The quality of the American medical system has deteriorated to such a point that if the Doctors are not the grifters they may at least be culpable for enabling the grift.
That hasn't been my experience. I have never experienced or heard of a doctor deceiving or lying in real life. I dont think I can think of an example from hospitals either.
I've had dentists discover that I needed a filling after they found out how good my dental insurance was. Their justification was that the tooth seemed "soft". They never took an X-ray or provide any other data than that.
I don't know, but in hindsight I would have asked for an X-Ray. I think it was a borderline call and they went on the side of doing it because I had good insurance.
I don't see anything wrong or nefarious with deciding a borderline call based on ability to pay.
Better preventative medicine and proactive treatment is one of the perks of having good insurance, so I would expect a recommendation from a good dentist to take it into account.
Ideally there is some discussion, but at the same time, the idea that someone with great insurance would want to use it seems a reasonable assumption.
> I have never experienced or heard of a doctor deceiving or lying in real life.
Meet Dr. Stella Immanuel who tells her patients that medications are made from alien DNA and that their illnesses are caused by demon sperm. In the USA she gets to keep her medical license/practice. (https://en.wikipedia.org/wiki/Stella_Immanuel)
See also: every doctor that accepted bribes from Purdue Pharma in exchange for knowingly prescribing excessive amounts of opioids to people who never needed them.
I actually really liked that article and how it at least tried to present both sides. However, I tend to agree with the opposing side, but think there are some edge cases that could be improved. I have spent my career working in drug and device development so I probably have a more nuanced view informed by my experience. I have payed millions to doctors, and think my actions are justified.
One thing that the article touched on that I like is the role of non-industry associations, which I think could do a lot more to spread information. However, there's no one that will pay them to do it.
> I have payed millions to doctors, and think my actions are justified.
You aren't at all worried that paying those doctors will result in them prescribing something to a patient when they might not have otherwise or influence their choice for one option over another? I'm not talking about the education or awareness a doctor might get, purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
The vast majority of the payments are either education or payment for services rendered, like the article mentions.
At a high level, companies actually think their products have value to patients and want doctors to know about what it can do. It is virtually impossible to decouple knowledge sharing from influence. The point of knowledge sharing is to impact choice and behavior.
On the services front, If I want to hire a doctor to fly across the country and do Brian surgery on a pig or cadaver, I expect to have to pay them. Similarly, if they are running a clinical trial, I expect to fly them to the surgical training and feed them, and pay for their time.
>purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
Direct kickbacks for prescriptions are a thing of the past. It is pretty hard to come up with a situation where future benefits is conditional on the behavior. Like, I suppose you wouldn't invite a doctor that doesnt use your product to give feedback on it or be part of a clinical trial, but that is a niche feedback to worry about.
Lastly, articles like are very misleading when it comes to the details. In their reference for $2B in payments [1], includes things like Royalties.
>The greatest proportion (27.3%) of value was from royalty or license payments (≈$484 million of $1.8 billion) followed by service fees (26.6%), such as faculty lectures ($472 million of $1.8 billion).
If they are claiming paying royalty or license payments for inventions (like developing a hip implant) are a kickback, it frames the whole argument as rhetoric.
I’ve found the “collective common knowledge” regarding pop-culture topics such as this, is much like generals preparing for the last war they fought.
Direct kickbacks were an actual problem decades ago. That has long been “solved” all the way to the typical over correction the industry is known for.
The same holds true for the opioid epidemic and folks still thinking pill mills and the medical industry as a whole are the primary way folks get hooked.
It’s fighting last decades battles that have long since moved on. The zeitgeist seems to “stick” each generation and does not seem to keep up with current reality.
yes. Conflating Perdue Pharma/OxyContin with the larger opiate epidemic is a particularly egregious example.
Perdue engaged in criminal actions, but it did not cause the epidemic. It is just a small part of the story. Deceitful labeling and aggressive marketing of OxyContin in the 90's has zero bearing on people dying from fentanyl laced weed in 2024.
I think the biggest factor in all of this misinformation is a human desire to compress the complexity of life into simple soundbite narratives that make sense.
The more emotionally charged or pressing an issue is, the greater the human desire is to think/feel like they have it all figured out. Even if that means sacrificing truth.
Humans have a compulsion to categorize and explain everything they encounter. Failure to do so is cognitively painful so anything too difficult is simplified until it "makes sense".
In my opinion, this compulsion is at the heart of all human problems, but also all of our achievements.
My dental surgeon refuses to design or install an implant. They will only put in the screw for the implant.
Why? Because of a pyramid scheme.
That might not be a direct "lie," but it is misleading. Doctors mislead constantly. They tend to accept norms that are harmful because they are systems outside of their control.
I think there is a conflation occurring between harm and sub-optimal behavior (from your perspective). Is the doctor harmful or simply less helpful than you would like?
Would you be better off with no dental work or healthcare? Zero harm is being done in this case IMO.
If Im alone in the desert dying, I dont think others are harming me for my lack of water and food. That is simple neutrality and indifference.
I don't think you understand what a pyramid scheme is. There are some unethical providers who optimize for their own profit rather than the patient's best interests but those are a small minority. And it is entirely normal to separate implant design from installation; those things take different skills and equipment.
