Every single doctor in the Western world can tell you some variation of the same story, usually relating back to when they first got the MD letters at the end of their name and cemented themselves in the professional world.

Sometimes it starts with a phone call (or an email these days), but very often a personal interface visit is how everything kicks off.

A young man or woman struts into the office, looking for just a moment of your time, hoping to open your eyes to the miracles of modern science and the potential of new pharmaceutical solutions – all while promising you an opportunity to kick back and relax in the lap of luxury on all expenses trip to some far-flung locale, just to learn a little bit more about what these pharmaceutical options might have to offer.

Or maybe it starts at the country club, with offers of free membership and new opportunities to hobnob and network with some of the most well-heeled members of your local community – all of which is facilitated by the same pharmaceutical representative, of course.

Or maybe it starts with a nice, fancy steak dinner at an upscale joint in your local community. The pharmaceutical rep foots the bill, of course (with no expense spared), just for the opportunity to have a couple of moments of your undivided time to see if you might be interested in learning a little bit more about the wonder drugs his company has to offer.

Or maybe it starts somewhere else and somehow else entirely.

At the end of the day, the point is that these conversations ALWAYS start – and are always initiated by the pharmaceutical companies themselves, promising the moon and the stars (no small amount of impressive riches and bonuses) to doctors that are willing to just listen about the potential that their drugs might offer moving forward.

Before we go any further, it’s important to highlight the fact that many of these pharmaceutical reps aren’t pushing or peddling subpar drugs, shady “elixirs”, or the kind of modern-day snake oil that gets people chucked into the slammer.

More often than not, these pharmaceutical representatives are looking to get more doctors on board world-class drugs and pharmaceutical options from reliable and reputable companies, and very frequently these pharmaceutical reps really do have the patient’s best interests at heart.

It just doesn’t always look like that from the outside – and it’s easy to see why.

“Because That’s Where All The Money Is”

One of the most famous outlaws in American history and bank robber that led a more than 40 years long career – stealing millions and millions of dollars over that block of time – was asked why he robbed banks.

Willie Sutton, the bank robber in question, calmly and coolly replied “because that’s where all the money is”.

Pharmaceutical reps understand this principle in their very bones, which is why they go after medical professionals and doctors that have every opportunity to prescribe the drugs and medical solutions they have to offer.

The medical world in general is a multi-trillion dollar a year industry with absolutely zero signs of slowing down. Recession proof (more so than maybe any other industry out there), people are always going to get sick, people are always going to get injured, and people are always going to want to lead longer, happier, and healthier lifestyles.

There’s a mountain of money in medical solutions, drugs, and services – but the doctors of the world act as the “tollgate” that determines where this money flows by and large.

And that’s why pharmaceutical reps are always working double overtime to increase the relationship that they have with different medical professionals, to convince these medical experts to recommend their solutions more than anyone else’s company and why they are able to offer such lucrative “bonuses” – above board and sometimes not – to get doctors to offer their drugs and medical solutions as often as possible.

Again, as we highlighted a little bit earlier, the overwhelming majority of pharmaceutical reps aren’t pushing snake oil. Instead, they represent legitimate companies with generic drugs and legitimate medical solutions that doctors can use to have a great impact on the health and well-being of their patients.

Even still, there’s something that just doesn’t feel all that “fair”, open, and evenhanded about pharmaceutical reps working to convince doctors to prescribe one particular medication for heart conditions (for example) over another cheaper and equally effective medication that promises to offer the same benefits.

Worse, there’s something off feeling as a patient when you learn that your doctor may or may not be encouraging you to take advantage of a specific drug or a specific medical instrument not because it’s the perfect thing for your situation but because they’ve been getting healthy kickbacks and bonuses from drug companies behind those options.

Plenty of Horror Stories Abound

When you get right down to it, the overwhelming majority of medical professionals around the world today take very serious the Hippocratic oath – the oath that they are to do NOTHING that would harm their patients, but instead EVERYTHING they can to help them lead happy and healthy lifestyles.

But that doesn’t mean that there aren’t plenty of less than ethical or more unscrupulous doctors out there that don’t mind flooding their own personal coffers with pharmaceutical company money, all in exchange for becoming “invisible” sales agents for the companies that are sending them checks.

A nonprofit organization called ProPublica runs an online tool that they call Dollars for Doctors, giving you immediate information and insight into the kinds of payments that doctors you might be considering moving forward with have received from drug companies or device companies around the world.

As of right now the tool encompasses payments made – and payments disclosed – between August 2013 and December 2016, though the folks behind this tool promise to include a lot more information as the data becomes available. More than $9.15 billion was disclosed being paid out from drug or device companies during this three-year block of time, with more than 900,000 doctors at more than 3200 hospitals and companies receiving payments.

