Update: And it gets worse: KIDS!!!!
Petition (and see our visit to DC and DC Press Conference + Rally)
Suppose a person is wandering the country and winds up in an area where there are only a couple of restaurants: 'Marvelous Mike's Michelin-starred' restaurant and 'Salmonella Sam's Toxic Waste Dump' restaurant where the chef has graduated from "Typhoid Mary's School of Culinary Delights!". Being hungry, but not knowing the area, it is decided to ask a local wandering by where a person might partake of a good meal and refreshments. The local assures the traveler he knows the lay of the land very well - but recommends the traveler dine at 'Salmonella Sam's'! Why? It isn't because the local hates tourists, turns out the local is co-owner of 'Salmonella Sam's'! Hey, the local might otherwise be an upstanding member of the community, but good intentions don't feed the bulldog!
The local restaurant owner could tell themselves: "It is only one meal! The out-of-towner will probably survive? It isn't like a steady diet of crap!". Now imagine a steady diet of crap served up by your local doctor! A local doctor who may not be part-owner of a restaurant, but a dialysis clinic. Let's call this clinic 'Fred's Discount Dialysis', motto: "Discount Care, at High, High Prices!", catchy huh? Instead of clientele who are free to leave and get out of town, the doctor's "customers" are force-fed a steady diet that is eventually going to kill them sooner than when their time would normally be up. Traveling out of town isn't an option for most of them. A 'Marvelous Mike's' of dialysis could show up in town, something like 'Community Dialysis Houses', a wonderful innovation where dialysis patients don't so much as 'cook' for themselves, but control their own treatments! Between the two dialysis options, you may have already guessed which place the local doctor maybe very tempted to recommend - the one he has a financial interest in, 'Fred's Discount Dialysis'! (aka the huge for-profit dialysis companies DaVita and Fresenius)
(You may wonder where the oversight for dialysis clinics is at, much like the health department for restaurants. Can you say 'Captured Regulation'? But that is more a story for another day)
There is good news that there is a tool in the arsenal to keep doctors from recommending things like a 'Fred's Discount Dialysis', that they have a financial interest in! It is called the 'Stark Law'! It is named after federal Rep. Pete Stark who was a main force in getting it passed in 1989 and 1993. It was supposed to stop physician self-referrals. It was supposed to stop co-owner doctors from referring things like a 'Fred's Discount Dialysis' clinic. But the bad news is kidney doctors (nephrologists) got an exemption to the Stark Law! Oh, what big money, corporations, and lobbyists can buy under the guise of the need for rapid expansion! (uh, why couldn't places like small care co-ops just get loans? But maybe I'm naive, but I like to think I know crap when I see it)
An excellent article about physician self-referrals and joint ventures was done by Scientific American and Undark in a series of articles about dialysis.
Here are a few quotes from the article:
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Dr. Berns who has serious qualms about joint ventures: the arrangement leaves many nephrologists with a financial incentive to steer patients to their co-owned clinics for dialysis, even when other, perhaps even better or more appropriate interventions like medication and lifestyle changes are available.
Dr. Moss, who could play the devil's advocate: acknowledged that these same financial incentives could also cause a physician to subconsciously steer patients towards their own clinic and away from options that might be more beneficial.
Dr. Meyer of Tufts Medical Center: if you have the stock market sucking away resources (epitomized by the for-profits DaVita and Fresenius), you just have a mess left over to take care of the patient, even though the people on the ground at the bedside may all have the best intentions and be very, very devoted.
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But getting back to comparing restaurants to dialysis clinics, it seemed more apt to compare DaVita's and Fresenius clinics to 'Salmonella Sam's' restaurants than what former ceo of DaVita Kent Thiry compared them to, Taco Bells. Comedian John Oliver felt compelled to apologize to Taco Bell on behalf of Kent Thiry starting at 21:50 of this video. Quote: "You are actually more likely to find a doctor in one of our restaurants (Taco Bell) than a dialysis clinic".
*Carrie Arnold, a lead reporter for the series of articles mentioned, also did an article about what happens to patients who make the mistake of questioning their care - terminations!
*For a deeper dive, NYT's best-selling author Tom Mueller last year put out the book 'How To Make a Killing; Blood, Death and Dollars in American Medicine'. He is also mentioned attending a press conference in DC in January 2024 along with a 'Rally to Congress' in February of 2024 (same article).
Update: And it gets worse: KIDS!!!!
Petition (and see our visit to DC and DC Press Conference + Rally)
