A great example of evidence based medicine put to great use....
Doctors Paid To Switch Patients To Generic Drugs
Incentives Raise Ethical Questions
BOSTON
Team 5 Investigates discovered that health insurers are giving doctors incentives, sometimes in cash, to switch patients to generic brands.
NewsCenter 5's Janet Wu reported Wednesday that the payments are legal, but health care experts said they clearly raise ethical questions if patients are not told the reasons behind the switch.
Much of the controversy centers on the cholesterol drug Lipitor, which is the best-selling medicine in the world. It is currently under a patent and does not have a generic version. Thousands of Massachusetts patients recently discovered their insurer won't pay for it anymore or that their out-of-pocket cost has skyrocketed. Other patients told Team 5 Investigates they were switched by their physicians with little explanation. Earlier this year, Blue Care Network in Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor to a generic version of its competitor, Zocor. They were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.
“Without saying to the patient, ‘I have a financial incentive in making this decision, which goes along with my professional incentives to do what's right for you,’ it's unethical,†said professor Regina Herzlinger, of Harvard Business School . “It's a clear conflict of interest.â€
Team 5 Investigates asked Blue Care Network of Michigan if patients were told of the financial kickback.
Earlier this year, Blue Care Network in Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor to a generic version of its competitor, Zocor. They were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.
“Without saying to the patient, ‘I have a financial incentive in making this decision, which goes along with my professional incentives to do what's right for you,’ it's unethical,†said professor Regina Herzlinger, of Harvard Business School . “It's a clear conflict of interest.â€
Team 5 Investigates asked Blue Care Network of Michigan if patients were told of the financial kickback.
A spokeswoman said "not specifically."
In Massachusetts , financial arrangements for switching patients from Lipitor are less blatant, but they do exist.
In a letter obtained by Team 5 Investigates, Partners Community HealthCare's Me dical Director, Dr. Thomas Lee, told his colleagues that "physicians will increasingly be rewarded in our pay-for-performance contracts if we increase the percent of generics we use. Increasing our use of generic statins is therefore very much to our advantage."
Former Lipitor patient Genie Holland told Wu, “I'm shocked. They're paying the doctors? Yes. I'm shocked.â€
Holland said she was surprised earlier this year when her doctor switched her from Lipitor to a generic version of Zocor without explanation, “because it had worked for me for so long. I also found that my cholesterol went up after I went on the generic.â€
But Herzlinger said the medical efficacy is irrelevant to this debate. “You've got to tell the patient that 'I'm switching you to a generic, not only because it's best thing for you and it's going to save you money out-of-pocket, but because I'm going to make more money as a result of that.'â€
This is a priceless example of the counterdetailing that the Priesthood of Purists have proposed. It is also going on in the VA where docs are getting cash to prescribe a la ALLHAT. (I wonder if patients are being told of this kickback "specifically.") This is supposedly evidence-based medicine. But where is the evidence that bribing doctors to practice one size fits all medicine is good for the patient?
Soon to follow: cash prizes to get doctors to use recycled and older hip implants, chloroform for surgery, and amputations instead of diabetes care.
http://www.thebostonchannel.com/news/13800173/detail.html
Doctors Paid To Switch Patients To Generic Drugs
Incentives Raise Ethical Questions
BOSTON
Team 5 Investigates discovered that health insurers are giving doctors incentives, sometimes in cash, to switch patients to generic brands.
NewsCenter 5's Janet Wu reported Wednesday that the payments are legal, but health care experts said they clearly raise ethical questions if patients are not told the reasons behind the switch.
Much of the controversy centers on the cholesterol drug Lipitor, which is the best-selling medicine in the world. It is currently under a patent and does not have a generic version. Thousands of Massachusetts patients recently discovered their insurer won't pay for it anymore or that their out-of-pocket cost has skyrocketed. Other patients told Team 5 Investigates they were switched by their physicians with little explanation. Earlier this year, Blue Care Network in Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor to a generic version of its competitor, Zocor. They were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.
“Without saying to the patient, ‘I have a financial incentive in making this decision, which goes along with my professional incentives to do what's right for you,’ it's unethical,†said professor Regina Herzlinger, of Harvard Business School . “It's a clear conflict of interest.â€
Team 5 Investigates asked Blue Care Network of Michigan if patients were told of the financial kickback.
Earlier this year, Blue Care Network in Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor to a generic version of its competitor, Zocor. They were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.
“Without saying to the patient, ‘I have a financial incentive in making this decision, which goes along with my professional incentives to do what's right for you,’ it's unethical,†said professor Regina Herzlinger, of Harvard Business School . “It's a clear conflict of interest.â€
Team 5 Investigates asked Blue Care Network of Michigan if patients were told of the financial kickback.
A spokeswoman said "not specifically."
In Massachusetts , financial arrangements for switching patients from Lipitor are less blatant, but they do exist.
In a letter obtained by Team 5 Investigates, Partners Community HealthCare's Me dical Director, Dr. Thomas Lee, told his colleagues that "physicians will increasingly be rewarded in our pay-for-performance contracts if we increase the percent of generics we use. Increasing our use of generic statins is therefore very much to our advantage."
Former Lipitor patient Genie Holland told Wu, “I'm shocked. They're paying the doctors? Yes. I'm shocked.â€
Holland said she was surprised earlier this year when her doctor switched her from Lipitor to a generic version of Zocor without explanation, “because it had worked for me for so long. I also found that my cholesterol went up after I went on the generic.â€
But Herzlinger said the medical efficacy is irrelevant to this debate. “You've got to tell the patient that 'I'm switching you to a generic, not only because it's best thing for you and it's going to save you money out-of-pocket, but because I'm going to make more money as a result of that.'â€
This is a priceless example of the counterdetailing that the Priesthood of Purists have proposed. It is also going on in the VA where docs are getting cash to prescribe a la ALLHAT. (I wonder if patients are being told of this kickback "specifically.") This is supposedly evidence-based medicine. But where is the evidence that bribing doctors to practice one size fits all medicine is good for the patient?
Soon to follow: cash prizes to get doctors to use recycled and older hip implants, chloroform for surgery, and amputations instead of diabetes care.
http://www.thebostonchannel.com/news/13800173/detail.html
