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A new analysis out of ProPublica, a research organization, has found that doctors who work at Louisiana hospitals are more likely than their peers at hospitals in every other state in the country besides New Jersey to accept money from companies behind new drugs and medical devices.
For example, in the New Orleans area, about 85 percent of doctors at four hospitals accepted payments from medical and drug companies. Comparatively, the national average is 66 percent. To develop these numbers, ProPublica tracked payments to doctors over the past six years at hospitals across the country.
But what does this information mean for patients? It means that it may increase the likelihood that a doctor will choose to prescribe a certain medication or device for a patient when there may be multiple options. They may even be more likely to prescribe certain medications for off-label use in different situations. Though most doctors will say that they would never prescribe a medication or device that was not medically warranted and believed to be effective, the end result is that the decision about how to treat a patient is an equation that doctors must solve based on the evidence at hand. If one of those pieces of evidence at play is a payment from a company that requires consistent prescription of a certain medication, then the patient’s best interest may not be the primary consideration.
Many believe that payments by companies who produce addictive painkillers to doctors played a role in the current addiction epidemic. Physicians may have prescribed a painkiller that was far stronger than needed or for longer than necessary, or may not have paid attention to how long the prescription continued if it contributed to their earnings.
The Impact
While doctors are allowed to receive payments from drug companies for things like research and speaking engagements, there is concern that these payments can influence the way doctors prescribe medications.
According to Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, "There's a large body of evidence that suggests that even small gifts, or payments, or meals, or trips, can influence prescribing behavior."
This is particularly concerning in Louisiana, where the state is currently facing a major opioid epidemic. In 2017, Louisiana had the sixth-highest rate of opioid-related deaths in the country.
Types of Payments
The ProPublica report found that Louisiana doctors received a variety of payments from drug companies. These included:
- Speaking fees: Drug companies paid Louisiana doctors to speak at events and conferences about their products. In 2018, Louisiana doctors received over $3 million in speaking fees.
- Consulting fees: Drug companies hired Louisiana doctors as consultants to provide advice on their products or marketing strategies. In 2018, Louisiana doctors received over $7 million in consulting fees.
- Research payments: Drug companies paid Louisiana doctors to conduct research studies on their products. In 2018, Louisiana doctors received over $5 million in research payments.
- Gifts and meals: Drug companies also provided gifts and meals to Louisiana doctors as a way to promote their products. In 2018, these gifts totaled over $1 million.
It's important to note that not all of these payments are inherently problematic. For example, research payments can help advance medical knowledge and improve patient care. However, it's crucial for doctors to disclose any financial relationships they have with drug companies so that patients can make informed decisions about their healthcare.
The Impact on Patient Health Outcomes
Studies have shown that there is a correlation between the amount of money doctors receive from drug companies and the medications they prescribe. In some cases, these payments can lead to doctors prescribing more expensive medications that may not be in the best interest of their patients.
Furthermore, research has found that patients who see doctors with financial ties to drug companies are more likely to receive prescriptions for brand-name drugs instead of generic alternatives. This can result in higher out-of-pocket costs for patients and even contribute to medication non-adherence.
In Louisiana, where opioid addiction rates are high, it's particularly concerning that doctors receiving payments from opioid manufacturers could potentially contribute to overprescribing and fueling the epidemic.
It's important for patients to be aware of any financial relationships their doctors have with drug companies and to discuss potential conflicts of interest with their healthcare providers. Transparency in these relationships can help ensure that patient health outcomes are prioritized over profits.
Ethical Considerations
The relationship between drug companies and doctors is a complex one. While drug companies argue that these payments are necessary to advance medical knowledge and improve patient care, critics argue that they create a conflict of interest for doctors.
When doctors receive payments from drug companies, there is concern that they may be influenced to prescribe medications based on financial gain rather than what's best for their patients. This can erode trust between doctors and patients and compromise the integrity of the healthcare system.
