95 percent of both Republicans & Democrats trust their personal physicians' advice. Should they?

In docs we trust

A recent survey conducted by KFF (formerly the Kaiser Family Foundation) on “Health Misinformation” has found that the overwhelming majority of Americans trust their doctors' healthcare advice. The findings hold true among both Republicans and Democrats.

In CDC, we don't necessarily trust

The difference in level of trust between supporters of the two parties varied greatly, though, when they were asked about the Centers for Disease Control and Prevention (CDC), with 87 percent of Democrats and 49 percent of Republicans saying they trusted information deriving from the CDC. Republicans tended to trust their local health officials more, with the figure rising to almost 60 percent.

Lunna Lopes, the lead author of the report and the senior survey analyst at KFF, concluded that family physicians are therefore best situated to produce behavioral changes espoused by public health officials:

Doctors are particularly well positioned to be the messengers when it comes to health recommendations that people really trust.

The survey also revealed that even people who use social media a great deal are relatively skeptical when it comes to accepting healthcare-related advice from any of the various platforms, and indeed, from media of any kind. People are far more ready to place their trust in a healthcare professional with whom they are acquainted, and this will have come as no surprise to governments across the globe who directed a good deal of their messaging toward GPs during the COVID period.

You paid your doctor. But someone else paid more

Trust in one's doctor can seem intuitive; after all, the physician is being paid to take care of your health. Few people consider that they are not the only people paying doctors, though, and that their admittedly considerable bills are often dwarfed by what physicians receive from other sources.

In 2014, the government decided to make some of this information freely available to the public, with the passage of the Physician Payments Sunshine Act. As the title of the legislation indicates, the intent of the legislators was not only to reveal how much money doctors and other healthcare workers were receiving from the pharmaceutical companies, but also to enable people to use this information to reduce corruption. 

How many people, however, have ever heard of CMS Open Payments? Not many, despite their website being extremely user-friendly. If you want to look up your local doctor and see who, aside from his patients, has been paying him, it is very simple to do so. A random inquiry into one Dr. Robert D. Abbott, of Virginia, for example, reveals that in 2021, he was paid $11.49 by AbbVie Inc. for “food and beverage.”

Was $11.49 enough to change Dr. Abbott's prescribing practices? AbbVie, the maker of Humira for the treatment of autoimmune diseases, clearly believes that giving doctors money for food and drink is a worthwhile investment, however. In 2022, the pharma company handed out $17 million for “food and beverage” to doctors, in just over 870,000 payments, representing almost 15 percent of its total payments to healthcare workers that year.

This sum is not atypical of pharma companies; Pfizer, for instance, handed out around $3.5 million to physicians that same year in almost 200,000 individual payments. Merck spent around $2.5 million in the same category of expenses — other categories include “travel and lodging,” “education,” “charitable contribution,” and compensation for serving as a speaker.

Patients talk, but money talks louder

Identifying a clear cause-and-effect relationship between Pharma money and pharma prescriptions is not at all simple. However, some effect between money and physicians' actions has been acknowledged by at least one government. In 2017, the British National Health Service (NHS) decided to award local health authorities £5 per person in their area if they managed to reduce the local level of antibiotic prescribing by at least one percent. The result? Prescriptions for antibiotics dropped by at least three percent following the implementation of the scheme.

This was doubly significant, because already several years before the financial incentive scheme, a huge campaign against over-prescribing of antibiotics was launched in the U.K., with very limited success, even though GPs were trained in the potential danger of antimicrobial resistance (AMR). According to an article dating from 2015, 

Nine out of ten GPs say they feel pressurised to issue the prescriptions and 97 percent of patients who ask for them are prescribed them … As many as 10 million prescriptions, about a quarter of the annual total, are being given unnecessarily to patients who will not benefit from the drugs.

