Study shows most doctors endorsing drugs on X are paid to do so | Hacker News Reader

Study shows most doctors endorsing drugs on X are paid to do so

medicalxpress.com

100 pointspeutetre109 comments

> The research team points out that while some may see the practice of being paid to endorse drugs as unethical, it is not illegal and does not affect licensing.

Does the US have no transparency laws for this? As in: "if you promote a product, then you must disclose if you're paid for it"?

Even for things like "sponsored posts" on Instagram this is required; e.g. from the FTC: "Do you work with brands to recommend or endorse products? If so, you need to comply with the law when making these recommendations. One key is to make a good disclosure of your relationship to the brand." https://www.ftc.gov/business-guidance/resources/disclosures-...

That must also apply to drugs? Some Open Payments website seems incredibly untransparent, and wouldn't comply with the social media transparency requirements as I read that FTC page.

Surely the rules for Instagram tat can't be more strict than drugs?

Imagine if doctors had to say if the drug company paid him to prescribe the drug when he prescribes a drug for you?

That seems like it would make sense though, wouldn't it? To it's important information that you, the patient, need to understand before you can make an informed decision about whether or not the medicine being given to you is the best option for you.

Otherwise you can't know if a recommendation from your doctor means they've genuinely considered all the options and chosen the best one, or just that one company paid them the most money.

That is already illegal.

I think you're right. Same as everywhere else, legality and enforcement are at odds. US isn't special in that regard.

Yes, the US has transparency laws. You can find all the payments listed here.

https://openpaymentsdata.cms.gov/

To repeat: "Some Open Payments website seems incredibly untransparent, and wouldn't comply with the social media transparency requirements as I read that FTC page."

I don't understand your point. All of the data is right there.

Did you read that FTC page? Do you think it's compliant to just fill in something on some website?

So your argument is that the rules for Instagram tat are more strict than the rules for drugs? Maybe they are, I don't know. But seems rather undesirable, because how many people are going to look up some doctor's name in some website most people don't even know exists? This seems a classic "pretend to be doing something while not actually doing something" type of non-solution.

It’s a business opportunity! I’d love it if my insurance provider notified me about possible conflicts of interest from doctors as soon as they received bills from them

Bundle it with a service that lets me schedule doctors’ appointments without phone calls, and I’d pay for it out of pocket

Social Media is only required to do that because of the EU. the US have no laws that require this.

As I read that FTC page and various other pages it links, it's very much a MUST and not a SHOULD.

Doctors who fail to disclose an interest should lose their license. The SEC doesn't tolerate such shenanigans for finance, why should the FDA permit it for drugs?

As of their latest reporting I could find on the fda site, 3.3B out of their 7.2B budget comes from "user fees", so the more drugs are sold, the more they get back in user fees.

Pretty sure user fees are tied to new drug applications, not to sales. As in FDA validating your trial results is obscenely expensive and they make the companies who consume those services pay for them.

This is correct. It isn't validation or technical series. It is purely review.

Doctors who are paid to endorse a drug should lose their licence

Why is that? Surely you mean without proper disclosure.

Because it conflicts with their duty to their patients. Patients should be able to trust their doctor and not have to look for fine print disclosures in the middle of receiving treatment which may or may not impair them cognitively or emotionally.

Patients are often in a vulnerable position and we use laws to protect the vulnerable. Not only is the patient often impaired, but there is a massive information asymmetry naturally between an expert with years of post graduate education on a specific topic and a general member of the public. Many other fields that require similar amounts of training have strict codes of ethics regarding who they may take compensation from and how that is disclosed.

I agree, but i take it that this isn't about advertising to patients, but the general public.

Some doctors don't even have patients. Some work in drug development itself.

I think you can assume based on context that GP is referring to practicing physicians, not to research doctors.

You can tell because one has a clear conflict of interest and one does not.

Drug company employees who attempt to bribe a doctor should be imprisoned.

If you believe this you should vote for RFK Jr. He’s the only presidential candidate that has actually taken on industry. The VO has pledged to open up all the data in the FDA and CDC for transparency. We need this.

Yeah but then you’re voting for RFK.

US Gov't FDA and CDC can already be FOI'd.

Records from neither department will cover ongoing "bribery" of regular doctors by Pharma reps, so it's unclear how "we need this" to address that.

They can be FOIA'd, for all the good that will do you. They apparently have, according to the news, employees dedicated to deleting records before they can be FOIA'd, they use burner phones and private email accounts, and when caught the agency boss will say "I don't know who my personal assistant was working for when he did that" in front of Congress.

And get away with it.

