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> I have never experienced or heard of a doctor deceiving or lying in real life. Meet Dr. Stella Immanuel who tells her patients that medications are made from

> I have never experienced or heard of a doctor deceiving or lying in real life. Meet Dr. Stella Immanuel who tells her patients that medications are made from alien DNA and that their illnesses are caused by demon sperm. In the USA she gets to keep her medical license/practice. (https://en.wikipedia.org/wiki/Stella_Immanuel https://en.wikipedia.org/wiki/Stella_Immanuel) See also: every doctor that accepted bribes from Purdue Pharma in exchange for knowingly prescribing excessive amounts of opioids to people who never needed them.

s1artibartfast 2y ago
I included real life as an intentional qualifier. I know that quacks, grifters, and criminals exist. The fact that they exist doesn't bother me. Some will always exist. What matters is how common it is and what the average experience is. I don't think most doctors treat their patients the same as Stella Immanuel. Same for the two doctors that perdue was convicted of bribing
- autoexec 2y ago
  Half of all doctors in the US accept money or gifts from drug and device companies. (https://www.statnews.com/2020/12/04/drug-companies-payments-gifts-affect-physician-prescribing/ https://www.statnews.com/2020/12/04/drug-companies-payments-...)
  - s1artibartfast 2y ago
    I actually really liked that article and how it at least tried to present both sides. However, I tend to agree with the opposing side, but think there are some edge cases that could be improved. I have spent my career working in drug and device development so I probably have a more nuanced view informed by my experience. I have payed millions to doctors, and think my actions are justified. One thing that the article touched on that I like is the role of non-industry associations, which I think could do a lot more to spread information. However, there's no one that will pay them to do it.
    - autoexec 2y ago
      > I have payed millions to doctors, and think my actions are justified. You aren't at all worried that paying those doctors will result in them prescribing something to a patient when they might not have otherwise or influence their choice for one option over another? I'm not talking about the education or awareness a doctor might get, purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
      - s1artibartfast 2y ago
        The vast majority of the payments are either education or payment for services rendered, like the article mentions. At a high level, companies actually think their products have value to patients and want doctors to know about what it can do. It is virtually impossible to decouple knowledge sharing from influence. The point of knowledge sharing is to impact choice and behavior. On the services front, If I want to hire a doctor to fly across the country and do Brian surgery on a pig or cadaver, I expect to have to pay them. Similarly, if they are running a clinical trial, I expect to fly them to the surgical training and feed them, and pay for their time. >purely the influence of the money/benefits and perhaps their hope to get more of the same from you later. Direct kickbacks for prescriptions are a thing of the past. It is pretty hard to come up with a situation where future benefits is conditional on the behavior. Like, I suppose you wouldn't invite a doctor that doesnt use your product to give feedback on it or be part of a clinical trial, but that is a niche feedback to worry about. Lastly, articles like are very misleading when it comes to the details. In their reference for $2B in payments [1], includes things like Royalties. >The greatest proportion (27.3%) of value was from royalty or license payments (≈$484 million of $1.8 billion) followed by service fees (26.6%), such as faculty lectures ($472 million of $1.8 billion). If they are claiming paying royalty or license payments for inventions (like developing a hip implant) are a kickback, it frames the whole argument as rhetoric. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470350/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470350/
        phil21 2y ago
        I’ve found the “collective common knowledge” regarding pop-culture topics such as this, is much like generals preparing for the last war they fought. Direct kickbacks were an actual problem decades ago. That has long been “solved” all the way to the typical over correction the industry is known for. The same holds true for the opioid epidemic and folks still thinking pill mills and the medical industry as a whole are the primary way folks get hooked. It’s fighting last decades battles that have long since moved on. The zeitgeist seems to “stick” each generation and does not seem to keep up with current reality.

s1artibartfast 2y ago

I included real life as an intentional qualifier. I know that quacks, grifters, and criminals exist. The fact that they exist doesn't bother me. Some will always exist. What matters is how common it is and what the average experience is. I don't think most doctors treat their patients the same as Stella Immanuel. Same for the two doctors that perdue was convicted of bribing

autoexec 2y ago
Half of all doctors in the US accept money or gifts from drug and device companies. (https://www.statnews.com/2020/12/04/drug-companies-payments-gifts-affect-physician-prescribing/ https://www.statnews.com/2020/12/04/drug-companies-payments-...)
- s1artibartfast 2y ago
  I actually really liked that article and how it at least tried to present both sides. However, I tend to agree with the opposing side, but think there are some edge cases that could be improved. I have spent my career working in drug and device development so I probably have a more nuanced view informed by my experience. I have payed millions to doctors, and think my actions are justified. One thing that the article touched on that I like is the role of non-industry associations, which I think could do a lot more to spread information. However, there's no one that will pay them to do it.
  - autoexec 2y ago
    > I have payed millions to doctors, and think my actions are justified. You aren't at all worried that paying those doctors will result in them prescribing something to a patient when they might not have otherwise or influence their choice for one option over another? I'm not talking about the education or awareness a doctor might get, purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
    - s1artibartfast 2y ago
      The vast majority of the payments are either education or payment for services rendered, like the article mentions. At a high level, companies actually think their products have value to patients and want doctors to know about what it can do. It is virtually impossible to decouple knowledge sharing from influence. The point of knowledge sharing is to impact choice and behavior. On the services front, If I want to hire a doctor to fly across the country and do Brian surgery on a pig or cadaver, I expect to have to pay them. Similarly, if they are running a clinical trial, I expect to fly them to the surgical training and feed them, and pay for their time. >purely the influence of the money/benefits and perhaps their hope to get more of the same from you later. Direct kickbacks for prescriptions are a thing of the past. It is pretty hard to come up with a situation where future benefits is conditional on the behavior. Like, I suppose you wouldn't invite a doctor that doesnt use your product to give feedback on it or be part of a clinical trial, but that is a niche feedback to worry about. Lastly, articles like are very misleading when it comes to the details. In their reference for $2B in payments [1], includes things like Royalties. >The greatest proportion (27.3%) of value was from royalty or license payments (≈$484 million of $1.8 billion) followed by service fees (26.6%), such as faculty lectures ($472 million of $1.8 billion). If they are claiming paying royalty or license payments for inventions (like developing a hip implant) are a kickback, it frames the whole argument as rhetoric. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470350/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470350/
      - phil21 2y ago
        I’ve found the “collective common knowledge” regarding pop-culture topics such as this, is much like generals preparing for the last war they fought. Direct kickbacks were an actual problem decades ago. That has long been “solved” all the way to the typical over correction the industry is known for. The same holds true for the opioid epidemic and folks still thinking pill mills and the medical industry as a whole are the primary way folks get hooked. It’s fighting last decades battles that have long since moved on. The zeitgeist seems to “stick” each generation and does not seem to keep up with current reality.