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The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way

• xiaq 7y ago
  > The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.
  • r_singh 7y ago
    Haven't experienced this so don't know as much, but yes, does make sense (in theory, at least).
  • catalogia 7y ago
    The government may have that incentive, but what about the individual doctors who are actually examining patients and diagnosing people? Do these employees truly share their employer's desire to cut costs? I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.
    • pimmen 7y ago
      Universal healthcare doesn’t erase that incentive, nothing does. You need a vigilant medical board that penalizes bad doctors to deal with that, fortunately something like that can be reconciled with the system we have in the Nordics. Of course, it’s far from perfect just like any regulatory agency ever.
  • Consultant32452 7y ago
    What is unique about healthcare that the government would feel incentivized to reduce costs? How is it different from roads, schools, military, etc?
    • virgilp 7y ago
      Government is in theory incentivized to reduce costs because it has limited funds. The thing with healthcare is that the purchaser, if private, pays whatever (s)he can afford (how much is your health worth it to you?). Whereas if the state is the purchaser, it is (a) A monopsony, having substantial power over healthcare providers; and (b) Doesn't care as much about any individual patient, thus being able to make decisions that are rational on the aggregate level On short: much better to be a healthcare provider in US; much better to be a patient in EU.
      • Consultant32452 7y ago
        Do you think the same downward pressure on costs applies to schools? What about fighter jets?
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    • refurb 7y ago
      The demand for healthcare is infinite. Even when there are marginal improvements in treatment, patients and physicians want the best. The ability of national health systems to say “no” is one of the big levers to controlling cost, in the US, that control is quite fragmented.
  • gvjddbnvdrbv 7y ago
    In general you are correct but sadly there are perverse incentives even in a system like the NHS. There are two problems. (1) treatments are approved only if they make financial sense for the country and (2) sometimes those calculations go wrong. At one point people were being allowed to go blind based on a cost calculation. Even though letting people go blind was more expensive overall to the country. The cost of treatment to the NHS budget was greater than non-treatment but the social care costs came from another budget.
    • eterm 7y ago
      Source? Because the NHS doesn't optimise for cost, it optimises for cost per QALY (quality adjusted life years). Given the high impact to quality of life for blindness your claim is dubious. NICE make the decisions over cost effectiveness of treatments, and publish their findings. If you can tell me the name of the drug we can find the actual report.
      • gvjddbnvdrbv 7y ago
        I heard this on a BBC radio 4 radio program related to disability issues aired on either a Tuesday or Thursday around 9pm in around 2014/2015.
        • DanBC 7y ago
          2011? https://www.bbc.co.uk/programmes/b016817t https://www.bbc.co.uk/programmes/b016817t Avastin / Lucentis does not support the point being made. Lucentis, a very expensive medication, was both licenced for AMD and was approved by NICE for that use. Avastin is identical, but was not licenced for AMD and so NICE was not able to recommend its use for AMD. Doctors were using Avastin off label, and they wanted the government to force Avastin to be licenced for AMD which would have allowed it to be recommended by NICE. The makers of Avastin and Lucentis fought this in the courts for years, and took action against NHS Trusts using Avastin off-label. The NHS won that legal case. https://www.bbc.co.uk/news/health-30138097 https://www.bbc.co.uk/news/health-30138097 https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wins-landmark-legal-battle-against-drug-companies/7023422.article https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wi... There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma, not AMD, and it has nothing to do with NICE (who are the organisation that decides about cost effectiveness) and everything to do with a government that has chosen to de-fund the NHS.
  • WalterBright 7y ago
    > Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. It's hard to see how this can be true, since government operations are infamous for excessive cost.
    • speedgoose 7y ago
      Look at the health-care situation in Europe.
      • throw47899544 7y ago
        In France if, for an average employee, you add the employer and employee contribution to social security, for 40 years, you find that it pays two large houses. At the same time most average employees will struggle to buy a house. And the social security will reimburse well only medical costs (visit to family doctors or medical acts done in hospitals). For other costs, hospital care, glasses, dental or hearing costs, it reimburses very little. So for me France's SS is actually a kind of mandatory way to channel money towards doctors.
        • pbhjpbhj 7y ago
          I thought France has a rental culture, no? I'd rather be alive and renting than dead with an estate that has ownership of a building.
        • kokx 7y ago
          Lets assume that instead that money would go to the employee and not to social security. And we will assume that a large house would cost about 500k EUR. Thus, in 40 years, you would have collected a million euros more. That is about 25k EUR extra per year. That seems to be about the amount of income tax a French citizen would pay every year. Thus, that money doesn't just go to health care. It also goes to other social security programs and government projects.
