funding high-quality accredited continuing medical education that is free of industry influence.” Significantly it also recommends clinical guidelines — which can carry great influence over what doctors to their patients —  should not be funded by industry and that doctors with ties to industry should be excluded from the panels who write guidelines.

The tough calls come at a time of continuing controversy in Australia about drug company connections with the development and promotion of blood clot guidelines, and a recent deal between a leading medical research organization and a drug company — both of which are being actively debated at Croakey.

Despite their closeness, doctors and drug companies are becoming increasingly uneasy bedfellows, with calls from the very top of the global medical profession for a major clean up.

A group of influential doctors writing in the Journal of the American Medical Association this month called for medical associations, to “work toward a complete ban on pharmaceutical and medical device industry funding ($0)” for their general budgets, although journal advertising and exhibit hall fees were acceptable. And like this week’s IOM report, the group suggested panels that write guidelines simply exclude doctors “with any conflict of interest ($0 threshold)”.

The new recommendations should give much food for thought, to medical groups in Australia currently debating their relationship with industry sponsors.

http://www.crikey.com.au/2009/04/30/crackdown-on-doctorpharamceutical-romance/