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posted by LaminatorX on Friday November 28 2014, @03:40AM   Printer-friendly
from the getting-what-you-measure dept.

Pamela Hartzband And Jerome Groopman write in an op-ed in the NYT that hidden financial forces are beginning to corrupt medical care in the US and undermine the bond of trust between doctors and patients because insurers, hospital networks and regulatory groups have put in place rewards and punishments that can powerfully influence your doctor’s decisions. "For example, doctors are rewarded for keeping their patients’ cholesterol and blood pressure below certain target levels. For some patients, this is good medicine, but for others the benefits may not outweigh the risks. Treatment with drugs such as statins can cause significant side effects, including muscle pain and increased risk of diabetes," write the authors. "Physicians who meet their designated targets are not only rewarded with a bonus from the insurer but are also given high ratings on insurer websites. Physicians who deviate from such metrics are financially penalized through lower payments and are publicly shamed, listed on insurer websites in a lower tier."

According to Hartzband and Groopman these measures are clearly designed to coerce physicians to comply with the metrics. Thus doctors may feel pressured to withhold treatment that they feel is required or feel forced to recommend treatment whose risks may outweigh benefits. Some insurers are offering a positive financial incentive directly to physicians to use specific medications. For example, WellPoint, the largest for-profit managed health care company in the Blue Cross and Blue Shield Association, recently outlined designated treatment pathways for cancer and announced that it would pay physicians an incentive of $350 per month per patient treated on the designated pathway (PDF). The authors propose a public website to reveal the hidden coercive forces that may specify treatments and limit choices through pressures on the doctor. "Medical care is not just another marketplace commodity. Physicians should never have an incentive to override the best interests of their patients."

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  • (Score: 0) by Anonymous Coward on Friday November 28 2014, @04:39AM

    by Anonymous Coward on Friday November 28 2014, @04:39AM (#120773)

    Dear God, can we possibly begin to practice medicine where EVERYBODY doesn't get the same treatments, judged on the same metrics?

    Apparently not. Too bad about that whole genetic diversity thing that's necessary for a sustainable population.

  • (Score: 0) by Anonymous Coward on Friday November 28 2014, @04:44AM

    by Anonymous Coward on Friday November 28 2014, @04:44AM (#120774)

    The authors presume (without evidence) that my physician knows best. I tend to believe that my insurer knows more about Evidence Based Medicine than my physician does.

    • (Score: 2) by kaszz on Friday November 28 2014, @05:03AM

      by kaszz (4211) on Friday November 28 2014, @05:03AM (#120776) Journal

      The physician perhaps doesn't know best. But the insurer may know better unless they had a negative expense incentive.

    • (Score: 0) by Anonymous Coward on Friday November 28 2014, @05:08AM

      by Anonymous Coward on Friday November 28 2014, @05:08AM (#120778)

      Insurance companies have absolutely no interest in a persons health. They are money companies in an industry where one of the raw materials is people.

    • (Score: 2) by Whoever on Friday November 28 2014, @06:03AM

      by Whoever (4524) on Friday November 28 2014, @06:03AM (#120785) Journal

      I tend to believe that my insurer knows more about reducing the cost of Medicine than my physician does.

      FTFY.

      • (Score: 1) by Anonymous Coward on Friday November 28 2014, @06:35AM

        by Anonymous Coward on Friday November 28 2014, @06:35AM (#120788)

        I did note the $350/month incentive paid to doctors used to be what my monthly health insurance premium used to be a few years ago.

        It has climbed so high I can no longer afford it, but to make matters worse, I am very leery of even seeing a doctor for anything as I fear he will first ask for all my private information then turn me in to the government for not being insured.

        Its not that he's being mean, but rather he is corporate, and corporate must be submissive to government so they can get the perks they ask for codified into law. That is just the way things work in a free-enterprise capitalistic system. Its nice having enough money to fund those who have the gun, so they can laws codified to enforce payments to themselves.

    • (Score: 3, Insightful) by davester666 on Friday November 28 2014, @08:25AM

      by davester666 (155) on Friday November 28 2014, @08:25AM (#120792)

      The insurer knows the path that has the lowest financial cost to them, for your specific condition. This is the path they will pay extra for your doctor to take. A significant number of those paths [for a variety of conditions] result in your death, while other paths [for the same condition], which would cost them more, would have a significantly higher chance that you live.

