11/22/2022    Lawrence Oloff, DPM

The Commercialization of Medicine

RE: The Commercialization of Medicine
From: Lawrence Oloff, DPM

I would like to share my frustrations with the
commercialization of medicine. I grew up in an era
of medicine where surgical equipment companies
would introduce doctors to their newest gizmo via
reps and meetings. Some of these were true
advancements, and other not. Doctors would attend
labs, listen to experts, and would then incorporate
new devices/implants into their practice that they
felt had merit. We have now entered an era where
companies target the consumer.

In essence, a backdoor approach to the doctor.
Promises of better results and faster recoveries
have flooded the marketplace via the internet, and
have zeroed in on an easier target - the consumer.
The non-medical mind does not have the same
expertise to evaluate studies, compare the value of
a new product and how it compares to what is out
there. I can at least admire this for its
cleverness.

What perturbs me is I find myself in the awkward
position, every day, of having to explain to
patients why these procedures do not offer any
benefit to their situation compared to what I do
now. I cannot label these procedures as sales
pitches to my patients because it will just come
across as being defensive. I just sit and spend
endless time trying to educate patients to the
medical facts.

I apologize for narrowing on one procedure, but the
lapiplasty is one such example. I have been doing
Lapidus procedures for many years. It is one of the
bunion procedures that I use when I feel it is
indicated. I feel that the fundamentals for a
successful Lapidus is a good joint prep as with any
arthrodesis, and good fixation as with any
arthrodesis.

There is a lot of money involved in this era of new
devices. I do not want to deny any doctor the right
to profit from their inventions. I wish them all
the best and congratulate them on their success. I
feel if someone invents something it would then be
best to then take a step back and let others who
have no vested interest, either via direct
ownership or generous speaker honorariums, then
advocate the value of these products to the medical
community. I will not comment on the extreme costs
of these new devices that, in my humble opinion,
offer little advantage less expensive alternatives.

Lawrence Oloff, DPM, Burlingame, CA

Other messages in this thread:

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12/04/2022    Robert Kornfeld, DPM

The Commercialization of Medicine (Ivar Roth, DPM, MPH)

Kudos to Dr. Roth for his direct pay success. I
went direct pay in 2000 and I agree, it was a slow
start. However, with a strong niche, consistent
marketing, a schedule that eliminates waiting time
and rushed appointments as well as being easily
available to speak with patients, you can build a
very low stress, low expense, successful practice.
There are downsides though. You need to
consistently market your services. No one will find
you in a list of participating doctors. You’ll get
many calls from prospective patients who are
interested but once they find out you don’t take
insurance, will not come.

But, it is the epitome of working smart and not
hard. When I dropped insurance, I was up to 60-70
patients a day. I was exhausted and stressed.
Mistakes were made. Omissions were made. A fair
amount of angry patients had to wait in the waiting
room sometimes up to 2 hours. I hated it. Worst of
all, expenses were so high my %age net was dismal.
My only word of caution. I believe now is a good
time to begin positioning yourself for the change
but because of the looming recession, do not expect
lots of interest/traffic too soon.

I have been in a good position for many years
because most of what I do is not covered by
insurance. You must have a STRONG NICHE to make it
work or possess superior expertise to stand out to
those who are willing to pay.

I have consistently opined that the only way to
make health care a great profession again is for
ALL doctors to drop out. Realize without us,
insurance companies have no product to sell. One of
two things would happen. 1) They would have to
create logical reimbursements rates or 2) it would
push the one-payor system into being. But doctors
have cooperated with insurance companies and now
they’ve got you by the b*#”s.

Now, at 68 years old, it doesn’t much matter to me.
I tried for years to get podiatrists on board with
my paradigm and practice model but instead of
growing the sub-specialty of functional medicine
for foot and ankle care, podiatrists who did not
know me or ever bother to learn about what I was
doing attacked me on the internet and turned me
into the NYS Education Dept. for practicing
“dangerous, unproven protocols”. Small minded
people do small minded things. The investigator
that interviewed me actually became a patient of
mine. After suffering with chronic Achilles
tendinitis for 9 years, he was healed and has sent
me many patients over the years. I’m still here in
spite of my “colleagues”.

You can all do what you wish to do. In my 40+ years
of practice, I’ve watched this profession choose
the road of a slow and painful death.