    • tonyedgecombe 7y ago
      We have a pretty lean system in the UK, possibly too lean. The private system in the US however seems a poster child for excessive cost.
  • ekianjo 7y ago
    > Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. Except that in such countries healthcare costs completely explode over time as well.
    • donkeyd 7y ago
      Can you please provide some form of a source for your statement? I read this a lot, but I can't find any factual basis for the statement. The US is known for having the highest cost of health care per capita, more than twice that of France and the UK, two countries commonly named for having socialized health care [0]. 0: https://www.businessinsider.com/cost-of-healthcare-countries-ranked-2019-3 https://www.businessinsider.com/cost-of-healthcare-countries...
      • ekianjo 7y ago
        Please find me another country that creates as many new drugs as the US and that has a national health care system. If you dont have such an example it cannot be a fair comparison. the world is not summed up by a single variable.
        • majewsky 7y ago
          Why are you moving the goalposts by now requiring the country in question to "create as many new drugs as the US"? I don't see how that relates to this discussion at all.
        • kiney 7y ago
          switzerland has way more new drug patents (per capita) and universal healthcare
          • cyphar 7y ago
            Switzerland (unfortunately) doesn't have what I (as an Australian) would recognise as universal healthcare. It's very similar to the "public option" to use the US terminology. It is still closer to modern healthcare than the US, but it's not the same thing (and suffers from problems that other more progressive healthcare systems do not suffer from).
  • cosmodisk 7y ago
    In countries with national health system, doctors have the opposite target to not referr people further for expensive procedures. A good example was in London,where a hospital was paying to GP practices so they won't refer people for certain treatment ( because of the workload the hospital had). You need to go to your GP at least 3 times before they even start listening what's going on or prescribe more than just paracetamol.
  • refurb 7y ago
    It really comes down to how doctors are compensated. I know Canada used to be fee-for-service. The more the doctor does, the more they get paid. They certainly had an incentive to “do more”.
• IAmEveryone 7y ago
  It’s technically true that doctors need patients. But does anyone believe any doctor actually thinks in those terms? Not just because it’s unethical. The mechanism doesn’t work: your future income will benefit a lot more from being regarded as a competent doctor, than it ever would from the minuscule damage you could do to public health with being purposefully bad. I’ve also rarely seen doctors that cared about patient acquisition in the way normal businesses do. Since health care is somewhat expensive, governments tend to try running the system with a slightly low number of people.
  • chimeracoder 7y ago
    > It’s technically true that doctors need patients. But does anyone believe any doctor actually thinks in those terms? > Not just because it’s unethical. The mechanism doesn’t work: your future income will benefit a lot more from being regarded as a competent doctor, than it ever would from the minuscule damage you could do to public health with being purposefully bad. Almost none - certainly not when it comes to preventive care. The original article shows misaligned incentives with a tiny, short feedback loop, and even then these instances are (thankfully) not common on a large scale. The idea that a GP would encourage their patients to have unhealthy diets and never exercise, just so that in twenty years some other doctor - a cardiologist, endocrinologist, etc. - could have a greater supply of patients in need of care is absurd. The GP's expected lifetime earnings are not going to go up if their patients decide not to engage in preventive care, and the GP's expected lifetime earnings definitely will go down if they actually discourage preventive care, because they'll develop a reputation as a shoddy doctor.
• TACIXAT 7y ago
  Celiac here too. I hold a very similar opinion about doctors. I used to have regular sinus headaches. They would prescribe nasal spray. Even after I stopped eating gluten and noticed a correlation I would bring up that gluten gives me sinus headaches and these geniuses would advise me to avoid it. Yea, thanks for the help doc. I can not believe I had an issue for decades and no medical professional suggested an elimination diet.
• missosoup 7y ago
  Even ignoring perverse incentives, GPs are actually pretty clueless about diagnosing anything outside the 90th percentile bracket. There's a surprisingly low standard of knowledge and no system in place to enforce up-to-date knowledge like there is for e.g. pilots. Go approach 5 different GPs with the same presenting symptoms and story, and you'll get 4 different answers. Having consulted for the healthcare sector a little bit, I am terrified of ever going into the system if I develop anything slightly unusual. This is a sector that really needs to be overhauled with evidence based practice and heavy, heavy use of automation and ML to minimise the human element.
  • mattkrause 7y ago
    > no system in place to enforce up-to-date knowledge I don't think that's correct. Many states require a certain amount of continuing medical education to maintain a medical or nursing license. It's often not a TON of training and you have some flexibility in what topics you choose to study, but it's something.
