thelastpsychiatrist.com - A Case Study On Why Policy Changes Fail: Pharma Paying Docs. Adnotated.

The authors report no conflicts of interest

Two reporters' investigations into docs who speak for Pharma have found:

• Fewer than half are formal educators affiliated with academic medical centers or prominent leaders in their medical societies. The rest are a mix of physicians with limited credentials or about whom little could be gleaned.
• Five of the top 43 are from Tennessee
• Eleven of the 43 have board certification in the small field of endocrinology... Eight physicians, the next-largest subgroup, hold no advanced certification, despite speaking on specialized diseases and treatments.
• Only three of the top earners are women--all endocrinologists
• More than half worked for two or three companies. One Tennessee diabetes physician worked for five. Seven earned money solely from Glaxo.

A different article goes into more detail:

And in Georgia, a state appeals court in 2004 upheld a hospital's decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why.ⁱ He'd also been accused of exposing women's breasts during medical procedures. When confronted by a hospital official, Taylor said, "Maybe I am a pervert, I honestly don't know," according to the appellate court ruling.

Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

The underlying principle is, "Docs should not accept money from Pharma." If this is indeed what you believe, then you should look upon these reports and articles with dismay: they're helping Pharma.

II.
I have to wonder if as they uncovered all this stuff, there wasn't a sense of glee, rubbing the hands together like Perez Hilton does when he discovers Lindsay Lohan's gmail password. (It's "velveteengirl"ⁱⁱ)

But that's all besides the point. While this information is interesting and salacious, it is masturbation: purposeless and for yourself only. From a (Machiavellian) policy perspective, the thing to do would be to bury this info about bad doctors, not publicize it.

Approaching this from the "bad/crazy/uncredentialed docs speak for Pharma" angle changes the focus from the noun (docs) to the adjective (bad/crazy).

This happens all the time in political debates, which is why nothing gets done.

Because the outcome you've guaranteed is that Pharma tightens their speaker's bureaus -- and only uses top tier academics. So if you are worried your doc might give you Depakote because he gets paid by Abbott, imagine what will happen when your doc is told to use Depakote by the academics who write the journals and the reviews, who are paid by Abbott. You don't have to imagine it, you just have to remember it, 1999-2006. Were you on Depakote? Yes. Did your doc speak for Abbott? No. Enjoy your liberal democracy.

"Well, it shames the docs so they don't accept the money!" Why would it shame them? In fact, it gives them a defense. "Since I'm not bad or crazy, since I do good clinical work, since I am not doing vaginal examsⁱⁱⁱ, therefore I can take Pharma money."

You can extend this to any social or political question. There's an internal sense of "rightness" or "wrongness" to some issue, but lacking the information, logic, or simply the skills to defend the position, people resort to a core dump.^iv They hope that either something will stick or the volume of criticism will speak for itself.

But it doesn't, it allows the other side to counter with logical, precise, and legitimate fixes to your myriad of complaints -- all while keeping the main premise intact. "Ok, we shouldn't pay docs to speak, we'll only pay them to write."^v

If you think using oil is bad for the environment, don't say that it also leaves us beholden to terrorist nations. I know you think that helps your case, but it doesn't, it gives the other side a straw man to ignite.

Argue from principle.

Arguments with your spouse go bad for the same reason. Her chronic lateness is the problem, but you bring up her past infidelity, cooking skills, bitch friends, etc. Result: you've just given her three new options for a counterattack. If she can effectively defend any one of them, you lose the entire argument.^vi "My husband is an ass." She's kind of right.

III.

The problem is that the principle is often a cover for more base instincts. Put down your Diet Coke for one second and really consider what I am about to tell you.

While considerable investigative journalism went into finding out how much money speakers earned, their backgrounds, disciplinary actions, CVs, etc, not one single reporter has actually listened to one of their presentations. Think about this. Not one reporter thought it important enough to investigate what they said.^vii

No one's even interviewed an attendee. "Hey, what goes on in there?"

