Guest guest Posted November 15, 2002 Report Share Posted November 15, 2002 Has anyone ever considered the ethical dilemma in profiting from the sale of pharmacy items that you prescribed. Medical doctors are not allowed to sell drugs for profit from their offices. Many are selling supplements and various therapeutic devices in order to supplement their incomes and this has caught the attention of medical boards. According the bylaws of the american association of naturopathic physicians, members are advised to only charge for pharmacy products sufficient to cover the expense of running the pharmacy. Granted, this has had no impact on the actual practices. But the two other major medical professions in the USA that rely on professional prescribing (western and naturopathic medicine) officially frown upon physicians earning income from pharmacy. Where do we stand as a profession on this matter. As has been noted here, profit on pharmacy items can be a significant factor in making a successful living as an acupuncturist, perhaps 25% of one's net income before taxes. If we decide as a profession that profiting on pharmacy is ethically questionable, how will we handle that? Would one charge more for office visits to make up the losses? How is that any different than profiting on pharmacy? I assume everyone knows the argument about physicians profiting on pharmacy. If one profits on pharmacy, then one is compromised in one's objectivity when deciding therapy for the patient. One may prescribe more in order to generate more revenue. the argument in rebuttal has been that we need to have control of our own pharmacies in order to ensure quality for our patients. that is no longer completely true as comprehensive mail order pharmacies of various sorts exist around the country. Personally I think that the average practitioner seeing 50 patients a week plus management and paperwork should be able to net $100,000 before taxes. they deserve to make that whether the income is said to come from pharmacy profit or office visits. Office visit fees tend to be fixed and flat while the potential variability of pharmacy charges lends itself to abuse (similar to procedure abuse especially when billing insurance). So shifting the source of revenue to office fees and away from pharmacy gives an appearance of greater propriety. I have recently experienced a practitioner of alternative medicine who attempted to make outrageous profits on pharmacy items sold to me. I am fairly familiar with the actual cost of most herbs and supplements, so I was mostly appalled, but I noticed he made a fortune on his poor unsuspecting patients who were being charged literally 500% profits on pharmacy items. Any thoughts? Chinese Herbs " Great spirits have always found violent opposition from mediocre minds " -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2002 Report Share Posted November 17, 2002 " Has anyone ever considered the ethical dilemma in profiting from the sale of pharmacy items that you prescribed. " Two comments: 1.If you are freed up from the obligations a pharmacy requires, you have time to see more clients. 2.A quality pharmacy would have to be available to your clients. This would be heaven sent for me. Mark Costello Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2002 Report Share Posted November 17, 2002 There is no ethical dilemma in profiting from the sale of pharmacy items---you're supposed to, it's your job. Any decent business has mark ups built in for each service and product. It becomes unethical when you are misrepresenting those products or services. My pricing to the patient includes both acupuncture and herbs for a week. It's easier for me to keep track of costs. Even though I have a complete pharmacy of concentrates, I order my main formulas encapsulized and made from concentrates by Spring Wind (23,000 caps per formula will last about a year), and hire someone parttime to make up other and incidental formulas. You can always have Spring Wind or another company make up formulas (concentrates or raw) so you don't have to carry any inventory. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2002 Report Share Posted November 17, 2002 , " James Ramholz " <jramholz> wrote: > There is no ethical dilemma in profiting from the sale of pharmacy > items--- Jim You missed the point or just coincidentally deleted the last part of the sentence above which was the crux of the point. It is not whether one should profit from the sale of pharmacy items, it is whether it is OK to profit from the sale of pharmacy items " that you also prescribed " . Medical doctors are banned from doing this because of the temptation to prescribe unnecessary and expensive items in order to generate revenues. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2002 Report Share Posted November 17, 2002 , " " <@i...> wrote: > You missed the point or just coincidentally deleted the last part of the sentence above which was the crux of the point. It is not whether one should profit from the sale of pharmacy items, it is whether it is OK to profit from the sale of pharmacy items " that you also prescribed " . Medical doctors are banned from doing this because of the temptation to prescribe unnecessary and expensive items in order to generate revenues. : My opinion is still the same. Hasn't it always been the case that many Chinese doctors make a profit---if not their living---from the herbal formulas they prescribe? I've known many Asian herbalists who owned their store and prescribed their own formulas. CM and the business of Western prescritions are apples and oranges. Applying the Western medical doctor model to CM confuses the issue and seems unnecessary since herbal formulas cannot be prescribed like drugs. Herbal formulas are chosen and individualized to the patient; and, we don't have a herbal pharmacey on every corner to send patients to. What is considered expensive and unecessary will always be controversial. MDs prescribe expensive and unecessary drugs all the time, and profit from that act. It is even an accepted practice, a standard of practice. For example, this coming flu season, millions of doses of antibiotics will be prescribed even though they have no effect on any virus and their impact is no better than placebo. The doctors may not share in the immediate revenue from the sale of the antibiotic, but they benefit from the expensive office fees. Doctors often know that what they have prescribed is unecessary and unscientific. But they are afraid that the patient will leave empty- handed, disappointed, and not return. Or worse, go to another doctor and get an antibiotic. I don't think you can successfully legislate ethical behavior (even when the issue is clear); although you can often address and curb blatant abuses. I don't think that many of us got into this field with an expectation to exploit the system and create windfall profits. I think what you have in mind (tell me if I'm wrong) are those practitioners who misrepresent the effectiveness of a herbal formula to severely ill patients and charge as much as the patient can bear. And some practitioners who overhype basic formulas with expensive ingredients as magical elixirs. And practitioners who knowingly prescribe an expensive formula when a cheaper and equally effective one is available. Sure, that is unethical; but not necessarily criminal. Each of those situations should be individually addressed; but I don't think that global action is required. And if redress is needed, what sort of oversight and action is available to us? If you are leading up to making herbal prescribing a licensed practice separate and apart from acupuncture or taking it out of the public's hands, it will divide our profession's political efforts, double our political expenses, and make herbalism an easy target for outside control by MDs, the FDA, etc. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2002 Report Share Posted November 18, 2002 , " " <@i...> wrote: It is not whether one should > profit from the sale of pharmacy items, it is whether it is OK to profit from the > sale of pharmacy items " that you also prescribed " . Medical doctors are > banned from doing this because of the temptation to prescribe unnecessary > and expensive items in order to generate revenues. > One thought among many on this is; why is the temptation to over prescribe or overprice the products one sells, any different to the temptation to do the same with acupuncture treatments and herbal consultations? Simon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 , " Simon King " <dallasking@b...> wrote: > > One thought among many on this is; why is the temptation to over > prescribe or overprice the products one sells, any different to the > temptation to do the same with acupuncture treatments and herbal > consultations? simon now that's a good question. in fact, doctors were notorious for profiteering on procedure charges before the days of managed care. the current system is pretty terrible, but we need to remember that it was designed to fix abuses in the old system. I think the logic, which is admittedly shaky, goes something like this. A person can decide whether or not to see a doctor, but once they have committed themselves to the process they are somewhat at the mercy of the physician. the average person doesn't have the time or money to go traipsing around for a dozen opinions, so usually the first doctor gets to prescribe. the patient assumes they are getting good care and just complies. However, the same abuse definitely happens with procedures. the chiro profession has a bad rep for overscheduling procedures as do surgeons and acupuncture is starting to get this rap in some circles, too. Since we can't restrict docs from doing the procedure, the only area that can be controlled is who sells the drugs. I think it is a matter of making a potentially bad situation less bad. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 Speaking of overcharging, one of my patients got a granulated formula from another practitioner in town here (Santa Monica, CA) and was charged $70 for 2 weeks' worth. What do people think of this pricing? I don't prescribe granules so I am unfamiliar with the going rates. Julie > One thought among many on this is; why is the temptation to over > prescribe or overprice the products one sells, any different to the > temptation to do the same with acupuncture treatments and herbal > consultations? > > Simon > > > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 , Julie Chambers <info@j...> wrote: > Speaking of overcharging, one of my patients got a granulated formula from > another practitioner in town here (Santa Monica, CA) and was charged $70 for > 2 weeks' worth. What do people think of this pricing? If the patient was prescribed 20 grams per day, that would be about 100% markup. Like many of you, I have also made profit from pharmacy. 100% markup is common in the health food industry and that has been our model, so no reason to feel guilty about past actions as we consider the future. However since I normally prescribe 12 grams per day, $42 would be more typical (at .$25/g). Basically, I'd make about $10 profit per week on herb sales to the average patient. that always seemed reasonable to me. this could kick up your income by $500 per week or $25,000 per year (anyone see the temptation yet). Since it takes no more labor or effort of any kind to prescribe larger doses of herbs and because my budget was based upon $10 per patient, if I prescribed higher dosages, I would still sell the herbs for cost plus $10. And that $10 per pt. basically paid me for my formula filling time. some people do not consider that profit, per se. Admittedly it is a gray area. Naturopaths are ethically constrained from markups beyond the cost of running the pharmacy, not from markups altogether. I don't want anyone to think I am suggesting selling herbs at cost. In fact, one can easily justify 100% markup if the pharmacy is staffed and busy. so unless the practitioner is prescribing very large doses (which is atypical and unlikely), this price seems steep to me. $140 per month is more than most patients can afford and it is unnecessarily expensive in order to achieve both therapeutic results and fair income, even when fair is based upon healthfood store ethics rather than medical ethics. speaking of this whole ethical issue, one cannot help but consider the typical chinese herb shop owner who only charges for herbs and not for consults. that suggests a different ethic in china which perhsps we should also consider in this debate. However, it is my understanding from Unschuld that those who profited in the sale of herbs inancient china were looked down upon by the literate scholar doctors who often did not even take money for their consults, but practiced out of confucian obligations to family. Does anyone know if this true? We have all heard the discredited legend about the chinese doc of old getting paid to keep his patients well. Is this another such bogus legend? Unschuld usually doesn't traffic in legends without basis. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 That's really not overwhelmingly expensive if the daily dosage is high and/or the ingredients are pricey (i.e deer antler, ginseng, etc). Mark Reese - " Julie Chambers " <info Tuesday, November 19, 2002 12:19 PM Re: Re: pharmacy > Speaking of overcharging, one of my patients got a granulated formula from > another practitioner in town here (Santa Monica, CA) and was charged $70 for > 2 weeks' worth. What do people think of this pricing? > > I don't prescribe granules so I am unfamiliar with the going rates. > > Julie > > > One thought among many on this is; why is the temptation to over > > prescribe or overprice the products one sells, any different to the > > temptation to do the same with acupuncture treatments and herbal > > consultations? > > > > Simon > > > > > > > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare > practitioners, matriculated students and postgraduate academics specializing > in Chinese Herbal Medicine, provides a variety of professional services, > including board approved online continuing education. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 Julie, Did the patient get some other modality for the 70 bucks. Maybe the practitioner also gave dietary advice or taught the pt some qi gong. If all you're doing is filling a formula, then it seems high. However, if the practitioner was also the pharmacist, then it's is worth every bit of it. The practitioner has the knowledge and training to make the needed substitutions to the rx should a)herb's out of stock b) the pt's condition changes and the formula has to be slightly altered. My point is that the knowledge from schooling, and selfstudy is worth the money. One to one interaction, dedicated practitioner/patient time during the office visit is valuable. There's also the perception of value. The less one pays; the less valuable; sad but true. Fernando Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 You know Julie, For the life of me, I can't draw a line on a price list and say that below the line is ethical and above the line is not. To me, ethics is simply acting on behalf of the patient's needs first and the practitioner's second. That's the line I draw. Without money, I can't keep my office open and continue to serve the public, I must charge money. Most of my patients agree that the money is not the issue, the efficacy is. An herbal formula priced at cost that doesn't work is percieved as a rip-off whereas a highly inflated price for a formula that addresses a need that no other therapy can is priceless. -al. Julie Chambers wrote: > > Speaking of overcharging, one of my patients got a granulated formula from > another practitioner in town here (Santa Monica, CA) and was charged $70 for > 2 weeks' worth. What do people think of this pricing? > > I don't prescribe granules so I am unfamiliar with the going rates. > > Julie > > > One thought among many on this is; why is the temptation to over > > prescribe or overprice the products one sells, any different to the > > temptation to do the same with acupuncture treatments and herbal > > consultations? > > > > Simon > > > > > > > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare > practitioners, matriculated students and postgraduate academics specializing > in Chinese Herbal Medicine, provides a variety of professional services, > including board approved online continuing education. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2002 Report Share Posted November 19, 2002 > Julie, > > Did the patient get some other modality for the 70 bucks? Fernando, the patient paid for the consultation as well (over $100, established patient), and the $70 was just the cost of the herbs. I am hearing a range of responses as to this cost, and it seems many find it justified. I agree, $140 a month is steep for medicine, and the woman's husband is out of work! Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2002 Report Share Posted November 20, 2002 , Julie Chambers <info@j...> wrote: I am > hearing a range of responses as to this cost, and it seems many find it > justified. Julie The range of responses you are hearing (offlist, I presume) is proof positive that some of our colleagues may be doing exactly what I fear. I know what these products cost and $70 for a 2 week supply of powders is outrageous unless the dosage is extremely high. I would be very curious if this practitioner's literature advises the patient of the high cost of herbs prior to starting treatment. Bob Felt is right. Many practitoners bait patients with cheap or free initial consults for the express purpose of sucking them dry on supplements. I am very tempted to post the average wholesale cost of herbs on my website so patients can be informed and will not get ripped off. I won't actually do this because my site is for professionals, but this angers me and I hope someone else will do just this thing. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2002 Report Share Posted November 23, 2002 I've been thinking about this reflecting on my own practice and in preparation to teach practice management at MCOM this coming year. To me it is a practical matter. The herbs we prescribe should be readily available to patients. The most readily available is me handing it to them. I have discussed internet pharmacy with many of my patients and none was even warm to the idea. They much prefer I hand them the herbs and that I make a reasonable profit in doing so. I live in an area where no one else is using powdered extracts and I stongly believe in them. A few teapills are available at the health food store and from my competitors, but I don't believe teapills will help most of my patients. I do see potential for abuse, but not moreso than with numerous other professions such as financial planners (that sell you insurance products), insurance reps, stock brokers (ok maybe bad example as that whole system is structured with conflicts of interest... hopefully changing), even auto mechanics and plumbers (charge for parts), etc, etc, etc Consumers are vulnerable in many situations because it takes time and effort to become expert enough to know whether they are being taken advantage of. It then becomes a matter of trust. IMO, businesses need to act ethically to survive in the long run. It would be foolish to betray the trust of a customer to make an extra dollar in the short run. Michael Buyze , " " <@i...> wrote: > , " Simon King " <dallasking@b...> wrote: > > > > > One thought among many on this is; why is the temptation to over > > prescribe or overprice the products one sells, any different to the > > temptation to do the same with acupuncture treatments and herbal > > consultations? > > > simon > > now that's a good question. in fact, doctors were notorious for profiteering on > procedure charges before the days of managed care. the current system is > pretty terrible, but we need to remember that it was designed to fix abuses in > the old system. I think the logic, which is admittedly shaky, goes something > like this. A person can decide whether or not to see a doctor, but once they > have committed themselves to the process they are somewhat at the mercy of > the physician. the average person doesn't have the time or money to go > traipsing around for a dozen opinions, so usually the first doctor gets to > prescribe. the patient assumes they are getting good care and just complies. > However, the same abuse definitely happens with procedures. the chiro > profession has a bad rep for overscheduling procedures as do surgeons and > acupuncture is starting to get this rap in some circles, too. Since we can't > restrict docs from doing the procedure, the only area that can be controlled is > who sells the drugs. I think it is a matter of making a potentially bad situation > less bad. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2002 Report Share Posted November 23, 2002 , " mbuyze " <mbuyze@h...> wrote: > Consumers are vulnerable in many situations because it takes time and > effort to become expert enough to know whether they are being taken > advantage of. It then becomes a matter of trust. IMO, businesses need > to act ethically to survive in the long run. It would be foolish to > betray the trust of a customer to make an extra dollar in the short > run. Doctors must have a higher ethical standard than most other professions since we care for people's health. But Mike is right that it is shooting yourself in the foot to not charge fairly. Unfortunately, not everyone sees the big picutre. The recent business climate (pre-enron) could've infected anyone to believe short term gain is worth any sacrifice. that is how the rich corporate warlords work, right? trashing towns and companies and just walking away with massive profits. Like it or not, a chunk of the public and mainstream researchers looks at us with suspicion because of well publicized profiteering (such as metabolife or sunrider, even though they have nothing to do with TCM). We are still beating at the door of credibility. You've got to ask yourself why far more people think it is safe to buy supplements from health food clerks than licensed professionals. We have a long way to go to change public perception of " healers " like us. The media and sitcoms consistently lump us with charlatans and con artists. That is probably a more accurate reflection of public perception than vitamin sales or weight loss clinics. One way to overcome this is demonstrate our ethics as a profession on this matter, just as the other major prescribing professions have. As stated, I think full disclosure of potential costs PRIOR to treatment satisfies this goal in my mind. I agree with Mike that in many places, it is almost essential to have an onsite phamacy to dispense in a timely manner and control quality. However, one can certainly profit using mailorder pharmacies. When you calculate the savings in time and labor costs to have an inhouse pharmacy, I actually made more money using an outsource one. For those who like this option, I have identified one such trustworthy pharmacy and notifed folks about this last night. the problem is that while the majority of L.Ac. are probably fair and ethical, it is the shysters who attract massive negative attention for the profession as a whole. I think we should distance ourselves as a profession from those among us who practice these things. I mean what do people think about L.Ac. engaging in multi level marketing schemes to their patients. I have known quite a few who do this. It is question of where do we draw a line. I don't know the answer and I apologize if my polemic style of uncovering " truth " has ruffled some feathers. But there is an old saying that silence is complicity. Quote Link to comment Share on other sites More sharing options...
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