      You really prefer your health care decided using the 'least cost' method [not least cost to you, least cost to the insurance company]?

  • (Score: 2) by kaszz on Friday November 28 2014, @05:00AM

    by kaszz (4211) on Friday November 28 2014, @05:00AM (#120775) Journal

    Treatment with drugs such as statins can cause significant side effects [mayoclinic.org], including muscle pain and increased risk of diabetes,"

    It's even worse. Statins don't do much better than vegetables [utoronto.ca] to lower cholesterol though for diets under highly controlled conditions. Statins have side effects however. But it shows it a farce! Only people that refuse vegetables even at the peril of their own life may have a need for statins. I hope this make you consider the utility of a lot of other medicines. Some are essential but others just poison your body. But a there's also a lot of scams. When effects of a medicine is up for government approval. The pharmaceutical company gets to choose which studies to include. And thus the submitted result is out of touch with reality.

    One way to make the impact of a corrupt system like this probably is to do as the authors suggest and create a website outlining the incentives of the different insurer corporations. That will enable people to avoid the worst crap.

    • (Score: -1) by Anonymous Coward on Friday November 28 2014, @05:10AM

      by Anonymous Coward on Friday November 28 2014, @05:10AM (#120779)

      One way to make the impact of a corrupt system like this probably is to do as the authors suggest and create a website outlining the incentives of the different insurer corporations.

      Preach it, brudda! Blogging is gonna fix EVERYTHING.

      • (Score: 3) by kaszz on Friday November 28 2014, @05:34AM

        by kaszz (4211) on Friday November 28 2014, @05:34AM (#120780) Journal

        Straw man argumentation.

        A website where one can efficiently compare the conditions that insurers have on doctors working for them may enable individuals to avoid the bottom crap.

        • (Score: -1) by Anonymous Coward on Friday November 28 2014, @05:54AM

          by Anonymous Coward on Friday November 28 2014, @05:54AM (#120783)

          And by "individuals" you mean white yuppie hipsters, right? You know no one else will ever see your shitty bottom feeder blog. Insurers are counting on it! Counting all the way to fucking bank, bro.

          • (Score: 3, Funny) by GreatAuntAnesthesia on Friday November 28 2014, @10:20AM

            by GreatAuntAnesthesia (3275) on Friday November 28 2014, @10:20AM (#120803) Journal

            You're quite right, GP is a fool to think that anybody will read his blog.

            He should anonymously insults to an obscure niche website and get immediately modded troll, that's how to get the message out!

          • (Score: 2) by Immerman on Friday November 28 2014, @10:21AM

            by Immerman (3985) on Friday November 28 2014, @10:21AM (#120804)

            Hey, if you're dumb or lazy enough to do whatever your profit-motivated doctor suggests without doing even basic research, well then you get what's coming to you. They have *their* best interests at heart after all, not yours. Sometimes those two align, but the claim right in the headline is that they are separate and diverging.

            Besides, even the most altruistic and competent doctors make mistakes and oversights. They can't possible fully absorb all the research articles related to all their patients' conditions and the latest and greatest treatments for them. It's your life, and ultimate responsibility lies in your hands. If nothing else doing your homework help you ask the right questions to get you (and your doctor) thinking in useful directions.

            • (Score: 2) by GreatAuntAnesthesia on Friday November 28 2014, @12:36PM

              by GreatAuntAnesthesia (3275) on Friday November 28 2014, @12:36PM (#120821) Journal

              Wow, really? Anybody who lacks the intelligence or time to double-check their doctor's work deserves to suffer and/ or die? You admit yourself that doctors don't have the time to absorb all the latest research, so why the hell should Joe Q Public have time to do it?

              So tell me, if a faulty part or design flaw causes your car to be in an accident, is it your fault for not being an expert in automotive engineering and not checking every component in the car before you got in?

              If you walk into a shop and the whole building collapses on your head, is it your fault for not double-checking the engineering, materials quality and workmanship that went into designing and building it?

              If you go out to a restaurant and get food poisoning, is it you own stupid fault for not standing over the chef and making sure the fish was properly cooked? What do you mean you aren't an expert chef? Well then you deserve to get the shits, stop complaining dumbass. Maybe you should have checked on the fisherman, too, to make sure that he got it to the freezer promptly. Perhaps you should need to see evidence of proper conduct at every link in the supply chain for every ingredient before you pick up your fork.