That should be your signal that they don't care what was said, what matters is the money.^viii Which makes this much less about Pharma influence on medicine, and much more about class warfare: why should they get to have so much money?^ix

While I completely understand the sentiments, this approach, let alone this sentiment, won't make patients feel better or healthcare run better. (Which is why the solution I offered -- simply making it illegal to accept any kind of Pharma money, at all -- is the most honest way of approaching it. But, as I pointed out, it will have some consequences society may not be ready to accept.)

If it's class warfare you're going for, be honest about it. Just say you don't like docs getting paid so much, period, or you don't like taxes so high, or so low, end of story. You hate welfare handouts. You hate how investment income is taxed at half the rate of earned income, it seems unfair to you. At least these are arguments that everyone can participate in because they're honest, they are your true sentiments undisguised by intellectualization. If you're ashamed to say these things, however, then perhaps you need to ponder why you believe them.

If you pretend -- even to yourself -- that it's really about Pharma causing doctors to do something they wouldn't/shouldn't do, then you have to explain how this happens. I'm not saying this is a hard thing to do, either, but it must be done, it's not enough just to say it.^x

But, and this is the point, if you have not really be[en] honest about your principle, once you explain your reasons the other side will quickly dispatch a series of remedies which legitimately address each of your complaints, all while leaving the underlying principle untouched. And yes, now I'm talking about today's elections.

1. Training for a job with the TSA, maybe ? [↩]
2. I wonder if this is a reference to the rabbit, or to tubgirl. [↩]
3. I can't decipher this guy's stance anymore (or, for that matter, his culture's). So, on one hand, "we all know what cheerleader means" would require "young women getting a few more rectal exams is all the better for everyone, loosen them up a little". He even says this explicitly in a different context (spoiler : it's psychiatry) : "whatever-- sure, those people could use a psychiatrist" ; "did many have a legitimate disorder? sure. whatever." For that matter, the whole thing about "national security" seems to gravitate around the para-religious belief that giving some random people a free rectal now and again will impress the Ether gods, and thereby preserve us all for another day. Heck, even roadside anal-ization by the police is popular over there, as a factual matter ; and [what passes for] education's been on a multi-decade kick of publicizing among [relatively young] teenagers the glories of stuffing various objects up their respective holes.

   Why is he then turning around and (seemingly, maybe I misread) implying that free, clean and secure anal/vaginal insertion's a bad thing now, and undesired / undesirable ? What the hell sense does this make ? Is he / are all of them so very deeply conflicted about all of this, no possibility of making up their mind's available ?

   The young women in question'd have been way the fuck worse off getting free fries instead of free probings, also as a factual matter. Or is this also in question ? [↩]

4. Check him out, he knows what core dumping is ?! Just... how ?

   I suppose this'd be the first question I'd wanna ask a resurrected Ballas, "say, where'd you hear about core dumps ?" [↩]

5. This is actually a most astute description of the historical problem of the provincial colonies : they "fixed the problems of Europe", but "as they understood them". Which... [↩]
6. If the relationship with the spouse is "argument"-governed, meaning if there isn't a clear font of authority the other submits to, the relationship's already lost anyway ; both are "an ass", in the sense of, two subbies arguing with each other to see who has to dom for the evening. Discussing "correct argument techniques" with a view to domestic arrangements is a lot like discussing correct yoga postures with a view to being drawn and quartered. [↩]
7. For that matter, I'm still curious whether Dr. Donald Ray Taylor's free medical procedures were officially a bad thing or what.

   You know that as part of boobjobs they offer a histopathology exam, by the way ? It makes sense, since you've opened the thing up anyway might as well send some tissue off to the lab. You have to pay for it, and it's generally pointless, as in, serves no legitimate medical purpose. It's not an exam, in the usual sense, it's not ordered by a clinician for some kind of reason ; it's a matter of availability, "rather than throw out 100% of the material we might as well throw out merely 99.95% and laboratorize the rest, do you feel like paying for it ?" They even tell you, "it's very likely a waste of time and money". But be that as it may, some people pay, some people don't -- I imagine most do, seeing how if you can afford thousands to bolt on tits for purely aesthetic reasons you probably can also afford fiddy bux to discover early an extremely improbable case of cancer. Is this also a bad thing ? Should they be ashamed of themselves ? I mean, it's tits, right ? Shame ?