In a matter that regarded some two million or so deaths in the US.

[0]: "Fauci concedes wrongdoing at NIAID, just not by him": '“That was wrong and inappropriate and violated policy,” Fauci said of Morens’s scheme to “disappear” problematic emails. “He should not have done that.”

Fauci’s chief of staff was in on the scheme. Emails show that Gregory Folkers intentionally misspelled the name of Kristian Andersen, a tactic Morens suggested to avoid FOIA, after Andersen received an $8.9 million NIAID grant, which came two months after he authored a paper arguing that it was “improbable” that COVID-19 had a lab origin.'

[1]: It's an image of an email from Gerald Keusch, who worked at NIAID.

[0]: https://www.washingtonexaminer.com/restoring-america/fairnes...

[1]: https://x.com/gdemaneuf/status/1797494390535160205

and how, exactly, does any of that have any bearing on

> Drug company employees who attempt to bribe a doctor

in the context of non US Government Pharma companies paying non Government doctors to spruik drugs on twitter and by prescription?

Because a huge part of the regulatory agencies’ monies comes from royalty payments from the companies they’re supposed to be managing.

And the obstruction of the FOIA process helps entrench the resulting corruption.

Payments from pharmaceutical companies to physicians are already publicly disclosed.

https://openpaymentsdata.cms.gov/

And if I'm not a US citizen and the drug company bribing the doctor isn't in the US? There's more places around the world, you know.

Then a thread talking what the FDA and SEC do is not a place where your experience is helpful.

> Doctors who fail to disclose an interest should lose their license.

I didn't realize all doctors are regulated by the FDA and SEC. The statement at the beginning of the thread doesn't specify doctors in the US.

Isn't the very fact a doctor is on social media saying how great a drug is a giant flashing sign that they are being paid to do it?

Lots of doctors from reputable places eg Mayo on X. Weighing in on things with media coverage like whether cholesterol drugs are a good treatment option. Possibly they're countering quakery from charlatans with good, measured opinion. That opinion could also be influenced by paying for their conference attendance, or just plain cash. Undisclosed, such payments would be far from obvious and radically change one's opinion on how convincing their case is or isn't.

The new weight loss drugs. Are they good? How serious are the side effects? How often are there problems? Is the risk low and benefits high? Are they good for cancer? Are they good to help alcoholism? Are they scary? Should I take them?

Much legit debate there and I'd rather know who is being paid for their opinion faced with the choice when trying to weigh probability in the face of imperfect information.

The Doctor could conceivably be a passionate professional who wants to share health information with a wider audience. You know, as opposed to a shithead shill. The fact that being a corporate mouthpiece is apparently the default assumed state is a condemnation of our current medical standards.

It's easy to imagine a stereotypical "When my patients find their pancreas swimming around in their fish tank, I recommend ACME Pancrease De-marination forceps". But the more important bit is the massive grey area. Let's say your kid plays with Bob's kid on their little league team, you've added each other on Facebook, you put out a post asking if anyone has any advice about your fish tank dwelling pancreas and bob chimes in because he's a doctor. Do you assume Bob is being paid then?

I assume 100% of people on social media are doing for other than altruistic reasons.

100%

Doctors endorsing anything are being paid. Doesn't matter if its on X or not. The whole system is corrupt.

Every large pharmaceutical and medical device manufacturer has been busted for kickbacks and have mandatory internal training as part of the punishment to prevent it, yet it still happens.

If you try to bring a product to market and are looking for feedback and an endorsement, doctors will openly hint of receiving compensation for the endorsement.

Show me the incentive and I'll show you the outcome - Munger

From related stories on TFA page:

> Doctors received approximately $12.1 billion from drug and device makers between 2013–2022, study reveals

https://medicalxpress.com/news/2024-03-doctors-approximately...

This is the bad kind of statistic, because it doesn't actually tell us anything interesting about the impact on individual doctors (but does sound scary / impressive!).

A Google search says the US has 1 million doctors, so $12B over 10 years is $12k/doctor/year on average - nice, but not wow...

The linked article did actually have something useful to say on a per-doctor basis:"The analysis showed that more than half of physicians received at least one payment, and roughly 94% of payments were associated with one or more marketed medical products. A small percentage of physicians received the largest amounts, often exceeding $1 million".

So: nice but small for most doctors, rather (too?) large for a small percentage.

> $12k/doctor/year on average

That is a ton of money, imagine how much you would do if you get an extra months of salary to do it? And they get that level of an offer every year...

A month of salary is a very large bribe for anyone.

