A whiff of corruption

A whiff of corruption

Over at Medscape* they ask the question Is It Right for Doctors to Sell Nutritional Supplements?

And they conclude no:

…it’s unethical. It’s also unethical to the American Medical Association, the Canadian Medical Association, and many other groups who say that you can’t be selling things like that out of your own office.

I agree. It is a fundamental conflict of interest. You should not profit from products that have not been shown to work. But it is one of those areas where the legitimate interventions  bleeds into questionable into unethical.

It is OK to offer vaccines, although half of doctors at best break even on vaccines.

It is OK to provide a procedure from which you profit. A patient sees a cardiologist doctor for chest pain and it is ethical for the doctor to do a stress test or a cardiac catheterization. There are usually well defined criteria for determining if a patient should get a procedure, although there have been of MD’s who abuse the system. If will be interesting to see what happens to arthroscopic partial meniscectomy for degenerative medial meniscus tear and whether it goes the way of internal mammary ligation for angina.

Hospitals have pharmacies and many doctors now work for hospital systems. I suspect not. I ask the patient what pharmacy they use and send the prescription to that pharmacy. I think it would be wrong to send patients to my pharmacy. But I do send people to my lab and radiology department, although I try and send the patient to the primary hospital system that patient came from.  However, I receive no money as a result of my referals.

So what makes supplements different? Well, they do nothing to benefit the patient, unlike medications and procedures. And there should be no direct financial benefit for the physician from a prescription or order if possible. Many a pseudo-medical provider offers supplements as

The financial benefits of selling supplements, remedies and other products in your practice are enormous. An established dispensary is a gold-mine, adding tens of thousands of dollars a year to your bottom line. It’s practically free money.

I suspect the above quote is now the motto for the Cleveland ClinicGiven the relationship of the Cleveland Clinic doctors it would be no different from doctors selling supplements from their office. ​ Setting up an herbal clinic that your doctors refer patients to, who pay cash for unproven therapies and your system reaps the financial benefits does not pass the smell test.  

MARCELLUS

Something is rotten in the state of Ohio.

HORATIO

Science will direct it.

MARCELLUS

Nay, let’s follow him.


*COI: I am a paid Medscape blogger.

Points of Interest: 04/26/2014
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