This is small potatoes compared to some of our Supreme Court justices poor ethics.. And the justices affect more Americans lives. Not an excuse for these doctors and pharma, just a comment on how pervasive this behavior is in our society.
There are many I've known whose only goal in life is to make money. Their professions vary but they share one thing in common - they prove that if your only goal is to make money, then making money is easy.
They are not happier, they are not more satisfied with their work, family life or interpersonal relationships. Collecting wealth and the trappings of status be they cars, diamonds, houses children who matriculate to Harvard or trophy spouses is of no real benefit because they lack depth, integrity, honesty and a true sense of fulfillment in their life.
Saddened by the comment that an exotic car mechanic has higher billable hours than a doctor {considering time invested in study and training} I wonder if that mindset somehow fuels a rationale for greed?
I’m not a Heme-Onc ologist. Every day I thank my personal God I am not.
I spent my career in the ICU and/or seeing febrile neutropenic patients on the floors - trying to spare them the ICU.
In my non Academic system when clinical trials are run, nothing gets in the ologist’s pocket aside from their every-other-week paycheck. Or, at least, it’s not supposed to.
I’ve been led to believe that salaries at Universities are partly driven by grants - if that’s the case the incentive will always be in the direction of more is better.
I am a recently retired physician. I trained in the late 70's. I worked in private practice and academic medicine. I think you are completely correct about the current state of affairs. It pains me greatly to see deeply devoted and incredibly ethical professors that I had now almost laughed at as archaic. Honesty and doing what is best for your patient is never archaic. Our patients have trusted us to do our best for them and help them past many difficult decisions and they have depended on our honesty to give them advice as to what is likely to serve THEM best. I see this pecuniary effect as wholly destructive to the profession. It is a source of great disappointment and it is pervasive and ubiquitous.
In my first Pharma stint (which I enjoyed and saw as largely positive), I quickly realized the problem was the pervasiveness. ‘Consulting payments’ simply weren’t seen as out of place within a physician’s practice leave alone unethical. Now this is in India, where multinationals mostly abide by their headquarters’ policies, but the stories of junkets and kickbacks from local companies were revolting.
I met and got to know straight-as-an-arrow physicians whose industry engagements accrued to the benefit of their institutes. They asked hard questions of the system, but mostly were neck-deep in the delivery of affordable care to their patients. Since that often meant seeing an extra-ordinary volume of patients, they rarely had time to be contentious (in a good way) by speaking out against the impropriety of clinicians and their private practices held in the pharma stranglehold.
I think the remedy is for good men and women to explain themselves. As Billy Graham said, “when a brave man takes a stand, the spines of others are often stiffened.”
I believe he is saving up so he can create a website with publications that are not peer reviewed, not paid for, or inherently biased by a journal / big pharma. He referenced it before and it would be quite expensive to start up, but a free database for those who wanted access.
The problem now is that most doctors look pretty underpaid given the educational time commitments and cost and difficulty of the work compared to techsters and whatever it is people do working from home into NYC, LA and San Francisco (Not sure what that is, exactly, but appears quite remunerative). If the MD is not a proceduralist, a halfway decent car mechanic probably bills more, without needing to see 4 patients an hour.
I don't think you analyzed the context correctly. It's not just few naive or greedy physicians that take money they don't need and it's not just about money.
Michelin may not "help themselves" with the single auto-repair, but surely does with potential business deals large enough to justify the effort.
Lobbyists know very well what they are doing & its critical value for their businesses and since decades promoted systems to become stable regulatory stakeholders and interlocutors.
This is not the norm in pediatric oncology, just adult. I work with young adults age 10-30, so I see both.
This is small potatoes compared to some of our Supreme Court justices poor ethics.. And the justices affect more Americans lives. Not an excuse for these doctors and pharma, just a comment on how pervasive this behavior is in our society.
There are many I've known whose only goal in life is to make money. Their professions vary but they share one thing in common - they prove that if your only goal is to make money, then making money is easy.