   Supposedly there's nothing wrong with the doctor seeing you naked, feeling up your tits, sticking two fingers up your cunt, etcetera. Some dude you barely just met five minutes ago, but it's also not sexual, it's "medical", and anyway you can't formalize yourself over such a thing, the social narrative goes. It'd be barbaric. Right ? We're civilised people over here, unlike Arabic lands or whatever, we have no problem being doctored upon by the doctor, it's the doctor after all. So then ? Does something magically change if... if what exactly ? Inadvertence ? Negligence ? Humanity ? That's what it is, isn't it : if the doctor ceases being a robot the shame philter magicaly loses its magic power, and suddenly it's not okay to be having a perfect stranger's fingers right up your slutty daughter's snatch. You realise every other boy in school already scratched her / deposited random if microscopic collections of scum and assorted fungi down there ?! The doctor's at least working with a god damned glove.

   Suppose he found something. What then ? My best guess would be, that should the doctor feeling exploratorily around the teenager's vagina out of sheer curiosity discover malignancy, the victim/patient would apply to the court : for the adventurously curious doctor to be disdoctored, and for the malignancy to be thrown out of court, as fruit of a poisonous tree. It was after all discovered without a warrant, so it shouldn't cunt. Doesn't that sound just about right to you ?

   You're fucking insane, all of you, you know that ?

   PS. To make your eyes really pop out of your head : you realise those girls could very well have refused the procedure, do you ? The accusation specifically isn't that good ol' Dr. Taylor gave anyone procedures they had refused, it's merely that he failed to explain to whatever standard why he, in his professionally deranged medical opinion, deemed them worth his time. Medicine has a lengthy tradition of trying to get people to undergo procedures they don't need, from the tonsilectomy craze to a whole regiment of dentists that've for twenty years been trying to convince me to operate my jaw to extract my copasetically benign wisdom teeth. I just refuse, and that's that.

   Those girls could have said no. If they cared one way or the other, they could just have said no. Do you realise that ? Since they didn't... they enjoyed themselves, yes ? He's covered, or at least, just as covered as you are, come Sunday noon. [↩]

8. To me, it seems rather that they do not believe themselves equal to the task of judging what was said. They perceive this approach to be "more objective", which is why they stick to it.

   And yes, they do pretend that "objective" matters and that this is more "objective" than that for ulterior reasons, but I also do not believe those ulterior reasons amount to any sort of projection of power. They don't think these sorts of things because they're conspiring to take over the world, they think these sorts of things because they have a lot of trouble mentally resolving the unresolvable chasm between how much they're repeatedly told they're worth and how little they ever manage to produce. It's this esteem-power dichotomy that drives them to seek "more objective" aka "nobody can accuse me" venues towards what they perceive to be their goals. [↩]

9. I do not buy the "class warfare" line for half a second.

   The problem with the money is this : since we're so overvalued and so ineffectual, it is extremely dangerous to us for value to be squandered. If these other guys get X but produce Y that means great Inca's perhaps leaking turkey dollars and we'll all starve.

   That's the concern there, entirely outside of any possible class consideration, as the drones involved already live in a wholly imaginary, completely realised socialism, which therefore has absolutely no classes nor any possiblity of such a wonder. Their concern with the money wastage here is of the exact kind as their concern with how much styrofoam garbage their office lunches produce, it's purely an ecological concern. [↩]

10. Well, reading between the lines, the proposed argument would be that a) Pharma selects for the type of "curious" doctor who'll look up a girl's twat whether she needs it or not -- because he needs it, or whatever ; then b) that like people work with like people, and therefore this sort of rep will in turn increase the density of similarily minded doctors and simultaneously decrease the density of all other types of doctors ; which c) eventually will result in an environment more attuned to the needs of Pharma and less attuned to the expectations of people who are simultaneously ashamed and not ashamed of their cunt and simultaneously can and can not reason about the topic at hand.

    It's a decent theory, as such ; but as the plain statement thereof also makes directly obvious, it can only be the theory of someone firmly committed to the dualist insanity. Everyone else will just resolve that part, and get a free solution to the "problem" as a package deal. [↩]