The Wrong Way to Make Money in Medicine

I am a proud American and an avowed capitalist. I am sure that Adam Smith’s “invisible hand of the free market” maximizes social benefits. Capitalism has its flaws – the concentration of wealth and environmental degradation among others -- but no other system is as good at organizing societies and improving standards of living. Maybe more debatable are the benefits that capitalism offers medicine but it is hard to ignore the leading role capitalist countries play in medical advances led by doctors and medical scientists who turned ideas into hugely profitable companies that improve people’s lives.

That said, a certain kind of doctorpreneur makes me cringe. These are the doctors that seek financial success not by developing drugs or devices that measurably improve human health, but instead leverage their degree and professional standing to make money while helping no one.

The article that led to this essay was One Man’s Quest to Make Luxury Sunblock. The article tells the story of Dr. Antony Nakhla, a Newport Beach dermatologist and the (very) expensive skin care products that he developed and sells.

You can read the article but the story is simple. Dr. Nakhla was struck by how much money his patients were paying for designer skin care products. He noted that “when you look at the ingredient list” of these products, “there’s really nothing in there of real value.” Thus he began his work. The Times article continues:

“He created what he calls a “Peptide-rich Plasma” — a patent-pending mix of laboratory-produced extracts that he said are identical, on a molecular level, to what’s already in human skin. Peptides can help hide the skin’s signs of aging, which often become more pronounced as aging skin begins to lose collagen.

When he was satisfied with the formulas… Dr. Nakhla invested several hundred thousand dollars of his own money to start his company, hoping that the business could go from “expensive science project to enterprise,” he said.

What is missing from this? Oh yes, actual data that his products outperform other products (or even a mixture of 99.5% petrolatum and 0.5% lipids rendered from the skin of a garter snake). When you look at his beautiful website (adorned with spectacularly beautiful people) what passes for “science” is laughable.

Considering why this article energized me enough to write this piece, I came up with three points.

1.        Doctorpreneurs should make money, even enormous amounts of money, when they create exceptional value. “Exceptional value” is above and beyond providing excellent patient care: new drugs, novel science, devices, procedures that truly improve health.

2.        Doctors should not make money on their degree alone. This is what Dr. Nakhla is doing. He has created a product and sells it for a premium because he is a doctor. I’d be unperturbed had he become rich selling the same product with his fancy website, marketing savvy, and packaging inspired by his Audemars Piguet Royal Oak if his degree and profession were not the primary selling point.

3.        Lastly, there is no science here. No blinded comparison. No placebo-controlled trials. All that exists is his theories about the ingredients. Our mantra in Ending Medical Reversal is that things that should work don’t always work. I have no reason to think that his recipe even should work.

I did a little soul-searching to discover why stories like this get me so agitated. I’ll admit that I find it unseemly for doctors to make too much money from medicine. I think doctors should be paid well. We worked hard to get where we are and we work hard every day. We also need to pay doctors well so we recruit good people. We are not attracting the best and the brightest. There are many, many people, who make a whole lot more money than doctors doing significantly less productive things – maybe this speaks to a flaw of capitalism or to the restraints we have put on the free market.

Doctors are often paid from the public coffers and since I believe that healthcare -- at least basic, proven, healthcare -- should be a right in a wealthy country, too much money for doctors means less care for patients. I am not one who ever wanted, or needed, to make a fortune in medicine. Having grown up with a father who was a physician, around people who had real money, I knew that medicine was not the ticket to true, financial riches.

I will assume that Dr. Nakhla is a nice man who serves his patients well. I hope this article drives traffic to his website – all publicity is good publicity. I wish him all the best in his business endeavors. I just wish he was working to achieve financial success as something other than a snake oil salesman who goes by “Dr.”

Photo by Rosa Rafael