Robert Kornfeld, DPM, ny, ny

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11/28/2022    Allen Jacobs, DPM

The Commercialization of Medicine ( Lawrence Oloff, DPM)

Because the goal of industry is to profit from
sales, industry has an incentive to influence
potential customers. This creates a conflict of
interest between industry which drives to maximize
profit and the podiatric physician who wishes to
provide safe and effective care for the patient.
The question is whether you can perform a
procedure with 95% success, and whether the
addition of a widget which may cost as much as
$8000 would be of additional benefit to the
patient. The objectivity of industry marketing can
never be taken for granted. Industry influence is
reflected in industry sponsored research,
publication practices, marketing disguised as
education, and sponsorship of opinion leaders and
seminar lectures and lecturers.

Because industry begins their marketing with
students and residents, there is an impact on
knowledge, attitude and behavior of students and
residents, and an inability of students and
residents to recognize wrong claims by industry.
This fosters changes in attitude by students and
residents such that they develop a positive
attitude toward representatives from various
companies, increased awareness and preference for
their products, which tends to foster rapid
adaptation of new drugs and devices without a long
term view regarding patient benefit and safety.

The following questions should be considered by PM
readers:

Number one; should industry be allowed to market
implants or fixation devices or wound care
products which have not been demonstrated through
controlled studies to be effective and superior
and cost-effective. Is the 510 K process adequate?

Number two. Should podiatrist give industry,
sponsored lectures to students and residents

Number three. Should companies or device
manufacturers, hold promotional seminars for
residents and students

Number four; should podiatrist utilize information
from pharmaceutical or device manufacturers,
including research studies, to determine drug or
procedure selection

Number five. Should APMA or ACFAS or other
components or affiliated interest groups, allow
committee members who have conflict of interest,
to determine the content of CME programs or
participate in the development of practice
guidelines?

Number six; is it ethically problematic for
pharmaceutical or device manufacturers to ghost
write academic papers?

Number seven. Does industry-sponsored research by
residency directors, or podiatry colleges create
intellectual, and or financial conflict

Mark twain said it best. “Data is like garbage.
You better know what you are going to do with it
before you collect it”

Over 100 years ago, Sir William Osler warned of
industry generated “plausible pseudoscience” and
its influence in medicine.

Apparently not much has changed. Maybe the
recently discussed “ageism” has crept into my
practice. My question is why change what is safe
and cost-effective for personal profit?

Allen Jacobs, DPM, St-Louis, MO

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11/28/2022    Allen Jacobs, DPM

The Commercialization of Medicine (Lawrence Oloff, DPM)

Because the goal of industry is to profit from
sales, industry has an incentive to influence
potential customers. This creates a conflict of
interest between industry which drives to maximize
profit and the podiatric physician who wishes to
provide safe and effective care for the patient.
The question is whether you can perform a
procedure with 95% success, and whether the
addition of a widget which may cost as much as
$8000 would be of additional benefit to the
patient. The objectivity of industry marketing can
never be taken for granted. Industry influence is
reflected in industry sponsored research,
publication practices, marketing disguised as
education, and sponsorship of opinion leaders and
seminar lectures and lecturers.

Because industry begins their marketing with
students and residents, there is an impact on
knowledge, attitude and behavior of students and
residents, and an inability of students and
residents to recognize wrong claims by industry.
This fosters changes in attitude by students and
residents such that they develop a positive
attitude toward representatives from various
companies, increased awareness and preference for
their products, which tends to foster rapid
adaptation of new drugs and devices without a long
term view regarding patient benefit and safety.

The following questions should be considered by PM
readers:

Number one; should industry be allowed to market
implants or fixation devices or wound care
products which have not been demonstrated through
controlled studies to be effective and superior
and cost-effective. Is the 510 K process adequate?

Number two. Should podiatrist give industry,
sponsored lectures to students and residents

Number three. Should companies or device
manufacturers, hold promotional seminars for
residents and students

Number four; should podiatrist utilize information
from pharmaceutical or device manufacturers,
including research studies, to determine drug or
procedure selection

Number five. Should APMA or ACFAS or other
components or affiliated interest groups, allow
committee members who have conflict of interest,
to determine the content of CME programs or
participate in the development of practice
guidelines?

Number six; is it ethically problematic for
pharmaceutical or device manufacturers to ghost
write academic papers?

Number seven. Does industry sponsored research by
residency directors, or podiatry colleges create
intellectual, and or financial conflict

Mark twain said it best. “Data is like garbage.
You better know what you are going to do with it
before you collect it”

Over 100 years ago, Sir William Osler warned of
industry generated “plausible pseudoscience” and
its influence in medicine.

Apparently not much has changed. Maybe the
recently discussed “ageism” has crept into my
practice. My question is why change what is safe
and cost-effective for personal profit?

Allen Jacobs, DPM, St. Louis, MO