Does one not suppose that a fair bit of this is the trial and starter doses that they give to doctors? Surely the drug company values them at list price for purposes of a business expense.

Free samples aren't include. Look up the Sunshine Act, it's only direct payments to doctors.

But this can include things all the way from doctor getting $250 for spending 60 min consulting for a company (i.e. answering questions about how they treat a disease, what they look for in a new drug) to a doctor leading multiple speaking engagements throughout the year and making tens of thousands.

There was a recent HN post about a weight-loss drug where I bit my tongue and did not try to "rebut" stuff there with a comment about diet and lifestyle. Methinks this problem runs deeper than paying doctors to promote drugs. Americans fundamentally seem to see drugs and surgeries as "health care" in a way I find concerning.

...are drugs and surgeries not healthcare?

Eating right is health care.

Exercise is health care.

Decent housing is health care.

Drugs and surgeries are medical care and I grew up with the weird idea that it's crisis management, not your first line of defense while acting like diet and lifestyle are annoying details you can stop worrying about if you can get the right prescription.

We've tried and failed to get people to "eat right" and exercise for the last century or so. We've put a stunning amount of effort into that option, and failed.

My dream career was urban planning. We used to design walkable cities and now we design a world that is car centric.

Designing exercise into our daily lives used to be part of the urban planning profession. Paris was redone to put a stop to health issues in overcrowded slums.

Nutritional value of produce has gone down for decades while we strip mine our soils and try to make up for it with chemical fertilizers.

I don't think the obesity epidemic is going to be solved with lecturing people like they aren't trying hard enough to starve themselves while we build "fuck you, pedestrian" environments all over the country.

cool story bro, but:

1. there are plenty of obese people in rural areas where they have all the walkable space they might desire

2. do you even know how little energy humans need to walk? a single candy bar is enough for a three hour hike

3. pick a random chinese/japanese city, find a youtube video with visible crowds, and count the number of morbidly obese people you see. it would take you a while to find a single mobility scooter tier flesh golem, if you can find one at all

"lecturing people like they aren't trying hard enough to starve themselves" is the only solution for the obesity crisis, because the only reason for the obesity crisis is vast abundance of cheap, artificially tasty empty calories. 300+++ lbs blobs of fat virtually did not exist before Standard American Diet

> 1. there are plenty of obese people in rural areas where they have all the walkable space they might desire

Rural areas are much less walkable since stuff are so far away, and thus are significantly fatter than walkable areas.

When it is easy to walk to places you need to go to people often walk, and such areas have much less obesity.

I get what you are saying, but dind the "no, no, that's too much walking" comments kinda funny.

Walking 1/4 mile to a coffee shop every day won't make people skinny.

>1. there are plenty of obese people in rural areas where they have all the walkable space they might desire

No, they don't. Have you ever spent any significant time in rural American places? There's no place to walk at all, because:

1. everything is too far away for walking to actually be useful for going places, 2. there's no sidewalks even if you don't mind walking 2 hours to the nearest Walmart, and 3. there's no wild places to walk either, contrary to popular belief, because all the land is privately owned and "trespassing" is not allowed (and can get you shot).

Rural Americans can only walk places if: 1. they have a lot of land around their house, which granted is more affordable than in more urban places, or 2. they get in their vehicle and drive to a state or national park someplace and use the hiking trails there.

It's so weird how many people think rural America is some bucolic place that resembles the Shire of the hobbits, when in fact it's a car-bound hellscape even worse than the worst American car-centric city. It's not like the UK, where you have an absolute right to roam across rural lands.

We designed walkable cities before people had cars.

And now we act like if you don't drive, you're not really allowed to have a full life.

It negatively impacts kids, seniors, handicapped people and those who could potentially afford housing if they only needed to pay rent but can't afford both rent and a car.

I may just be coming at this from a different angle (as someone with chronic genetic conditions), but differentiating between "health care" and "medical care" seems like unnecessarily splitting hairs to me. The place I go every few months to get the drugs that make me a functional human being has "health" in the name :P

Like, I understand where you're coming from on the diet angle specifically, but some of this strikes me as painting with strokes that are just a bit too broad for the other thousands of reasons people need drugs or surgery.

I also have an incurable genetic condition.

It's part of why I have spent so much time thinking about this and feel so strongly about it.

Okay, but imagine you work in public health. We have decades of attempts at convincing and helping people to make lifestyle changes. There are a thousand diet plans, a thousand attempts at consumer education, and it's gotten us this far, which isn't very.

What non-pharmaceutical intervention would you propose- something that could be rolled out as a program- that hasn't been done before, and would work, in say the next decade?