They are not happier, they are not more satisfied with their work, family life or interpersonal relationships. Collecting wealth and the trappings of status be they cars, diamonds, houses children who matriculate to Harvard or trophy spouses is of no real benefit because they lack depth, integrity, honesty and a true sense of fulfillment in their life.
Saddened by the comment that an exotic car mechanic has higher billable hours than a doctor {considering time invested in study and training} I wonder if that mindset somehow fuels a rationale for greed?
This is alarming. One could get the impression there may be integrity issues with the industry.
I’m not a Heme-Onc ologist. Every day I thank my personal God I am not.
I spent my career in the ICU and/or seeing febrile neutropenic patients on the floors - trying to spare them the ICU.
In my non Academic system when clinical trials are run, nothing gets in the ologist’s pocket aside from their every-other-week paycheck. Or, at least, it’s not supposed to.
I’ve been led to believe that salaries at Universities are partly driven by grants - if that’s the case the incentive will always be in the direction of more is better.
Don’t ever underestimate doctors’ venality.
There are COI guidelines for NCCN Guidelines committee members, including recusing themselves from panel discussions/panel removal for COIs. https://www.nccn.org/guidelines/guidelines-panels-and-disclosure/disclosure-policies-and-potential-conflicts-of-interest
I am a recently retired physician. I trained in the late 70's. I worked in private practice and academic medicine. I think you are completely correct about the current state of affairs. It pains me greatly to see deeply devoted and incredibly ethical professors that I had now almost laughed at as archaic. Honesty and doing what is best for your patient is never archaic. Our patients have trusted us to do our best for them and help them past many difficult decisions and they have depended on our honesty to give them advice as to what is likely to serve THEM best. I see this pecuniary effect as wholly destructive to the profession. It is a source of great disappointment and it is pervasive and ubiquitous.
Wow! Thanks Vinay for having the balls to speak out.
In my first Pharma stint (which I enjoyed and saw as largely positive), I quickly realized the problem was the pervasiveness. ‘Consulting payments’ simply weren’t seen as out of place within a physician’s practice leave alone unethical. Now this is in India, where multinationals mostly abide by their headquarters’ policies, but the stories of junkets and kickbacks from local companies were revolting.
I met and got to know straight-as-an-arrow physicians whose industry engagements accrued to the benefit of their institutes. They asked hard questions of the system, but mostly were neck-deep in the delivery of affordable care to their patients. Since that often meant seeing an extra-ordinary volume of patients, they rarely had time to be contentious (in a good way) by speaking out against the impropriety of clinicians and their private practices held in the pharma stranglehold.
I think the remedy is for good men and women to explain themselves. As Billy Graham said, “when a brave man takes a stand, the spines of others are often stiffened.”
Thank you for speaking up about this. It's sad that obvious conflicts of interest have become normalized in medicine.
Why any of the posts on this substack behind a paywall? All the writers are doctors. Do they really need the money?
I believe he is saving up so he can create a website with publications that are not peer reviewed, not paid for, or inherently biased by a journal / big pharma. He referenced it before and it would be quite expensive to start up, but a free database for those who wanted access.
Creating a website costs 20 $ a month on Squarespace. Why exactly would starting a website be so expensive?
Its not a website like godaddy... it is a database for research publications. He mentioned in his prior podcast it would cost 100k.
Listen to his prior podcasts. It's not a simple website.
Cards on the table face up. No added fluff to take away from the simplicity of the message.
The problem now is that most doctors look pretty underpaid given the educational time commitments and cost and difficulty of the work compared to techsters and whatever it is people do working from home into NYC, LA and San Francisco (Not sure what that is, exactly, but appears quite remunerative). If the MD is not a proceduralist, a halfway decent car mechanic probably bills more, without needing to see 4 patients an hour.
Bravo!!!!!
I don't think you analyzed the context correctly. It's not just few naive or greedy physicians that take money they don't need and it's not just about money.
Michelin may not "help themselves" with the single auto-repair, but surely does with potential business deals large enough to justify the effort.
Lobbyists know very well what they are doing & its critical value for their businesses and since decades promoted systems to become stable regulatory stakeholders and interlocutors.