Some doctors accepted only a few thousand dollars for “speaking arrangements” with drug and device companies, whereas others made millions and millions of dollars with much less transparent accounting. An orthopedic surgeon, a Dr. Stephen Burkhart, made just over $65.3 million from drug and device companies over this three-year stretch of time while Dr. Roger Jackson (orthopedic surgery) was paid $62.3 million over that same timeline.

We’re not talking about chump change here.

Interestingly enough, those two doctors may have been able to claim the top spot as far as the highest earning doctors from drug and device companies were concerned but they weren’t the doctors that were most frequently paid by drug companies. Dr. Anna Stankovic (a doctor of internal medicine) and Dr. Robert Busch (a doctor of endocrinology) were both paid over 3500 times over that three year block of time.

Pharmaceutical companies are ALWAYS looking for new opportunities to push a little bit of extra cash towards doctors that are willing to work with them, looking for ways to increase and strengthen relationships between medical professionals and the pharmaceutical companies that they represent.

Hopefully now you see just how obvious it is that these companies aren’t shy about spending a considerable amount of money to achieve their goals – and why so many people are skeptical about this kind of approach.

Doctors are also guilty of endorsing mobile applications claiming to improve your quality of life even when little to no evidence exists.

The Feds Have Already Cracked Down But May Need To Do A Lot More

In the US a Federal Anti-Kickback Statute exists to establish a number of different criminal penalties that can be applied to pharmaceutical companies and their representatives, but only if these crimes are associated with doctors that involve federal health care programs.

This has created a little bit of a gray area, as the rules and legislation that have been written are pretty vague and leave a lot of room for interpretation – and a lot of wiggle room for doctors, drug companies, and pharmaceutical representatives to work around.

Drug companies aren’t allowed to directly pay (or indirectly pay) doctors to prescribe their drugs, but they are allowed to offer services and solutions that “help patient care”.

This is why so many doctors are usually invited on incredibly expensive retreats and training opportunities put on by pharmaceutical companies that are little more than thinly veiled vacations, why so many doctors are hired by different companies to speak at events other medical professionals will attend, and why so many doctors find their offices flooded with new training tools, textbooks, and resources that can be almost prohibitively expensive to smaller practices on their own but represent just a small drop in the water for big time pharmaceutical operations.

Obviously, healthcare is a huge issue in the United States these days and tackling the relationship that medical professionals have with pharmaceutical experts is just one small piece of the puzzle that has to be solved.

The federal government has already recognized just how much of a problem of these kinds of payments and this kind of influence can be, but a lot of people – particularly advocates for patient rights – are wondering whether or not these federal rules, regulations, and laws go far enough and if they could go even just a bit further to better protect every US citizen from ending up with a doctor more concerned about their profits than the well-being of their patients.

Individual hospitals have been doing their part to curb the flow of “questionable money”, particularly those in academia and those that have set up training hospitals. Doctors here, research has found, are a lot more likely to prescribe cheaper and generic drugs compared to expensive, brand-name pharmaceutical options as the hospitals themselves instituted rules and regulations that restricted the amount of and type of visits pharmaceutical sales and representatives could make.

According to information from the University of California, Los Angeles Anderson School of Management that conducted research into how these hospital rules changed prescription rates and types, doctors that may have been driving name brand drugs before 100 times a month by now likely to prescribe the same kinds of drugs just 90 times a month – information that certainly points to (though it does anything but proof) pharmaceutical companies have some kind of influence over doctors, even if inadvertently.

At the end of the day, it’s going to be almost impossible to scrub “invisible” money from pharmaceutical companies from the medical world in general. These companies are looking for ways to make hundreds of billions of dollars every year, and any time that kind of money is getting thrown around the potential for draft, abuse, and outright corruption always exists.

The biggest expenses pharmaceutical reps and salesmen report every year is “food and beverage” expenses, and those kinds of expenses are the most challenging to be the peg down and pin down – particularly when that money is going directly to doctors in an effort to get them to push the kinds of drugs specific companies want sold.

The medical industry today is anything but the Wild West days it experienced after the Civil War and before modern science really started to take off, but there’s still a bit of that snake oil salesman attitude happening behind the scenes and quite a bit of money to be made recommending more expensive drugs that do the same thing less expensive drugs do – all in an effort to make a little bit of extra money on the backend.

A lot of control has to be exercised by individual patients that push back against their doctors recommending expensive name brand drugs, but that’s only going to happen if patients are willing to do a lot of research on their own behalf – research they probably shouldn’t have to do if they were assured that their doctors always had nothing but their best interests at heart.

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