Nip the Healthcare Industrial Complex in the Bud in Medical School

Does the 41-year-old you think like the 28-year-old you?

As much as we’d like to believe that our thinking would evolve or improve or mature over those 13 years, in a good way, it probably hasn’t. The 41-year-old you is much like the 28-year-old you, just more tired and less flexible. (Watch out for your Achilles, you pickleballers!)

What does that have to do with healthcare? It tells me that if we want to destroy the current Healthcare Industrial Complex and replace it with a healthcare system built from the ground up for consumers, we’ll need to reach healthcare leaders earlier than we thought. Preferably when they’re in undergraduate and graduate school.

That’s my takeaway from a new research letter published in JAMA Health Forum.

A group of six researchers wanted to reprise a survey they did of medical students and medical residents on their opinions of drug companies’ interactions with physicians, particularly company remuneration to doctors in the form of research grants, compensation, contributions, consulting fees, honoraria, speaking fees, travel expenses, gifts, debt forgiveness, education, entertainment, food and beverages and loans.

Those payments added up to about $13.2 billion last year, as I commented on in this blog post, “Open Payments? More Like Open Pockets.”

The researchers conducted their initial survey of 2,349 medical students and medical residents in 2011. The researchers were able to contact and resurvey 291 of those same students and residents last year, or 13 years later. The average age of the 291 physicians was 41, making them 28 when they took the survey for the first time. The researchers asked them the same questions to see if their opinions of drug company interactions with physicians had changed over time.

The short answer was not much.

In their published study, the researchers highlighted some differences in respondents’ opinions over time that the researchers thought were noteworthy. Unfortunately, they didn’t publish the exact results for all 14 survey questions so a reader like me could decide on our own what was noteworthy. (I’m 65 and, believe me, I would be just as miffed when I was 41 or 28.)

Anyway, here’s what the researchers thought was important:

• 14.5% of the doctors said they strongly agreed that interactions with drug reps threatened the trust that patients and the public put in doctors compared with 5.6% of their younger selves.
• 76.9% of the doctors said they agree or strongly agree that physicians can receive useful education about new treatments from interactions with drug reps compared with 66.3% of their younger selves.
• 28.5% of the doctors said they agree or strongly agree that limits on drug company consulting fees paid to physicians can hamper the development of new medications compared with 23.1% of their younger selves.
• 72.2% of the doctors said they agree or strongly agree that medical schools should not permit drug reps to have access to students in their training at clinical sites compared with 59.6% of their younger selves.
• 99.7% of the doctors said they agree or strongly agree that medical schools should require all faculty to disclose their financial conflicts of interest before their lectures compared with 88.9% of their younger selves.

Like all of us, the physicians who retook the survey think the older version of themselves is much wiser than the younger version of themselves.

Yet, all in all, their answers to all 14 questions really didn’t change that much over 13 years. That means if you want zero tolerance of overt or covert drug company incentives to doctors as one nail in the coffin of the Healthcare Industrial Complex, that zero tolerance must start early with medical students, medical residents, medical schools, medical professors and teaching hospitals.

Thanks for reading.