Total Transparency Manifesto

January 25, 2016

Total Transparency Manifesto 

 Reference: TTM Website, Leanna Wen TED Talk, Doctor’s Magical Thinking, Doctor’s Paid, Open Payments Database, What Can Patients Do? 

 Ok, this isn’t about nutrition per se, but the dynamics of health care behind the scenes.   Fundamentally, that had led to many parts of health care being “backwards”, and I wanted to explain that to you. In writing this, I also want to clarify my stance to myself. Your belief is that your doctor is your advocate, transparent and pure. Many doctors are wonderful, dedicated, caring persons who are your advocate. But they are swimming upstream against powerful forces.   

Those powerful forces are not always even evident to them. Let me give you some examples. Many physicians are subject to review of their practice for meeting "quality indicators".   As such, they are incented with bonus pay to meet certain guidelines, established by national committees. When seven panel members of the cholesterol guidelines committee revealed that they had financial ties to statin manufacturers, you get the drift. Now, your doctor may press you with a certain intensity on the need to be on a statin for the reduction of cholesterol.   And you are frustrated because you heard about the Hunt Study from Norway that showed higher cholesterol to not only be harmless, but protective. 

Then, there is your PCP insisting you be on a statin.   So, you get a cardiac calcium scan and see that you have no calcium in your arteries.   And you know that there is no mortality from cardiovascular disease when calcium scores are zero. . Do you need to be on a statin? No. But your doctor insists. Whose side is your doctor on?   In this context, it is not your own physician at fault, but the very nature of being in a large network of doctors, structured to have financial incentives for clinical work outcomes, based on national guidelines that have been cleverly manipulated to have biased results.   But it’s your doctor who carries it out. 

 The same conflict shows up in oncology, orthopedics, and on and on, virtually every field. So, what did Leanna Wen do? As a physician with a mother with breast cancer, she was unsettled on hearing that her mother’s oncologist gave chemo drugs that the oncologist was being paid to speak about publically. She was concerned about possible conflict of interest. She started a simple little project to advocate for total transparency by physicians, and to put that web site up so that everyone could search it. The intent was to create a means by which physicians could pledge that they didn’t have any conflicts of interest, or just what they were. 

Guess what happened? Well, if you guessed that she was attacked by thousands of angry doctors with floods of email, letters, even calls to her employer to fire her, you would be right.   That is painful to hear. But that is the world we live in today. Our health care system is designed to be a corporate structure which has to have some profit. Every manager in every health care system in Milwaukee is incented to increase their line of business this year by 4%, so they get their bonus. Milwaukee’s population is not increasing by 4%, so that increase can only come from getting more patients from the other systems, by increasing prices, or by doing more procedures, some of which may not have been necessary. Even Time Magazine has jumped into the fray about breast cancer. 

  www.What Will Work for me. I signed the Total Transparency Manifesto. Ask your doctor if they have. Suggest to them that you think everyone in their network should too. Wouldn’t that give you confidence that your doctor was really on your side?   

 Pop Quiz  

  1. Our health care system pays doctors when you get sick, not to keep you well. T or F.     Answer:  True
  1. We have designed our health care system to pay handsome sums for procedures, to fix you once you are broken. T or F.                        Answer:   True
  1. We have many national organizations, funded by pharmaceutical companies, that advocate for certain health conditions, that might just be covers for advertising and selling expensive drugs. T or F                        Answer:  That’s it in a nutshell. We should really have a Manifesto for all the advocacy organizations. Ask the Alzheimer’s folks who funds them!
  1. What percent of American doctor’s take some sort of money from health businesses like medical device companies, or pharmaceutical companies?                        Answer:   90%
  1. Would you feel safer if your doctor had taken the Pledge?                      Answer:  You tell me.