  • bluedino 7y ago
    Doesn't that apply to any field, though? Doctors get one thing wrong and then people want to self-diagnose with the internet. It's like a programmer originally thinking a bug is in one function when it's really in another. And then the customer reads a Java for dummies book and thinks they can find the answer.
    • missosoup 7y ago
      It does apply to most fields but not all. Notably, pilots are really good at what they do and improve constantly. It's hard to compare doctors with other fields because a fuckup in most fields will cost money, but a fuckup in medicine will cost permanent damage and lives. If doctors can't live up to a higher standard (and they can't) then we need to minimise the human element in diagnosis and treatment as quickly and aggressively as possible. Anecdotal but I've personally been saved from a potentially permanently-crippling medical procedure only because my med student friend visited me in the ward and questioned the procedure as it didn't make sense given my condition. If he wasn't around, I would be spending the rest of my life with a mild disability. That's not acceptable, but it happens all the time.
• entilzha 7y ago
  Totally agree on not trusting any one doctor. Nowadays, I basically assume doctors are narrow minded experts and do the broader thinking myself (by reading widely). It’s the old saying that when you have a hammer everything looks like a nail. I wish I realized the extent to which this is true earlier. My issue happened to be with sesamoid/metatarsal fracture, flat rootedness, and poor gait. No doctor cared about my gait which turned out to be the root cause of my other symptoms. They all wanted to do surgery/orthotics and basically thought that would fix it alone vs combined with PT.
• TheOperator 7y ago
  The average person has the most unusual attitude towards doctors. Treat the word of one doctor you've known for a really long time as if it's gospel.
• donkeyd 7y ago
  > It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. Maybe in the short term. In the long term, people will get older and will get more ailments due to age and still go to the doctor. When I visit a GP in the Netherlands, I mostly see children and old people in the waiting room.
• frobozz 7y ago
  The diet industry is worse. Those companies where you count some kind of points as you eat and pay membership to turn up for a weekly weigh-in and pep talk rely on the good habits being poorly embedded so that you get fat again without the meetings. I disagree with the conflict of interest RE doctors. At least with doctors, people will always get ill. If people no longer turn up for lifestyle-related ailments, they will still come in with a rash or pain or whatever. They will also have fewer complications or confounding factors for diagnosis. In a profit-driven healthcare system, I would imagine that lots of healthy patients is more profitable for a GP than a few sick ones. The sick ones incur more costs, and end up getting referred away to specialists for much of their care anyway.
  • wayoutthere 7y ago
    Eating Disorders as a Service?
    • JshWright 7y ago
      I assume you're getting downvoted because short comments are perceived as "low effort", but my sister-in-law is a registered dietician at an eating disorder in-patient facility. She has used the phrase "Uber for eating disorders" to describe those programs...
      • wayoutthere 7y ago
        Yeah, it wasn't intended to be low effort. The entire idea of "dieting" effectively encourages people into eating disorders. For me, losing a bunch of weight was as simple as cutting out big sugar bombs and alcohol. After about a month, anything that could be classified as a "dessert" became cloyingly sweet and gave me indigestion. I pretty much eat whatever I want otherwise.
        • AnIdiotOnTheNet 7y ago
          In my experience having lost and kept off half my body weight, and I'm sure my family would agree with me on this, effective weight loss basically requires an eating disorder. I don't know how much weight you lost, but I can't imagine it was all that much if all you had to do was cut out sugar and booze, unless that was the majority of your caloric intake.
• thrwaway69 7y ago
  Where do you actually find good mental health practitioners in India? My luck ran out last time I tried to find one. I wonder why there isn't any repercussions for lot of self claimed doctors...though government tried to deny the WHO report that said approx 65% doctors are not qualified in India and the rest are dubious to good. Doubled down and passed a bill for recognising ayurveds, homoeopaths, etc as actual doctors.
  • kranner 7y ago
    > Where do you actually find good mental health practitioners in India? There's this crowdsourced list: https://docs.google.com/spreadsheets/d/1pzckT6ns2H1IlmwYwJa8EnBh_1u3gRA9cEOoA4zfilc/htmlview# https://docs.google.com/spreadsheets/d/1pzckT6ns2H1IlmwYwJa8...
    • thrwaway69 7y ago
      Thanks. Only one result comes for my state. :( Sad reality.
• ramblerman 7y ago
  > The medical industry has the biggest conflict of interest I have seen in any industry Private prisons come close. They incentivize having more people in prison. So, when you see people lobbying against legalizing weed, some of that is genuine concern, but it also aligns very closely to people who realize what a drop in prison inmates could mean for there business... It's insane.
