Saturday, August 22, 2009


I thought that today, I should write about "Healthcare fraud " or " physician fraud ". We doctors depend on clinical trials ( the corner stone for gathering scientific data ), to establish practice patterns. Sometimes these same clinical trials are also used to form practice guidelines. Locally, our specialist tend to copy wholesale USA or European guidelines, as our own ( almost a "cut" and "paste" approach. Since the early nineties, we have suspected that some clinical papers in USA were written by professional ghost writers, sometimes employed by pharmas. So we have the pharma write a report, proportedly on an important clinical trial of one of their blockbuster drugs, pass it to a ghost-writing firm to touch up. Then they will pay some biggun in the medical circle to add their name as the first author, and send it to the esteemed journal for publication. Sometimes the pharma also time the date of release, just a day or two after it was "leaked" to the Wall Street Journal, for maximum impact. Afterall, it is a business and some physicians are co-operative to commit fraud. This seem to be the case with Vioxx, the important paper was by a Dr Kostam, in Circulation in 2001, reporting that Vioxx is safe. Unfortunately, this article was picked up by Senator Grassley, who began looking into the issue of "ghost-writing " and found that it was fairly common and not an isolated incident. There are even ghost writing companies out there, do this fulltime. He named one, DesignWrite, and the case quoted was a paper on OG products. In fact, Sen Grassley, together with Sen Kohl, is passing an act through senae called the " Physician Payment Sunshine Act " to ask pharmas the name of the doctors who had received USD 100 or more from the pharma for the year.
In cardiac circles, at all big meetings, the speakers all declare if they have any conflict of interest with the products used in their presentation, and of course everyone is clean as a wheasel.
In Malaysia the problem is a little different. Vety few of us do original research to get into US or European guidelines. Although I do hope that this will change, I don't see this happening in my lifetime. However, they are many " big boys and girls " who travel and holiday with and by pharmas and device companies, in exchange for their co-operation to get their products endorsed and pass through the DCA or government tenders. Business class travels, shopping holidays while on " conference ", some even bringing relatives along. When I am told these, I always say, "to each his/her own". It just tells me, what kind of values and person you are. I do not thing that I am in any position to stop it. I just wanted to highlight it and let the public know that sometimes the products and practice guidelines endorsed, are severely biased and not wholely in the interest of the patient. Doctors are not so clean afterall. Medicine is becoming more and more like a business.
Yes, when I was pioneering the stent work, I have many companies hosting me. I took a policy or rotation, and always go with the most evidence based product. I had an advantage. Since we are pioneering the work, we had alot of inside information on products, which is safe, which is good and which lacks evidence. That allowed us to use the best one for our patients and as it turns out, we chose the right one from 1991 till now ( for the stents at least ). Anyway, we are buying ( consigning ) such small amounts that it is virually no point " bribing" us, I suppose except for the marketing publicity.
Maybe Malaysia should also have a " Physician conflict of interest Act " to ty and safe guard the public and patients. But then, we are third world in many ways.

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