Are doctors unduly influenced by drug companies?
Dr. Virus: I don’t think that doctors make dangerous decisions because of the influence of the drug companies. But I think we make very expensive decisions. There’s an antibiotic for $10 and there’s an antibiotic for $150. I had dinner last night with the $150 guys, and it might be theoretically marginally better. There might be reasons that I prescribe it, and one might be that I liked my steak dinner. You’ll get well either way on the cheap one or the expensive one, but this way I’ll have another steak dinner. It’s low-level bribery—there’s no question about it. I used to go out to dinner with these guys, and I stopped because I found it too gross for words.
Dr. Lung: I used to be in charge of a department, and I told my unit that I’m not going to support big dinners where they take twenty doctors out. If you’re friends with one particular rep, then you can go as friends. But I’ve always felt that they’re expecting something in return.
Dr. Heart2: I am wooed. You know, all doctors are wooed. But the true excess is not in the pens and the steak dinners. It’s the relationships pharmaceutical companies develop with hospitals that are much more nefarious than buying a doctor a steak dinner. Companies strike deals with hospital pharmacies to provide their drugs at a low cost to get patients using them. Then they price the drug at a later date any which way they want.
As much as I can't stand the way Big Pharma uses perks and freebies to make doctors like them, "Dr. Heart2" is correct that the real issue is when a pharmaceutical company makes a deal with a hospital that effectively locks a hospital into using a particular drug for economic reasons - and only short term gains at that.
It's funny to that doctors who have been having an in depth conversation about the massive shortcomings of our health system - not enough nurses, shady financial dealings from hospitals and pharmaceutical companies, etc., all the sudden shift gears when the subject of universal healthcare comes up. "Oh no, quality of care will go down!" I suppose if you believe that universal healthcare means, instead of only one nurse for an entire floor of acute patients, there won't be any nurses in the hospital at all.
What could be changed about the health-care system to better help patients?
Dr. Baby: Universal health care.
Dr. Heart1: But you’re talking from a public-health perspective. If you are an individual … if your dad is sick and he has access to insurance and money, do you want him to live in the country with universal health care or our kind of health care? Our kind of health care.
Dr. Virus: The only place I’d defend American care is for the catastrophically ill, where there are miraculous outcomes still.
Dr. Heart2: If you’re talking about separating Siamese twins, yes, I’d want to do it in the United States rather than anywhere else in the world. When money is not an issue, I would still contend that we have the worst, because we get overtested. We chase incidental diagnoses that might not affect the patient’s health.
Dr. Virus: With universal, you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches. But for millions of people, that would be a big upgrade.