Change to Hippocratic Oath

[Aspergers_Aspie]

I realise the Hippocratic oath was changed for reasons, including not wanting to offend religions different from greek mythology and not to offend atheists, this explains the change of the content, but the title still has reference to, so I am a bit confused

 

[Matthias]

I didn't realize it changed. Maybe that's why many doctors no longer follow "Do no harm."

 

[Judge]

A Hippocratic Oath wouldn't mean much these days when the most critical thing for so many physicians need to abide by their contractual obligations to corporate pharmaceutical companies and their shareholders.

 

[Neonatal RRT]

A Hippocratic Oath wouldn't mean much these days when the most critical thing for so many physicians need to abide by their contractual obligations to corporate pharmaceutical companies and their shareholders.

I know where you were going with this, but it's a bit more nuanced. The US medical schools are highly influenced by the pharmaceutical companies... this much is clear. Almost no education in terms of health and nutrition. Nearly all the training is done in hospitals, with the sick, injured, dying, and those in need of surgery. They are taught to "heal with steel" and medications... but only if they are going to be reimbursed by their insurance companies they have contracts with. It's really the pharmaceutical companies and their contracts with insurance companies that tell physicians what they can and can not do... and which medications to use. The physicians also have crazy high liability insurance premiums... and sometimes, this alone will cause physicians to simply walk away from the profession. The physicians are more or less downstream within the system... they are not in control... it's way above their pay grade. Whether the physicians are in with a group... an LLC... or hired within a large medical system, it's all about reimbursement of services. If you cannot make enough profit for your self, the LLC, the healthcare system... you will not survive. Sure pharmaceutical and insurance companies are spending billions of dollars marketing to these physicians... free samples, free lunches, conferences, etc... it is as competitive for these companies as it is a total pain in the physician's rear end to be beholden to them.

 

[Judge]

I know where you were going with this, but it's a bit more nuanced. The US medical schools are highly influenced by the pharmaceutical companies... this much is clear. Almost no education in terms of health and nutrition. Nearly all the training is done in hospitals, with the sick, injured, dying, and those in need of surgery. They are taught to "heal with steel" and medications... but only if they are going to be reimbursed by their insurance companies they have contracts with. It's really the pharmaceutical companies and their contracts with insurance companies that tell physicians what they can and can not do... and which medications to use. The physicians also have crazy high liability insurance premiums... and sometimes, this alone will cause physicians to simply walk away from the profession. The physicians are more or less downstream within the system... they are not in control... it's way above their pay grade. Whether the physicians are in with a group... an LLC... or hired within a large medical system, it's all about reimbursement of services. If you cannot make enough profit for your self, the LLC, the healthcare system... you will not survive. Sure pharmaceutical and insurance companies are spending billions of dollars marketing to these physicians... free samples, free lunches, conferences, etc... it is as competitive for these companies as it is a total pain in the physician's rear end to be beholden to them.

Nothing I haven't heard before from the industry perspective. Not to mention that doctors can float their debt far more efficiently in the eyes of creditors than most of their patients can. Yet none of it IMO excuses a doctor's professional and ethical obligation to their patients either.

However not all of the industry is in lockstep over condoning or tolerating such corrupt practices.

Certainly not the American Medical Association Journal of Ethics:

"Yes, it is considered malpractice when a doctor prescribes medication primarily to receive kickbacks from the manufacturer, as this compromises patient care and violates ethical and legal standards. Such actions can lead to serious legal consequences for the physician, including fines and imprisonment."

https://journalofethics.ama-assn.or...cian-receive-payment-prescribing-drug/2003-07

 

[Neonatal RRT]

"Yes, it is considered malpractice when a doctor prescribes medication primarily to receive kickbacks from the manufacturer, as this compromises patient care and violates ethical and legal standards. Such actions can lead to serious legal consequences for the physician, including fines and imprisonment."

I would agree that there ARE cases where kickbacks are part of some private practice's... but it's not as common as some would think it is. I would suggest it's rare... at least in 2025. For the most part, insurance companies are the ones in control of who gets what drug and when... it's this way within the hospitals... it's this way in outpatient clinics. It's all about the reimbursement. Furthermore, behind the scenes, without any input from healthcare systems, insurance companies are always renegotiating with the pharmaceutical companies for the cheapest prices... and as such, one drug that they approved of for a patient for several months, will suddenly be NOT approved another month leaving the patient without meds or some other, potentially inferior medication to replace it with. Physicians are always writing letters to insurance companies in order to receive prior approvals... the process can go on for months... and sometimes the insurance companies will stall and stall and stall until the patient dies.

My uncle was an investigator for the Attorney General of the State of Michigan for several years. It was his job to investigate all manner of crimes within the health care system as an undercover agent... nurses giving half doses of narcotics to their patients, then using the rest themselves... a fair amount of controlled substances trafficking... even a front for a drugs for guns. It was his investigations that led to the widespread installation of the pharmacy dispensary machines (Pyxis) we use within the hospitals... requiring fingerprints and passwords and cosigners before the machine would dispense any meds. Everything is barcoded and timestamped with our ID as well as the patient's ID. This was decades ago, so what may have been more common, certainly isn't now-a-days... almost unheard of in 2025.

 

[Mary Terry]

I would agree that there ARE cases where kickbacks are part of some private practice's... but it's not as common as some would think it is. I would suggest it's rare... at least in 2025. For the most part, insurance companies are the ones in control of who gets what drug and when... it's this way within the hospitals... it's this way in outpatient clinics. It's all about the reimbursement. Furthermore, behind the scenes, without any input from healthcare systems, insurance companies are always renegotiating with the pharmaceutical companies for the cheapest prices... and as such, one drug that they approved of for a patient for several months, will suddenly be NOT approved another month leaving the patient without meds or some other, potentially inferior medication to replace it with. Physicians are always writing letters to insurance companies in order to receive prior approvals... the process can go on for months... and sometimes the insurance companies will stall and stall and stall until the patient dies.

My uncle was an investigator for the Attorney General of the State of Michigan for several years. It was his job to investigate all manner of crimes within the health care system as an undercover agent... nurses giving half doses of narcotics to their patients, then using the rest themselves... a fair amount of controlled substances trafficking... even a front for a drugs for guns. It was his investigations that led to the widespread installation of the pharmacy dispensary machines (Pyxis) we use within the hospitals... requiring fingerprints and passwords and cosigners before the machine would dispense any meds. Everything is barcoded and timestamped with our ID as well as the patient's ID. This was decades ago, so what may have been more common, certainly isn't now-a-days... almost unheard of in 2025.

The hospital where my husband worked had a robot, named "Robbie" of course, that delivered drugs to specific destinations in the hospital. It would get mad if anyone blocked its path and say in that mechanical robot voice "YOU ARE BLOCKING MY PATH. PLEASE STEP ASIDE."

 

[Judge]

The hospital where my husband worked had a robot, named "Robbie" of course, that delivered drugs to specific destinations in the hospital. It would get mad if anyone blocked its path and say in that mechanical robot voice "YOU ARE BLOCKING MY PATH. PLEASE STEP ASIDE."

I just remember "Roderick". The husband of an underwriting trainee I once mentored in the 80s.

Roderick's job was to visit numerous hospitals in the SF Bay Area to literally take count of all their controlled substances and how and where they were stored. No one would have ever dreamed of blocking his path while he did his job in having broad access to pretty much everywhere- and everyone. But then he didn't answer to the hospitals.

He answered only to his employer, the Drug Enforcement Agency. Wondering so many years later, if those "Robbies" replaced him ?

 

[Judge]

I would agree that there ARE cases where kickbacks are part of some private practice's... but it's not as common as some would think it is. I would suggest it's rare... at least in 2025.

Like much of crime (and litigation) in general, statistics only count for those who are caught in the act, as a result of when they are legally compromised given a civil suit of malpractice or formal criminal investigations leading to indictments.

Otherwise it's just a matter of contractual liability between a pharmaceutical manufacturer and a physician. Nothing "rare" about that.

Though "Do no harm" should not equate to "Don't get caught" either.

 

[Neonatal RRT]

Like much of crime (and litigation) in general, statistics only count for those who are caught in the act, as a result of when they are legally compromised given a civil suit of malpractice or formal criminal investigations leading to indictments.

Otherwise it's just a matter of contractual liability between a pharmaceutical manufacturer and a physician. Nothing "rare" about that.

Though "Do no harm" should not equate to "Don't get caught" either.

To the best of my knowledge, there are NO contractual liabilities between a pharmaceutical manufacturer and a physician... unless they are a paid consultant... within the US. Your typical physician within a medical group or hospital will not have that relationship. Now, more commonly (easier to disguise) there have been some cases... non pharmaceutical related, but medical device related that would speak more to what you may be talking about.

AI Overview
Physicians may engage in consulting or promotional relationships with pharmaceutical companies, but such financial relationships must avoid illegal sham arrangements and misuse that could influence prescribing, with strict scrutiny and enforcement by authorities; many such relationships exist, yet improper arrangements can lead to sanctions and billing violations.

III. Physician Relationships With Vendors

The Sunshine Act of 2010:
https://www.conformis.com/uploads/2017/09/Sunshine-Act-FAQ-1.pdf

 

[Mary Terry]

Patients always have the option to pay out of pocket for medications or procedures recommended by their physicians which are not approved by health insurers, but often people cannot afford them.

 

[Ronald Zeeman]

The American model is not everyone else's model.

 

[Mary Terry]

The american model is not everyone else's model.

Well, of course, Ronald. Why would you expect it to be so?

 

[Ronald Zeeman]

All the previous responses refer to insurance companies, not the model up here or I suspect in many other countries.
This is a bit of an alien conversation to many of us.

 

[Mary Terry]

All the previous responses refer to insurance companies, not the model up here or I suspect in many other countries.
This is a bit of an alien conversation to many of us.

I'm pretty sure that most people here are Americans so the conversation is pertinent to them.

Does Canada have a Hippocratic oath for its doctors? If so, what is it? Has it evolved over the centuries?

 

[Judge]

To the best of my knowledge, there are NO contractual liabilities between a pharmaceutical manufacturer and a physician... unless they are a paid consultant... within the US.

Apparently not. It just depends on the strength of the contract itself...and the ability to defend it in a civil court of law. To have a defense that meets legal and ethical standards in the eyes of a jury hearing them.

" A pharmaceutical corporation can have various types of contractual agreements with a doctor, such as for research collaboration, clinical trials, or educational services, as long as these agreements comply with legal and ethical standards. However, it's important that the services provided are legitimate and not intended to influence the physician's prescribing practices improperly."

- D-Duck Duck Go Search assist AI

The devil being the legal details and how skillful a lawyer can be in interpreting them in their favor, whether it be the prosecution or the defense. Just because there laws on the books and regulatory terms and conditions doesn't preclude they can be shredded in front of a civil court to six to twelve jurors. With corporate officers and their lawyers behind closed doors willing to throw the dice with their corporate insurers cringing at the prospect of a public trial.

Which in underwriting contractual business liability for many years seemed much closer to reality compared to simply citing the law and how it should work, as opposed to how it does work. I can't comment on the pharmaceutical industry, but I have no reason to believe they operate any differently than other industries where public safety is a concern often overlooked or deliberately ignored in the pursuit of profit and shareholder equity.

There are no real metrics to cite when it comes to laws effectively circumvented behind closed doors. Only to surmise that what we don't know about does in fact exist and happen. Regardless of laws and their penalties.

 

[Judge]

All the previous responses refer to insurance companies, not the model up here or I suspect in many other countries.
This is a bit of an alien conversation to many of us.

It's impossible to isolate any one participant like insurers relative to complex healthcare systems.

There's also global corporate pharmaceutical manufacturers and medical service providers, apart from armies of lawyers and government regulators. No matter what country you refer to.

A pitfall for politicians who continue to address such issues of the healthcare industry in targeting only select participants of this equation rather than address all of them relative to real reform.

 

[Ronald Zeeman]

Many of our doctors are not western trained. current doctor somewhere from middles east not sure where he was trained or the philosophy that was followed.

 

[Neonatal RRT]

All the previous responses refer to insurance companies, not the model up here or I suspect in many other countries.
This is a bit of an alien conversation to many of us.

For you "outlanders" who might not know... there is this undercurrent of thought amongst some people that it's the physicians... the people you deal with in the hospital or office, who are in control of the US health system. The reality is that most physicians, only after they pay off the several hundred thousands of dollars in educational loans... in their late 30's and 40's... and only if they can meet very high "billable hours" and see as many patients as they can see... will actually have the kind of income stream that most people associate with "rich doctors". The reality is that it takes decades to reach that point. There's a reason why the typical physician in an office will have multiple exam rooms full of patients and he/she pops his/her head in for a few minutes at a time. It's an assembly line in most cases. I can tell you for certain, the decisions made by the American Medical Association, politicians, health care systems, insurance companies,... the entities and relationships that are responsible for health care costs in this country... are way, way above their pay grade and purview. If a physician accepts insurance... the insurance companies have a lot to say about what they can and cannot do... they micromanage all manner of decisions. My personal physician does not accept health insurance... he has his own practice... has his clients he accepts... he gets paid in full with every visit. A lot less headache for him... but doesn't have hospital privileges... a trade-off.

All that said, I have been a part of a huge healthcare system for nearly 40 years... as has my wife... and with regards to our Hippocratic Oath of "...first do no harm..." is taken seriously. For many physicians, it is not a career, but a life. At times it seems like some have a difficult time with their bedside manner, actually listening, or seem like they are too busy... but I have not run across a physician that didn't have good intent and a good heart at their core.

 

[Neonatal RRT]

Apparently not. It just depends on the strength of the contract itself...and the ability to defend it in a civil court of law. To have a defense that meets legal and ethical standards in the eyes of a jury hearing them.

" A pharmaceutical corporation can have various types of contractual agreements with a doctor, such as for research collaboration, clinical trials, or educational services, as long as these agreements comply with legal and ethical standards. However, it's important that the services provided are legitimate and not intended to influence the physician's prescribing practices improperly."

- D-Duck Duck Go Search assist AI

The devil being the legal details and how skillful a lawyer can be in interpreting them in their favor, whether it be the prosecution or the defense. Just because there laws on the books and regulatory terms and conditions doesn't preclude they can be shredded in front of a civil court to six to twelve jurors. With corporate officers and their lawyers behind closed doors willing to throw the dice with their corporate insurers cringing at the prospect of a public trial.

Which in underwriting contractual business liability for many years seemed much closer to reality compared to simply citing the law and how it should work, as opposed to how it does work. I can't comment on the pharmaceutical industry, but I have no reason to believe they operate any differently than other industries where public safety is a concern often overlooked or deliberately ignored in the pursuit of profit and shareholder equity.

There are no real metrics to cite when it comes to laws effectively circumvented behind closed doors. Only to surmise that what we don't know about does in fact exist and happen. Regardless of laws and their penalties.

Agree... but what I am trying to get across here is that the typical physician at a hospital or office will not have those sorts of contractural relationships. The vast majority are just "running the rat race" of seeing how many patients they can see within a certain time frame. It's about work units and billable hours.

Those relatively few physicians that are consultants or in research... the ones that may have "associations" or contracts with pharmaceutical and medical device companies... are not "typical". Most of those are in academia in some capacity... perhaps heads of departments... and probably aren't the ones prescribing medications. These physicians... usually specialists in their fields... may be consulted and make recommendations, but it is NOT them who write the orders and prescribe anything... that is left to the patient's primary care physician.

The bottom line is that there may be corruption, fraud, and abuse within the US healthcare system...but your "average Joe" physician is far from having the access, relationships, and resources...and is under constant and on-going investigational review... there are systems in place to make it extremely difficult, if not impossible for them to engage in these sorts of activities.