Money, Media, and Medical Care

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By Marilyn Singleton, MD, JD:

More than 50 years ago Professor Marshall McLuhan posited that the medium is the message. Now it seems that money is the medium of the message.

This month Medical Marketing and Media magazine published its 2017 Health Influencer 50, a “list of professionals across the health care spectrum.” The magazine writes that these “influencers” made their impact by innovative thinking and “patient-centric” strategies. As expected, the ever-present Google, Facebook, Twitter, and several medical marketers were amply represented. Disturbingly, five of the top eleven influencers were pharmaceutical companies. The only physician on the list (#12) was Food and Drug Administration Commissioner Scott Gottlieb, M.D.

Only three of the named organizations were actually involved in the delivery of medical care: Dignity Health, the fifth largest health system in the nation; Ascension, the largest nonprofit health system in the U.S.; and the Cleveland Clinic.

One troublesome “patient-centric” strategy is the ubiquitous brazen direct-to-consumer pharmaceutical ad. One crafty example is an “informational” or public service-type announcement persuading the viewer to get vaccinated against pneumococcal pneumonia. Ummm. Was the ad sponsored by a health plan? Medicare? The American Academy of Family Physicians? No. The sponsor (credited in very small print) was Pfizer, the vaccine’s manufacturer.

Apparently, the influence of many of these entities extends to Congress. The 2017 lobbying expenses of Medical Marketing Magazine’s number one “influencer,” GlaxoSmithKline, totaled $3,070,000. The other influencers’ lobbying costs: Gilead Sciences (#2), $2,650,000; Allergan (#4), $2,380,000; Johnson & Johnson (#8), $3,160,000; Pfizer (#10), $8,510,000; and Bayer (#11), $7,050,000. Overall, the pharmaceutical manufacturing industry hired more than 800 lobbyists to the tune of $132,405,742.

The mega-health insurer Blue Cross/Blue Shield’s vice president of Strategic Communications made the list at number 39. If the criterion were lobbying, the Blue Cross/Blue Shield (BCBS) had a leg up with $14,173,960 in lobbying costs—more than triple that of the next health insurer that employs lobbyists.

Or perhaps BCBS was rewarded for navigating its way out of the financial depths of the Affordable Care Act’s essential benefit mandates. Of the 35 BCBS companies, 23 reported a collective $1.9 billion decline in earnings for the first nine months of 2015 and 16 reported net losses because the ACA’s “free” services resulted in claims paid exceeding premiums collected. But by 2017 BCBS along with the rest of the health insurance industry managed to regain its profits by increasing rates, restricting provider networks, and changing benefits packages.

At first glance, physicians appear to be playing hardball with the big boys. In 2017, the American Medical Association (AMA) spent $16,970,000 for lobbying. But the AMA might be called the American physicians’ version of AstroTurf. Only 15-18 percent of physicians are paying members and just 11 percent of physicians said AMA’s stance and actions reflect their beliefs regarding physician practice autonomy, tort reform, and intrusive government regulations. Moreover, the AMA benefits from the dominance of insurance market as it exclusively publishes the official CPT® billing codes necessary to file insurance claims.

The problems with the marketing penetration of drug companies and insurers go beyond simple unseemliness. At the patient care level, when insurance companies demand authorizations prior to agreeing to pay for treatment, they are dictating what care we receive. What good is health insurance if the treatments your physician recommends are not covered?

The current opioid problem is a distressing example. The New York Times reported that few opioids require preauthorization and are readily covered by insurance plans. When it comes to less addictive but more expensive pharmaceutical alternatives or addiction treatment, the coverage is not guaranteed.

Don’t blame the insurers and drug companies. After all, although they are providing useful products and services, it is their job to make money. It is our congresspersons who are not doing their job.

Sadly, influence peddling has become the norm. But your health is too precious to be bought and sold. Your physician should be the top “influencer” for you. Our physicians, not peddlers, should be the source of the pros and cons of medications and recommendations of specific treatments for their patients.

If you are tired of our do-nothing Congress and big business running up the score, play some defense. Demand transparent prices. Cash prices can be several times lower than prices charged to patients with an insurance card. Demand expanded health savings accounts and universal availability of major medical insurance. Find a direct-pay medical practice (e.g., jointhewedge.comselfpaypatient.com) and discover how eliminating the middlemen results in reasonable prices.

You have the influence. Use it.


Dr. Singleton is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) Board member. She graduated from Stanford and earned her MD at UCSF Medical School.  Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She interned at the National Health Law Project and practiced insurance and health law.  She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

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