Because at a population level, these drugs seem to be doing more than the cumulative efforts of a million dietitians.

The idea that if we had a safe drug that made people lose weight (we don't) we shouldn't immediately give it to all fat people without a lecture, borders on a religious belief about virtue. That case could be made for not giving insulin to diabetics or bronchodilators to asthmatics.

If there were a safe drug that can make people lose weight and put on muscle, I'd be actively telling people not to exercise unless they enjoy it. It's bad for the joints.

we are addicted to convenience and ease

This is hardly an American thing; you see the same in Europe, and presumably other places. This is why antibiotics resistance is a problem in many parts of the world.

I once overheard a coworker give a doctor a right bollocking over the phone because he wouldn't prescribe antibiotics for her daughter who had the flu, and she then proceeded to tell rant how ridiculous that doctor was. I've rarely had to spend more effort to stop myself from saying some rather unpleasant (albeit true) things.

> This is why antibiotics resistance is a problem in many parts of the world.

Antibiotic-resistant bacteria are more of an agriculturally-induced problem than a non-farmer-human-induced problem. Almost all commercial livestock are pumped full of antibiotics to make them fat, according to estimates ~2x the amount of antibiotics are used for animals as for humans.

I'm just going by Wikipedia, but it's not clear to me that it's the reason for antibiotic resistance in humans, rather than a reason.

Also, "livestock pumped full of antibiotics to make them fat" has been banned in the EU since 2006.

It's also supposed to be regulated in the US, but that hasn't reduced the use of them much.

"The research team points out that while some may see the practice of being paid to endorse drugs as unethical, it is not illegal and does not affect licensing." - are there countries where this is illegal and/or never get paid for drug endorsements?

In the UK you can't advertise anything that needs a prescription from a doctor.

Today in an AI related post on X, I got an ad for Nityananda (A known fugitive from India who claims his own country now) teaching about AI. The guy probably didn't graduate high school.

I hope X will add some quality control to ads they are showing.

Ad that came up: https://i.imgur.com/dSkqV6I.png

I'm confused that people have at the same time deep suspicion and also unwavering trust of drugs companies, depending on the story.

In most cases people are suspicious of pharma corruption & recklessness. Yet in a few contexts, for example with vaccines and psych meds , any criticism is deeply stigmatized. Critics are even slandered as backwards.

Why the paradox? I think a healthy dose of suspicion all around is warranted given their track record, plummeting healthfulness and the stakes at hand.

I think it's the difference between suspicion of the pharmaceutical vs the pharmaceutical company. You can criticize the company without criticizing the treatment.

can you explain that reasoning more? that makes no sense

In this case of doctors being paid to endorse drugs, the problem is that there is payment being exchanged at all. The issue persists whether or not the drug is effective.

sure but if we all agree that corruption is widespread , how can we discern what is effective? We're making our assignments based on corrupt testimony -- that of the corrupt vendors & doctors.

How much we trust the drugs rests entirely on how much we trust the industry

While non-disclosure by doctors prescribing drugs they profit from is unethical, I would be interested to know if doctors change which drugs they prescribe if when paid by different pharma companies ie are doctors recommending the drugs because they are being paid or are they just being paid because they recommend the drugs.

Yes, physician behavior is influenced by pharmaceutical sales/marketing.

https://www.pewtrusts.org/en/research-and-analysis/fact-shee...

Considering "marketing" extends all the way down to "hey, did you know our drug just got approved to treat disease XYZ", I'm hardly surprised it influences behavior.

You'd be surprised at how many doctors there are that know very little about newly approved medicines and pretty much rely on sales people for information.

So is patient behavior. How many drug ads for X include the line "ask your doctor about X" as if the patient has any clue whether that drug would be appropriate. Then they run to the doctor asking for X and the doctor says "eh, it's easier than trying (again) to get them to change diet and exercise habits" and they write it.

I don't actually know how often doctors do the last part but I would think that in some cases it happens.

I think drug ads are almost always completely out of place in consumer media and it's something that is really uncommon or totally banned in other countries.

I don't think those things are really different. Consider, for the sake of argument, that the doctors are endorsing drugs from the goodness of their hearts for the betterment of humanity. What incentive do the pharmas have to pay them? They're not known for altruism. If the payment had no impact whatsoever, they'd save their money. If docs know they might get paid, that's really not ethically different from having a payment agreement in advance.

The recent court cases related to the opioid epidemic is a great place to begin looking for answers to that question.

When has doctors endorsing any drugs, on x or real life, ever been anything more than paid advertisement?

