Wednesday, May 09, 2007

More bad news for the physician trust issue-Rebates for EPO ?

A recent issue of the the New York Times reveals that some physician groups have been receiving rebates from drug manufacturers for parenteral recombinant erythropoetin. While volume related rebates to purchasers of various products has been routine and legal the implication is that some physician groups ( nephrologists and oncologists) who may profit from these arrangements are overusing the medications such overuse possibly risking harm to their patients.

Profit to dialysis centers from EPO use as well the possibility of profit enhancement by rebates was mentioned in a recent JAMA editorial which was critical of current guidelines which I discussed recently.

It is hard-if not impossible-to find news of any current trend that would improve what may well be a declining trust in physicians on the part of patients. A recent commentary by the president of the AMA maintains that trust in doctors is quite high ( better that say what politicians enjoy) but everything I read points in the direction of falling trust.

The time and money crunch basically brought about by managed care is a major driver in dwindling trust. Less time with the patient can only be bad. Missed or incorrect diagnoses for the individual patient impacted by it has to be one of the biggest trust busters possible. A hurried encounter with your doc leads only to the impression that he does not really care. A letter from your insurance company telling you your physician is delisted because he doesn't meet the quality requirements may completely destroy trust even though the criteria used may be entirely bogus and born of cost control and not a tool to make your care better.

The renal doctors I have known professionally are not the sort of people who would knowingly overuse a medication ( i.e give too much EPO) to make a profit.I have no personal knowledge of large dialysis companies that would enable me to have the same sense of reassurance. The JAMA editorial lays some possible blame at the feet of the writers of the guidelines which may have recommended doses of EPO or targets for hemoglobin that lead to more harm than good and predictably there was at least the implication of increasingly talked-about conflict of interest on the part of the members of the guideline writing panel.

I don't know if trust in physicians is lower now than before but I do know that my trust titer has tanked and I am many times more skeptical and critical in regard to medical articles that in the not too distant past I would have read without a nagging doubt about the motives of the authors.

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