In response to these concerns, some states have implemented laws requiring doctors to disclose any financial relationships they have with drug companies. However, there is still debate about whether this goes far enough in addressing the ethical considerations surrounding these payments.
Ultimately, it's up to individual doctors to carefully consider the impact of accepting payments from drug companies on their practice and their patients. By prioritizing patient health outcomes over financial gain, doctors can help ensure that the healthcare system remains focused on providing quality care for all.
What Can Be Done?
One solution to this problem is increased transparency. Patients should have access to information about which doctors are receiving payments from drug companies, and for what reasons.
Fortunately, there are already resources available for patients who want to learn more. Open Payments is a government-run website that allows patients to search a database of payments made by drug and medical device companies to doctors and hospitals.
Additionally, some states, including California and Massachusetts, have passed laws requiring drug companies to disclose their payments to doctors.
Are Prescription Drugs Dangerous?
Prescription drugs that are addictive in nature have the potential to be dangerous. It should be noted that there is a difference between physical dependence and full-blown addiction. It is possible to become physically dependent on any medication that requires you to take steadily increasing doses as tolerance develops or that causes you to experience withdrawal symptoms if you miss a dose. It is when this physical dependence is coupled with psychological dependence, or cravings and an urge to take the drug, that addiction is the issue.
It is also important to note that only a percentage of people who leave a doctor’s office with a prescription for an addictive medication will develop a problem with the drug. But so many people are prescribed addictive medications that this percentage indicates a significant number of people, and others in the home who have access to those medications are also at risk if they use them nonmedically.
How Do I Make Sure that Use of a Prescription Drug Doesn’t Turn into Overdose or Addiction?
There are no guarantees in life, and certainly that principle applies to the use of potent medications. You can take precautions, but ultimately, the only way to guarantee that you will not overdose or develop a dependence is to avoid taking the drugs at all. Some precautions include:
- Talking to your doctor and/or pharmacist about the potential risks of using the drugs, including dosages, timing of doses, driving while taking the medications, and mixing of medications
- Keeping use of addictive medications to a minimum (e.g., minimum dose, minimum potency, minimum length of use, etc.)
- Working to manage issues through holistic measures
- Regularly checking with the prescribing physician to determine whether or not the medication or current dosage is needed
- Immediately scheduling an appointment with your doctor if you think you may have a problem
If you believe you are developing a problem with your medication or someone else in the house is using your medication without a prescription, do not wait to address the problem and get help.
How Do I Know if Someone Is Abusing Their Prescription?
It is not always easy to tell if the changes you see in someone you know well are normal side effects of the medication or a recent dose change or if they are signs of prescription drug abuse. In almost all cases, however, the following behaviors can indicate abuse of a prescription medication:
- Crushing pills before using them
- Ingesting pills in any other manner than swallowing them whole (e.g., snorting crushed pills, dissolving crushed pills in water to inject the solution, etc.)
- Mixing prescription medications with other drugs, including alcohol and marijuana
- Attempting to alter written prescriptions to get more pills
- Going to multiple doctors for the purposes of getting multiple prescriptions that are similar
- Going to multiple pharmacies to refill a prescription multiple times
- Going to the emergency room for additional pain pills
- Frequently asking for an emergency refill due to lost pills
Someone who is living with an addiction to their medication will often spend more and more time under the influence, become less social with others, and begin to lose focus at work, at home, and in personal relationships.
How Do I Help Someone to Stop Abusing Their Prescription?
If you believe that someone you care about is struggling with a substance abuse problem due to use of a prescription medication, do not wait to intervene. Overdose is always a risk as long as abuse of these drugs continues. The best way out? Treatment. Initiate a conversation today about how treatment can help your loved one to overcome prescription drug abuse or addiction and begin the healing process now.
Conclusion
While Louisiana doctors are among the most likely in the US to accept money from drug companies, increased transparency and public awareness can help to mitigate the potential negative impacts of these payments. Patients should educate themselves about the payments their doctors are receiving and demand transparency from both doctors and drug companies.