The article assumes this happens only on X. That's the American medical system. And not only endorsing - doctors are 'incentivized' to prescribe their drugs by pharma companies without any need to 'endorse' them too.

Anyone have the actual paper? Does it list who (eg Huberman) is receiving the payola?

ResearchGate makes it easy to email and ask for a copy, though you can usually find the corresponding author listed in the journal entry.

https://www.researchgate.net/publication/381007622_Industry_...

You can search the database they used: https://openpaymentsdata.cms.gov/

I can’t find Huberman, but it does look like Peter Attia [1] was payed $300k by Dexcom for consulting services. Dexcom makes continuous glucose monitors that Attia has repeatedly mentioned on the show. It looks like there’s even an episode where he interviews the CEO, although this happened before the payment [2].

This website [3] links his NPI displayed on Open Payments (1144596339) to his CA license number (A96452) which he displays on his about page [4]. So it does look like this is the Peter Attia of podcast fame.

[1] https://openpaymentsdata.cms.gov/physician/908146 [2] https://peterattiamd.com/kevinsayer/ [3] https://opennpi.com/provider/1144596339 [4] https://peterattiamd.com/about/

OpenPayments is a super cool tool. It's worth noting that some small payments can amount to things like "the drug rep came by to leave some pamphlets for the waiting room and donuts for the staff", which is how you'll occasionally find a doctor who accepted a grand total of $50 in payouts.

For the $100k+ payouts, though... hell, even the $10k+ payouts....

EDIT: Just looked up one of my doctors and it says he accepted a whole $70 last year, entirely in food and beverage lol. I hope he enjoyed the cookies or whatever it was :P

> On some of the world’s most popular health podcasts, such as Huberman Lab, hosted by Stanford professor Andrew Huberman, and The Drive with Dr. Peter Attia, CGMs have been both advertised and discussed on dedicated episodes. (Dr. Attia, in a disclaimer, notes that he is a paid advisor to Dexcom.)

https://www.fastcompany.com/90859142/continuous-glucose-moni...

It’s worth highlighting that Peter starts every podcast by stating that his conflicts of interest can be found on his disclosures page: https://peterattiamd.com/disclosures/

He’s done so since the start of his podcast.

In checking, Dexcom is clearly listed as a company he advised during the period listed on Open Payments.

Right I guess this didn't require sleuthing. This does display how large the payments were tho, if that makes any difference to someone.

I think it’s worth discussing, the absolute magnitude isn’t readily apparent otherwise and your comment helps inform a better picture. Thanks for taking the time to look into it.

This seems to work: https://jamanetwork.com/journals/jama/fullarticle/2819356

Sadly no specifics about the 28 physicians they analyze.

Huberman isn't a medical doctor and most of the things he talks about are non drug supplements.

He's probably getting a lot of cash and affiliate money.

Huberman isn't a medical doctor? TIL

Good, I'm on my public account. Happy to say this publicly at this point:

After the first time (over 12 years ago, now) I was misdiagnosed (and thus mismedicated) and dealing with a toxic work environment, I wound up in a spot where I 'had' to take a specific medication and do a follow up in a month.

The medication made me nearly useless at work, I had to have my music at ear damaging volume to not fall asleep driving.

At my first follow-up, I stated my concerns, and the doctor basically told me 'deal with it' when I asked for alternatives and whether this was the right thing given the circumstances.

I was so taken aback, it was only then I looked around the room.

The Notepads. The Pens. The Calendars on the wall.

All of it, it wasn't just the company it was that medication, that might work good for some people but FFS not anyone that just has untreated severe ADD/ADHD and childhood bullshit.

It didn't just 'not help', it also really turned me off from getting good help for a bit, which had a lot of consequences I'll live with the rest of my life one way or another.

I think at one point there -were- a couple settlement things related to the whole debacle.

1. So I was forced to see this doctor even though she was out of network and an in network doctor was likely available. For like a thousand dollars of related 'visits' my settlement would have been a hundred bucks.

2. IIRC, the medication was at least one of which, where, another nice benefit I couldn't see in the patient room were some cruises/vacations neatly wrapped as some form of 'knowledge sharing'.

RE Point 2, everyone in IT wonders why we use dumb technology BigCos/Influencers push? Here's why lol

The system is great at extracting wealth, manipulating people and manufacturing demand. It’s hard to find advice that is genuine and believable. Lots of genuine people are having their messages diluted by misinformation and misdirection. Nothing can be trusted.

Why in the absolute hell is it not illegal?

What about tv and YouTube?

What about in real life?

In other news, the sky is blue.

Reply on news.ycombinator.com