Payments to Doctors: Problems and a Solution

Let's play a quick game of what if. If you had an injury that required surgery to replace, say, a knee, wouldn't you want the best replacement knee possible to be used? If you had the option, wouldn't you want the actual doctor who created that knee to do the procedure? Even assuming that you answered yes to those questions, you might wonder if there was a hook. Would you mind if that doctor was paid over a million dollars a year in royalties because he helped create the knee? Would it matter if that doctor was working at a teaching hospital linked to a state university system? Or that some other options, including non-surgical options, might be available?

These are just some of the conflicting interests inherent in the way the medical system is currently structured in the US. Two quotes from a recent Wisconsin State Journal article on the issue sum up the main points of the two sides succinctly and accurately:

"Since doctors write the prescriptions, it's crucial for drug companies to win their hearts and minds — to bribe them, seduce them, flatter them, whatever it takes," Dr. Marcia Angell, former editor of the New England Journal of Medicine, said at a forum last month in New York. "The companies wouldn't do this unless it worked."

"We have an obligation to leverage the resources of the people of Wisconsin in partnership with industry, as long as it's done in a transparent and ethical way," said Dr. Robert Golden, dean of the UW School of Medicine and Public Health.

We typically strive for some basic level of objectivity here at Blawgconomics, and will tag issues where we feel we are being a bit more subjective as Op-eds. Therefore, it is common for us to present both sides of a story. However, objectivity aside, this issue is striking in that both sides have equally valid and strong arguments. Of course having doctors who work with products consult on their creation is beneficial to recipients. Of course we should allow people who create innovative devices to be financially rewarded. And of course these two facts lead to potential conflicts of interest.

While some point to disclosure as the cure for such conflicts, it is also true that the average consumer of medical services and products, to the extent that they even read disclosures, is unlikely to understand such conflicts. However, the solution to this isn't to eliminate the practices (and thus conflicts) in question. It is to give consumers more, and importantly better, options for understanding the conflicts that could impact their care.

One of the most innovative solutions we have heard of is a program where patients have the option to receive independent counseling on procedures and products which are being contemplated for their treatment. In such a program, a trained professional (though not necessarily a doctor) works with the patient to explore everything from conflicts of interest to alternative treatment strategies, removing many of the concerns that exist when doctors who work closely with device makers and pharmaceutical companies act as the only consultant. Some hospitals have such systems in place currently, and we would anticipate that it is a trend that will continue to move in a positive direction as these relationships face increased scrutiny.


  1. Sometimes disclosure is not enough. Josh Weiss of the GW Law Review wrote proposed legislation that would ban gifts or payments by drug and device marketers to doctors:


    The legislation would not touch the conflict your post focuses on, because that involves payment for a genuine service--the doctor/inventor reaping benefits from using a device she helped create. But it warrants attention and furthers the conversation on the general topic.

  2. Thanks for the comment.

    I was careful to stay away from other types of payments schemes in the post; that is clearly a whole different can of worms.

    However, I think you are correct that bigger changes are probably needed to the system than mere disclosure in some cases.


  3. Nice summation of the issues. I'd love to see an oped that delves into the Shared Decision Making programs that are beginning to pop up around the country, and whether a case can be made that they are anything other than a positive contribution to a patient's healthcare experience.