  • jonfw 7y ago
    Do you have any evidence that this is a legitimate problem? It doesn't really make economic sense IMO. It's a small percentage of people in jail who are non-violent marijuana drug offenders. https://www.snopes.com/fact-check/drug-law-lobbying-by-corrections-corporation-of-america/ https://www.snopes.com/fact-check/drug-law-lobbying-by-corre... The corrections corporation of America only spends a million a year on lobbying- this would be small change even if it was solely spent on anti-marijuana lobbying. But It's more likely that the majority of their lobbying budget would be spent on issues directly related to regulation and spending for private prisons
    • alistairSH 7y ago
      Not lobbying, but "Kids for Cash" is the worst case I've seen that demonstrates the conflict of interest. Several judges took bribes from private prisons to incarcerate juveniles for minor offenses. While the judges have substantial jail sentences, the developers got off light at <2 years in jail and some fines. For wrongly keeping minors imprisoned, and leading to the suicide of at least one of the wrongfully jailed. https://en.wikipedia.org/wiki/Kids_for_cash_scandal https://en.wikipedia.org/wiki/Kids_for_cash_scandal
    • JshWright 7y ago
      While it's a small percentage at any given time, it would be interesting to know what percentage of the prison population were "introduced" to prison by that route. Once someone has been imprisoned once, they are at a much higher risk for subsequent imprisonments.
    • reallydontask 7y ago
• nscalf 7y ago
  It sounds like you fall into the tail of medical diagnosis. Doctors are incredible good at traumatic response, that's where they're at their best. They're not so great at chronic illness. They're terrible at prevention. If you fall into the edge case of a chronic illness, where it is tough to diagnose (i.e. a test doesn't just spell it out for the practitioner), you may as well be on your own. You have to do tons of research into symptoms, isolate your environment and diet, etc. I've been through this, and I've seen a close friend go through this, and doctors have been far more harmful than helpful in my n=2 experience. They're quick to diagnose the most common possibility, and dismissive of any other possibility. But here's the thing: that all makes sense! Given the demands on doctors time and the ROI for quality of life for patients, doctors are, and should be incentivized to spend as little time as possible per patient and to diagnose them with what is most likely, given the evidence and previous knowledge. I think medicine is one of the last great frontiers for the people to relaim through the internet. We don't take anyone's word for it when it comes to any other field, only medicine. I think we should all come to accept that we are our own doctors, first and foremost. We need to research how to take care of ourselves. Doctors are dramatically undertrained on preventive medicine (particularly diet), and I've had them tell me things that are flat out wrong, including outdated science: "losing that much weight is bad for you" when I dropped from being obese over a 6 month period, "that diet is very unhealthy" when I tried Paleo, "fat's will give you heart disease" when I tested with keto and wanted blood work done, "there really is no need to supplement" when my blood work showed severe deficiencies in vitamin D and Magnesium (both extremely important), etc etc. Preventive medicine and health optimization does not come from doctors, we need to stop expecting it.
  • blix 7y ago
    I went to several specialists for a chronic digestive disorder and got wildly varying, directly conflicting instructions on which, if any, dietary choices might help me feel better. The common belief was that no dietary choice could make a significant difference. After 2 years of weekly injections, during which my health declined precipitously, and a couple of surgeries that took ~4x longer than expected for recovery, I abandoned this approach. I have since gotten my condition almost entirely under control through diet and other lifestyle changes. If a doctor had told me the simple rules I now follow, perhaps surgery and $4k/mo biologics could have been avoided, but the incentives are aggressively aligned against this option.
• socialdemocrat 7y ago
  I think the problem is less for doctors than companies. Doctors have to personally face their patients. You can only take being an immoral asshole so far. The problem is health care companies. To them patients are just faceless entities with wallets. The executive making decisions screwing them over never have to see their pain. There is a parallel to Nazi Germany here one could use. The reason concentration camps were made was because it was mentally taxing to just gun down innocent people day after day for normal soldiers. Concentration camps in contrast got organized so that the victims had to pick up the dead ones and car them off. All the ugliness was out of view for the evil people running the show. It was easy for Nazi bureaucrats to kill people with the stroke of a pen. Just names on a list. Never had to see somebody choking or bleeding to death. Hence you get a big problem when power is moved away from doctors to companies. In this example e.g. the doctor while immoral may not have been quite as immoral had it not been for a company actively pushing him to provide patients. Private enterprise should not be allowed to provide financial incentives to doctors. Who the doctor sends their patients to, should be entirely decided by medical necessity and not influenced by a potential for profit.
  • r_singh 7y ago
    > Private enterprise should not be allowed to provide financial incentives to doctors. One side of the coin. Pharmacy benefit management companies should be scrutinised for their choice of drugs included in an insurance policy and how they price them, etc. https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Controversies_and_litigation https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Co...