              I mean, if you can't do all that, all the time, then obviously you're too dumb to live.

              The whole point of having doctors, engineers, chefs etc is that all that people can specialise. This allows them to gain a greater depth of knowledge and hence be better at what they do, while freeing everyone else up to work on their own specialisations. If everybody in the world has to go through 5 years of med school in order to be fully responsible for their own health, then why would we need doctors at all? If everyone is a doctor, who is going to find the time to also be engineers, chefs and fishermen?

              Also, not everyone has the capacity to become a doctor. Do you think anybody below doctor-level intelligence should be rounded up and displayed in a zoo?

              We are social creatures. For better or worse, we live in this thing called society and that means that at some level, you just have to start trusting other people. Nobody has the time or energy to micromanage every aspect of their life. Yes, you can apply your judgement. No, you shouldn't trust just anybody. Yes, if you can it's a good idea to learn a bit about what other people do, so that you can apply your judgement more wisely. But at some point, at some level, you have to accept that there are other people who know more than you do on given subjects, and defer to their judgement. To call people "dumb" or "lazy" for doing so is ignorant, arrogant and hypocritical.

              Now if money is making doctors inherently untrustworthy in your part of the world then that's obviously a problem that needs fixing, but the fix isn't "well then do your own doctoring or die". The fix is to change the medical institutions and the way they are funded so that the doctors can be trusted again.

              • (Score: 2) by Immerman on Friday November 28 2014, @05:53PM

                by Immerman (3985) on Friday November 28 2014, @05:53PM (#120906)

                >why the hell should Joe Q Public have time to do it?

                Hmm, maybe because it's *their* health/life on the line, and thus they and their loved ones are the only ones (in the current system) that have any incentive to get them healthy again?

                I said nothing about *deserving* anything. If you toss a hammer straight up into the air and then just stand there you don't *deserve* to get your brains bashed in, but that *is* what's coming to you. Cause and effect cares nothing for moral weight. If you take all your car mechanic's advice without any understanding of mechanics, you *will* get screwed unless they're monkishly honest. Ditto the plumber, electrician, roofer, etc,etc,etc. The incentive structure is set up so that they have every reason to screw you, and only their own integrity keeping them honest. That sort of situation corrodes morality like little else, and while I'd like to believe most people are mostly honest most of the time, *very* few people can completely resist the temptation indefinitely. I mean you tell me, have you *never* milked a job for more hours than it's really worth?

                It's an ugly situation, but it's one of the fundamental realities of a capitalist economy. We can talk all day about how things "should" be, but at the end of the day we live in *this* reality, and need to act accordingly. Maybe (*maybe*) we could institute a network of regulations which would provide disincentives strong enough to change the balance, but I haven't seen much evidence that anyone in power is interested in doing such a thing, nor that the problem is well enough undertood that they would have a realistic chance of success if they tried. For medicine the only thing I can think of with a realistic shot is the old Chinese(?) strategy where you pay your doctor when you're healthy and stop when you get ill. And that provides strong incentive to simply allow for chronically ill patients to die.

    • (Score: 2) by Immerman on Friday November 28 2014, @09:46AM

      by Immerman (3985) on Friday November 28 2014, @09:46AM (#120801)

      Ah, but how well do statins work if you *also* start eating vegetables? Often in such situations the whole can be greater than the sum of its parts.

    • (Score: 1) by nicdoye on Friday November 28 2014, @11:51AM

      by nicdoye (3908) on Friday November 28 2014, @11:51AM (#120814) Homepage

      Of course the obsession with cholesterol levels may itself be a red herring or scam.

      I have no scientific knowledge or links to back this up, but a friend is a "cholesterol denier".

      --
      I code because I can
  • (Score: 1, Insightful) by Anonymous Coward on Friday November 28 2014, @05:04AM

    by Anonymous Coward on Friday November 28 2014, @05:04AM (#120777)

    There's quite an obsession with blood pressure precisely because it's so easy to measure. Robotic blood pressure machines have existed in supermarket pharmacies for decades. Portable blood pressure wristbands are becoming increasingly common. When will continuous blood pressure monitoring of all persons be mandated by law? Peer into the magical soy sauce to find out how soon!

