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From: Steve Harris <>
Subject: Re: Blood pressure - My Doctor is a putz.
Date: 18 Jan 2005 17:53:18 -0800
Message-ID: <>

>>The doctor is still promoting a sale, and he is selling you the idea.
You may not be out the money, but the doctor and the drug company are
still making money off the deal, and therefore, they are biased. <<


You need some explaining about economic reality.

The drug company may be biased, but unless the doctor makes money from
writing a prescription (vs spending the same time giving dietary
advice) there's no reason for the doctor to be biased. The free pens
the drug companies give out, are not a big bias source. Very few
doctors charge a prescription-writing fee. And no insurance companies
would pay one if they did. In the US, Medicare certainly doesn't pay
any such thing. You can add on a charge for medication review, but it's
the same as face-to-face time reviewing diet, so there's no point.

If you really want to take a look at a situation where there's
absolutely no way to disentangle the doctor's interests from the
patient's when it comes to the profits make in prescribing drugs, take
a look at veterinarians, who very often sell the very drugs they
prescribe.  Then take a look at oncologists, most of which would go
broke if they weren't allowed to keep the difference between what they
charge for the chemo they charge to deliver, and what they buy it for
wholesale. The oncologist who gives no chemo at all, is a poor (ie,
moneyless) oncologist indeed.  And there's no comparing even these to
the intrinsic bias that all surgeons face.

But aside from the situations above and perhaps a few others, I think
medicine is remarkably free from direct bias when it comes to
recommending drug treatment. Certainly far less biased than most of the
businesses and professionals you deal with in your daily life. I mean,
come on. The chiropractor recommending manipulation. The naturopath
selling you vitamins. The guy repairing your car has a big economic
interest in the results of his advice. So does your lawyer. So does
your real-estate agent. So does the guy administering your retirement
fund, which (more than likely) pays him a fully legal kickback to
recommend it, and not some other fund. And so on and so on. Compared to
these, nearly all of standard medical care is pretty darned pure. You
pay for the advice, sure, but the doctor stands to gain very little,
either way, from whether you follow it or not.

Now. The real reason why doctors prescribe pills is something the
cynics really don't want to admit. The pills aren't as good as the diet
and exercise (for sure), but on the other hand, most people can't or
won't follow the diet and exercise. If they would, they wouldn't be
overweight in the first place, now would they? The pills get blood
pressure, cholesterol, and glucose right where they should be, even if
the patient doesn't lose weight. The doctor paid by office visits would
make more from a given patient struggling to make him do it by diet and
aerobics alone, kind of like a piano teacher whose students don't
practice, or a dentist whose patients don't brush. So why don't doctors
do that? Because they're more interested in what works than in how many
times the patient has to come back. Sorry. You really can't explain it
any other way. You say you'd rather go to a naturopath or nutritionist
instead, and struggle with the diet to get off the drugs?  But NOW who
has the economic bias? At least the doctor can help you do which ever
you want to do, or can do. The people who *can't* legally prescribe the
pills are stuck recommending anything *but* pills, out of the very same
kind of self-interest that has you all fired up in the case of doctors,
but more-so.


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