Illinois Medical Malpractice Blog

As many medical schools don’t have conflict of interest policies that are as strong as hospitals’, drug companies often market directly to young doctors and students to gain an advantage. Many drug companies spend billions in marketing to doctors and students which is more than they spend on research or marketing. The Association of American Medical Colleges hopes that by limiting drug companies’ access to students to help cure conflicts of interest, bias, and curb the reciprocal benefit exchange between doctors and drug companies. Hopefully, medical schools following this program might help to curb medical malpractice and conflicts of interest in the future.

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Experts state that because there are so many different treatment options for varicose veins, it is best to get a second opinion when a doctor recommends it. A recent CNN article recommended going to a doctor who does multiple types of interventions because an individual who only performs one may be biased in their recommendations.

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An obstetrician is claiming that a medical center retaliated against him for testifying against doctors in medical malpractice cases. His employer stripped him of his hospital privileges, and he is now unable to deliver babies or perform other operations. Hospital "peer reviews" all over the country are being criticized for similar retaliation. The federal Health Care Quality Improvement Act is a 1986 law intended to protect patients from irresponsible or negligent doctors. There are concerns that, instead, it helps negligent doctors weed out doctors who speak up about medical malpractice. This could discourage expert physicians all over the country from testifying about serious medical mistakes that cause injuries. The hospital claims that it revoked permission for the doctor to practice medicine in hospitals due to unrelated discrepancies.

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A recent study indicates that psychiatrists have been receiving more money from drug companies than the doctors of any medical specialty. Drug companies have recently made efforts to increase the amount of money they spend on marketing fees and expenses targeted to psychiatrists. Their efforts have been largely successful. The amount of drugs that psychiatrists have been prescribing doubled last year, with most of the increase attributable to antipsychotic medications for children. The report mirrors accounts from other states that have observed similar increases in drugs being prescribed by psychiatrists.

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Joint ventures between store-based health clinics and pharmacy chains have been touted as providing convenient and affording health care, but the American Medical Association has expressed concerns over possible conflicts of interest. Retailers have been using the joint ventures as a way to increase in-store sales of prescription as well as non-health related items. The AMA has announced that it will begin calling for states to begin looking into these types of arrangements. Their concern was spurned by informal reports stating that these clnic members earn more money or get promotions based on the number of prescriptions that they write. While the AMA believes that most of the store-based health clinics will improve patients' access to health care overall, the call for state oversight aims to ensure that any potential conflicts of interest get resolved in the patients' favor.

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Click here for the AMA press release

Pharmaceutical companies and device manufacturers have access to information regarding which medications doctors prescribe for the reason that they are able to buy the information from the American Medical Association (AMA), and from companies that match the AMA’s data with pharmacy records. The AMA is holding its annual meeting in Chicago, where this topic is sure to be raised as an important issue. Some groups are planning to protest during the meeting in front of the Hilton Chicago. The information is being used to increase the sales of newer, more expensive drugs whereas it could be used to improve quality, safety of care, and lower drug prices. Many states, including Illinois, are proposing bills after noticing the correlation between the release of such information and the rising health care costs consumers face. Doctors that are not members of the AMA, about two thirds, are unaware that this information is being released. The AMA is planning to publish ads in medical journals to spread the information to doctors unaware of the fact that they can opt out of this practice.

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A study conducted shows that there is no connection between the quality of health care provided and the cost of that health care. The study compared the costs of a given medical procedure against the length of hospital stay required or against the death rates associated with that procedure. Suprisingly, there not only seemed to be no correlation between an increase cost of health care and an increase in the quality of that care, but the most expensive health care providers actually provided lower quality care in some instances.

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Despite efforts by the federal government to reduce the costs of health care, insurance premiums have continued to rise. A recent article blames the incentive structure for doctors. When the government limited the amount of profit that doctors could make on drugs that they administered in their offices, doctors responded by simply administering more drugs to more patients for whom the medicines would not help.

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A federal judge ruled yesterday that the pharmaceutical industry could continue to use computerized data showing which doctors are prescribing what drugs. This ruling struck down a state law that prohibited the purchase and resale of the data for use by the drug makers. The judge said that the law violated the First Amendment because it restricted commercial speech. The law may, however, have been helpful in cutting down the close ties between physicians and pharmaceutical companies in a time when 94% of physicians report close ties to the pharmaceutical industry. Moreover, it could have limited the influence that pharmaceutical companies have over physicians.

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A new study has found that virtually all doctors report some kind of relationship with the pharmaceutical industry. The relationships vary depending on the kind of medical practice and specialty, the patient mix, and the professional activities of the physician. One review found that on average, physicians meet with industry representatives four times a month and medical residents accept six gifts annually from industry representatives. Doctors in solo, two-person, or group practices met more frequently with industry representatives than did physicians practicing in hospitals and clinics.

This study highlights the ingrained connection between pharmaceutical companies and physicians. This pharmaceutical influence undoubtedly affects a physician’s choice in the procedures they perform, medical devices they use, and drugs they prescribe to their patients.

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60 Minutes recently aired a special on pharmaceutical lobbyists and the roles they play in Congress. One of the reasons why pharmaceutical profits are so high is because of the Medicare prescription drug bill. It was passed three and a half years ago in the middle of the night, long after most people had switched off C-SPAN and gone to sleep. The only witnesses were staffers, lobbyists, and U.S. Representatives. According to Representative Walter Jones, the pharmaceutical lobbyists wrote the bill, which was over 1,000 pages. People were being coerced to vote for the bill, with much of the credit to former Congressman Billy Tauzin, a Republican from Louisiana who steered it through the House.

To read the full CBS report on the pharmaceutical lobbying campaign.

A recent Center for Public Integrity study revealed that manufacturers of pharmaceuticals, medical devices, and other health products spent nearly $182 million on federal lobbying from January 2005 through June 2006. Much of the money has been spent to quell the antagonism the pharmaceutical companies face in the Democratically-controlled Congress. One effort by the lawmakers that drew heavy drug industry lobbying was to undo a provision of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The drug industry also lobbied forcefully to halt legislation that would have allowed drugs to be imported from other countries and sold in the United States.

For the full report.

The Food and Drug Administration recently proposed tightening rules to minimize conflicts of interest among outside medical experts serving on agency advisory committees. The panels are extremely important because the FDA tends to follow their recommendations on key matters such as drug approval and emerging safety questions.

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Merck & Co, developer of the new cervical-cancer vaccine, is funding efforts to pass state laws requiring girls as young as 11 to receive the vaccine. At least 18 states are debating whether to require Merck’s vaccine for girls. The pharmaceutical company has funneled money through an advocacy group.

This is the same pharmaceutical company who suffered many financial setbacks when Vioxx was pulled off the market for its harmful side effects. While the idea of potentially eliminating a cancer is undoubtedly a great goal, the manner in which the pharmaceutical company is attempting to benefit is worrisome.

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Executives from two dozen drug companies met last month to assess what appears to them to be a harsh new political climate. In hopes of preventing Congress from letting the government negotiate lower drug prices for older Americans on Medicare, the pharmaceutical companies have been actively recruiting more Democratic lobbyists, lining up allies in the Bush administration and Congress, and renewing ties with organizations of patients who depend on brand-name drugs.

In its campaign contributions, pharmaceutical companies overwhelmingly favored Republicans over Democrats. Drug companies worked closely with Republicans to create the Medicare drug benefit, excluding Democrats. Democrats now plan to return the favor. Democrats want to investigate drug pricing and profits, drug advertising aimed at consumers, and the marketing of drugs to doctors for purposes not approved by the FDA . The interaction between drug companies, who have enjoyed prosperous years under the Republican-controlled Congress, and the new political climate will be interesting.

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Two doctors will likely face fines in a proposed settlement from the state Board of Medicine disciplinary committee for their medical malpractice.

In one case, the physician failed to comply with patient care standards with regard to a seriously injured patient in the ER when he did not perform a rectal exam despite signs of pelvic trauma and rectal bleeding. More than a week later, a pelvic CT scan revealed that the patient had a rare flesh-eating disease. A medical malpractice lawsuit filed in this case settled out of court for $345,000. The fine imposed by the Board of Medicine would require this doctor to pay $4,000 and reimburse the state $5,500 for its costs. It would also require the doctor to take five hours of continuing medical education.

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In the past four years, the Justice Department has launched several investigations into relationships between physicians and medical device makers. The focus has been on potential conflicts of interest doctors may have in employing devices from companies they are receiving kickbacks from.

Healthcare attorneys say it’s only a matter of time before Hospitals become the subject of the same scrutiny. Regardless of the hospital’s knowledge of conflicts of interest between its staff and device sales companies, the hospitals are still on the hook.

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Another Times article in a series of articles examining financial incentives for doctors in prescribing drugs and treatments and evaluating patients examines cardiologist recommendations of treatment for patients.

Typically, options for patients with blocked coronary arteries are drugs, bypass surgery and vessel-clearing procedures like angioplasty. Among these choices, angioplasty is the most profitable for the doctors. While no accusations have been made or charges filed, several areas have a rate of angioplasties that are off the charts. For example, a northern town Elyria, has angioplasties at a rate nearly four times the national average.

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In the past few years, pharmaceutical companies have been under growing scrutiny as to the types of perks they can offer physicians during the course of sales pitches. More recently, extravagant dinners and golf outings have been banned. The new wave of buttering these doctors up is the “free lunch” according to a New York Times article.

The old adage there’s “no such thing as a free lunch,” holds true in these cases as the pharmaceutical sales reps provide lunches for the entire office as long as they can simultaneously pitch particular drugs while lunching with the docs. Buying lunch for the office fits within the pharmaceutical companies’ guidelines of approving “modest meals in the course of business” but may curry more favor and influence than one would think.

For example, when the University of Michigan Health System banned industry lunches last year, officials calculated that they had been worth $2.5 million in sales revenue for drug companies annually.

For the full article.