  • (Score: 3) by aristarchus on Friday November 28 2014, @06:02AM

    by aristarchus (2645) on Friday November 28 2014, @06:02AM (#120784) Journal

    This is how it goes: Capitalism starts in the trade sector, Holland, Genoa. Moves on to industry, Holland, and finally Britian, with textiles. Then moves into finance, London, New York, Hong Kong. But at some point, the market is made too efficient, so there is little advantage outside of outsourcing. So two things happen: creation of an entirely new "area of industry": Intellectual property!!! And, the insinuation of the profit motive into areas where it previously had no hold, like medicine, education, war, death, prisons, and operating systemds. So we only have to survive the final throes of the "dead-enders" of capitalism, and everything will be alright. In the mean time, check who is paying for you doctor's vacation.

  • (Score: 2) by Runaway1956 on Friday November 28 2014, @11:42AM

    by Runaway1956 (2926) Subscriber Badge on Friday November 28 2014, @11:42AM (#120813) Journal

    The beginning was quite a long time ago. Pharmaceuticals have offered incentives to push certain drugs for decades. I walk in to explain a condition to the doctor. He has five possible prescriptions, each of which has different characteristics, with different rates of proven effectiveness, and different possible side effects. Doc might lean toward prescribing a generic drug that has 50 years history behind it - but Big Pharma is offering him a kickback to prescribe a "new" drug with little history behind it. Worse, that "new" drug has a much longer list of possible side effects.

    That choice should be my own decision, made with an understanding of the possible consequences. Instead - Doc opts for the kickback scheme. And, over the next six months, I develop an entirely new set of symptoms that I don't understand at all!

    The fact is, I DO READ everything I can find about my prescriptions, as well as everything that was ever prescribed for my kids when they were growing up. Not everyone does that. I also ask the doctor if there is a generic replacement for any prescriptions. Why should I pay $50 for a pill, if there is an equivalent that costs $20 for a bottle of 50 pills?

    But this story goes much deeper that mere drug pushing. Good article!

    • (Score: 2) by c0lo on Friday November 28 2014, @02:36PM

      by c0lo (156) Subscriber Badge on Friday November 28 2014, @02:36PM (#120842) Journal

      Pharmaceuticals have offered incentives to push certain drugs for decades.

      And what you would preferred them to do, pull the drugs into you?

      --
      https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
    • (Score: 0) by Anonymous Coward on Friday November 28 2014, @05:34PM

      by Anonymous Coward on Friday November 28 2014, @05:34PM (#120898)

      > but Big Pharma is offering him a kickback to prescribe a "new" drug

      Part of the problem is that HIPPA prevents the pharmacy from telling the drug company that *you* purchased a specific drug, but it does not prevent them from telling the drug company what drugs have been purchased with a prescription from your doctor. That lets the drug company monitor your doctors actions, and even if he isn't participating in a kickback it still means they can focus more resources on convincing him, just like PR firms try to manipulate consumers into buying stuff they manipulate doctors into prescribing stuff.

  • (Score: 1) by No Respect on Friday November 28 2014, @12:02PM

    by No Respect (991) on Friday November 28 2014, @12:02PM (#120815)

    The problem with health care in the U.S. is that the sytem isn't actually meant to provide health care. It's meant to provide profits.

    • (Score: 2) by RobotMonster on Friday November 28 2014, @01:45PM

      by RobotMonster (130) on Friday November 28 2014, @01:45PM (#120830) Journal

      Hey! No dissing capitalism! Capitalism is perfect and anybody who says otherwise is a terrorist.

    • (Score: 2) by c0lo on Friday November 28 2014, @02:41PM

      by c0lo (156) Subscriber Badge on Friday November 28 2014, @02:41PM (#120844) Journal

      The problem with health care in the U.S. is that the sytem isn't actually meant to provide health care.

      Now that's the first thing I heard systemd is not meant to provide.

      What?... is not about systemd? Sorry...

      --
      https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
    • (Score: 0) by Anonymous Coward on Friday November 28 2014, @04:17PM

      by Anonymous Coward on Friday November 28 2014, @04:17PM (#120870)

      Yup, that old invisible hand at the end of Death's arm swings a mean scythe. Free markets, hellz yeah!