Monday, October 07, 2013

Roy Poses writes

Major parts of the US government may be shut down over a dispute about health care reform legislation made law several years ago, but Health Care Renewal (, written by volunteers and (barely) funded by individual contributions, soldiers on....

Use of Psychological Manipulation of Physicians to Sell Pharmaceuticals: The Drug Representative as "Den Mother"

Another vivid anecdote with a new twist reminds physicians that pharmaceutical (and device and biotechnology) representatives are not our "friends."  Instead, they are trained to appear "likable" (to use the proper social psychology term), whether appearing to be good 'ol boys and gals, sex symbols, or now den mothers, because we are more prone to trust, and hence follow the advice of "likable" people.   In the case of such marketers, that advice involves us prescribing their products for our patients, often regardless of their benefits, harms or costs to patients.    Of course, when likability is combined with the urge toward "reciprocity," generated by the various gifts and favors provided by these marketers, the likelihood we will prescribe needlessly expensive, sometimes useless, and sometimes dangerous drugs and devices increases.  Challenging such deceptive marketing and its use of psychological manipulation probably should not be done by the government, but by health professionals who must become aware of such tactics, and realize how they make us chumps, or worse, corrupt.

Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As "Advised" At The University Of Arizona Health Network

It is bad enough when health care professionals become chumps for marketers.  It is worse when they are turned into marketers themselves.  InformaticsMD provided a striking example of a big hospital system trying to turn its health professionals into marketers for its commercial electronic health record system.  The hospital system literally provided talking points for physicians and nurses to be used to persuade patients of the wonders of the EHR system, most of which were not exactly supported by evidence.  InformaticsMD ran down the specific positive words the doctors and nurses were supposed to use, and showed their emptiness.  

Round and Round Spins the Revolving Door, Unimpeded by "Obamacare," Nor By Those Protesting "Obamacare"

In which I found many recent examples of how government officials who regulate health care and legislators who make health care policy have become interchangeable with lobbyists and health care industry insiders.  Can we trust officials and legislators to put patients' care and the health of the population first when they are looking over their shoulder at those who might provide them lucrative employment opportunities in the private sector?  While there is a  battle raging over the recent US health care reform legislation, currently resulting in a partial government shutdown, neither the opponents or proponents of this reform legislation seem concerned about the potential for corruption provided by the "revolving door."  To truly improve health care we must attack such obvious conflicts of interest.

Another in the "Health IT Crashed, But Patient Care Was Not Compromised" Series - NHS Greater Glasgow and Clyde

InformaticsMD wonders again why, if modern commercial health care information technology supposedly offers so many wonderful benefits, its failures never seem to adversely affect patients?  In his latest example from Scotland, a IT failure led to postponement of appointments and surgeries, but somehow this was not supposed to have had any bad effect on patients.  
And still on the main page from the weeks before are:

Vested Interests and Their Influence on Physicians- New Understanding from Cognitive and Social Psychology

A long time ago, some of your Health Care Renewal bloggers were active participants in research on how physicians' human cognitive limitations made it difficult for them to make judgments and decisions consistent with the best evidence from clinical research   Now a paper by Sah and Fugh-Berman showed how physicians' cognitive limitations can enable rationalizations that favor continuing relationships between physicians and industry.  For example, ego or self-serving bias allows physicians to deny their personal susceptibility to bias due to financial relationships, while acknowledging that other physicians might be so biased.  In addition, the paper demonstrated how marketers of pharmaceutical marketers and presumably of other health care products and services can use  social psychological principles to enable manipulative and deceptive practices as well as conflicts of interest.  For example, the principle of reciprocity means that deliberate creation of even small conflicts of interest by marketers can lead to favorable results: even small gifts create the need for reciprocity, and the easiest way for physicians to reciprocate is to prescribe drugs favored by the gift giver.  (Do physicians ever think of inviting drug reps to lunches to reciprocate for the lunches given them? ;-) )  While much thought about cognitive and social psychology went into the creation of marketing schemes, health care professionals are not educated about how psychology may be used to manipulate and deceive them.  Such education ought to be a part of true health care reform.

A Plague of Bureaucrats - Now 10 Per Physician in US Health Care

This seems to be a major result of our US effort to create a (pseudo) market based health care system.  Presumably the multiplication of bureaucrats reflects both their power over health care and the resources they drain from it  Note that while many on the right like to criticize the bureaucracy of government, most of these bureaucrats live in the private sector.  True health care reform would dismantle large concentrations of power (which tend to be overwhelmingly bureaucratic) and return control of health care to health care professionals and the people.

Should "Diagnosing While Texting" Be Illegal?

InformaticsMD made an interesting analogy between the distracting effect of dealing with computerized devices while driving and the likely effect of dealing with other computerized devices while taking care of patients.  

The Adventures of the Purloined Bequest, the Resident Heiress, and the Hidden Hospital System

The first case as discussed in the media involved a hospital revealed to have systematically emptied capital from a bequest intended to have been held as an endowment.  The second case as discussed in the media involved a rich heiress allowed by another hospital to become a permanent resident despite not having any medical need to do so, and then persuaded by hospital management to leave some of her fortune to the hospital and its personnel.  While reported as independent, just reaching public attention at the same time, the cases were really part of a larger whole.  Both hospitals were subsidiaries of the same hospital system during the time period when these hijinks went on (although the first hospital later was sold to a second system.)  The real lesson is how executives erect complex corporate structures that can be used to hide all sorts of mischief (e.g., by attributing it to subsidiaries without acknowledging their relationship to the the larger corporation.)  True health care reform requires realistic consideration of how large organizations have come to dominate health care, and that organizational insiders have used this situation to their advantage.

UnitedHealth's Latest Blunders Include Lax Fraud Detection, Recalled EHRs - So Why is its CEO Worth $13.9 Million, or is it $34.7 Million?

Two stories appearing separately in the media reflected badly on the management of the giant multinational health insurance/ heath care company.  As usually is the case, no one heretofore noticed their relationship, nor their connection to multiple previous stories of mismanagement and unethical behavior by the same corporation.  Of course, that might lead to uncomfortable questions about why the same corporation has gone about making its CEOs fabulously wealthy.  True health care reform would make leaders of large health organizations accountable, and give them realistic incentives to first  benefit patients' and the public's health.

Roy M. Poses MD FACP
Foundation for Integrity and Responsibility in Medicine (FIRM)
Clinical Associate Professor of Medicine
Alpert Medical School, Brown University 

No comments: