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Ever have a puzzling conversation with your doctor about switching your medications from the older, generic drug that works to a newer, more expensive medication that just came out? Sometimes the reason is your doctor gets an "incentive."

In 2012, Jon had a heart attack. Unfortunately, he didn't have insurance, and he had the bad fortune to encounter a cardiologist who simply did not "work" on patients who do not have insurance. The cardiologist told him "You just had a mild heart attack, so we don't need to do an angiogram to look inside your arteries."

The doctor instead order a less expensive stress test and said it showed that Jon's coronary arteries were "100% open."

Actually, the test showed that Jon's left anterior descending aorta was nearly 100% closed and there was a similar blockage in his right coronary artery, as Jon was to find out when he had a second heart attack 10 days later. But the cardiologist did offer Jon lots and lots of free samples of the latest "blood thinner," actually a medication in a class known as anti-Platelet Activating Factors, more than he could use in six months.

Drug Companies Sometimes Offer Incentives to Promote Potentially Life-Saving Medications

The medication Jon received to prevent clotting did not prevent a second attack, but it was appropriate to his condition. Theoretically, it could have made the difference between survival and death, although it certainly did not substitute for the catheterization and stent Jon finally got with a different cardiologist.

The later doctors Jon saw prescribed this medication, too. The drug company that made the medication even offered it for free for people at Jon's income level, and the cardiologist--who would not do anything else--made sure Jon signed up the company's patient assistance program. While everyone expects that doctors want to earn money and pharmaceutical companies do as well, nobody could fault the company for failing to do the right thing. 

The financial incentive to write the prescription, however, may have been all Jon's first doctor cared about. Even after Jon had another heart attack treated at a different hospital and finally got a life-saving arterial catheterization at a third, the first cardiologist continued to order free samples of the drug in his name. 

Rarely, Unethical Doctors Prescribe for Medical Kickbacks Without Even Seeing Patients

Jon did not receive them. In fact, when Jon applied to the patient assistance program on his own, he was declined, with an explanation that he was already receiving twice the regular dose of this $600 per month drug. The doctor who had not seen Jon through seven hospitalizations, five heart surgeries, or two later heart attacks was, however, collecting a check from the drug company for every pill dispensed to the patient he would not treat.

Jon's case is an extreme (although real) example, but it illustrates a very important point. Drug companies sometimes pay doctors to promote drugs. And while most doctors actually will give their patients the best drug, not the drug they get a small payment to promote, patients have a right to know if their prescriptions are intend for more than just bettering their health. The new Physician Payments Sunshine Act will go along way toward making that information available.

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