Singling out physicians works as well

In Australia, authorities tried a different approach to cutting the number of antibiotic prescriptions: “feedback letters” sent out by the Health Department to certain doctors, telling them that they were prescribing far more antibiotics than the national average. The result of this campaign was apparently a drop of around nine percent in prescriptions.

Name and shame

The personal approach has also been tried with some success in the U.S. back in 2018, when researchers in conjunction with the CDC and Medicare launched a “Dear Doctor” study with the aim of cutting the number of prescriptions for Seroquel being handed out by GPs. Seroquel is a commonly prescribed neuroleptic ("antipsychotic") drug which is often used off label (that is, to treat symptoms and/or conditions for which it was not originally licensed).

In this study, individual physicians received letters from Medicare telling them that they were writing many more prescriptions for the drug than the state average. The doctors were also told that they were “flagged”:

You have been flagged as a markedly unusual prescriber, subject to review by the Center for Program Integrity.

The study found that doctors cut back Seroquel prescriptions by around 16 percent as a result.

Misguided compassion?

Seroquel has its uses, of course, but when prescribed, for example, to the elderly population, it can frequently hasten a patient's demise. Don't doctors know this? Of course they do. The FDA issued a warning on use of Seroquel in the elderly as far back as 2005. But perhaps many GPs simply find it hard to say “no” to someone who is exhausted from looking after an elderly parent with dementia and wants to give them something to “make them a bit easier to deal with.” 

In more notorious cases, doctors have been documented handing out antipsychotics to help parents deal with “difficult" children, with sometimes fatal results, as with the case of Rebecca Riley, who was just two when a doctor prescribed her Clonidine, Seroquel, and Depakote for “bipolar disorder.”

Lots and lots of black boxes

Seroquel is hardly the only dangerous drug being overprescribed. Most psychiatric drugs are handed out not by psychiatrists but by GPs, though it is unclear whether restricting the ability to prescribe these drugs to psychiatrists would have an impact on the number of prescriptions issued.

What do GPs know about the dangers of psychiatric medication? According to one recent medical school graduate, what she was taught about psychiatry amounted to:

Elicit a list of symptoms, pick any diagnosis that seems to fit, and write a prescription for any SSRI.

SSRIs, the most commonly prescribed class of antidepressants, have “boxed warnings” (once known as “black box warnings”). Horrific as the side effects can be, the withdrawal effects can be far worse. Do GPs know the extent of these adverse events? As recently as last year, the British Journal of General Practice published advice to GPs on antidepressant withdrawal. But SSRIs have been around for decades. Why do doctors still need to be educated on this topic?

Apparently they do. In Australia, where around 90 percent of all antidepressants are prescribed by GPs, clinical guidance is not followed in the majority of cases, with the average duration of “therapy” lasting for four years when the official recommendation is for between six and twelve months of treatment, and that only in moderate-to-severe cases.

The gold still glitters in the sunshine

Will more education help? Antibiotics and antidepressants remain among the most prescribed drugs. Even the Sunshine Act hasn't helped, according to a study conducted in 2021 which found that,

… the mandated financial disclosures have not prevented physicians from being influenced by pharmaceutical industry money … Leading experts on financial conflicts of interest … investigated the policy's impact over the seven years it has been in effect. They found no evidence that physician behavior regarding financial conflicts of interest has changed in that time.

The authors of the study concluded that,

Disclosure is necessary but not sufficient to address the damage that industry relationships cause to medical knowledge and public health.

Get it (the message) or die

Closer to “home,” how many GPs told their patients about the many reasons to doubt the safety of the COVID jabs? How many GPs were sufficiently well educated on the dangers, the multiple studies coming out, the background to the mRNA platform, and more, to be able to provide the possibility of informed consent?

More alarmingly, a study published in 2023 surveying primary care physicians on the methods they used to persuade hesitant patients to agree to be jabbed found that three percent of doctors admitted using “guilt/fear messaging” to “motivate” people, including making statements such as “get it or die.”