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Culture change needed to alter a health care system that favors only those on top

A study conducted by the UCLA Fielding School of Public Health highlighted many problematic under-the-table payments to physicians within the health care industry. This is a symptom of larger systemic problems that leave students and faculty of UCLA’s top-flight health and medicine programs especially vulnerable. (Axel Lopez/Daily Bruin senior staff)

By Andrew Raychawdhuri

Oct. 21, 2019 10:10 pm

“More money, more problems” may be one of the few universal truths in this world.

And it just happens to perfectly sum up the health care industry in America.

A recent study conducted by researchers from the UCLA Fielding School of Public Health adds yet another layer to this issue. The study investigated physician profiles and examined the association between physician characteristics and payments from drug and medical device companies from 2015-2017. These payments ranged from lunches to consulting fees to research grants.

The study found that payments given to physicians were concentrated within a small group, with 90% of these payments going toward 5% of physicians paid. According to the study, on average, male physicians are paid around 2 1/2 times more than female physicians are by industry.

There is no doubt the mere fact that there are so many under-the-table industry payments to physicians is problematic – but that isn’t the only problem in the health care industry.

These payments may appear to be the main issue, but they are only a symptom of larger systemic problems – namely, blatant issues with elitism and gender bias in the medical field that perpetuate a culture of hierarchical power dynamics. These dynamics only create an opportunity for exploitation by profit-pursuing companies that don’t serve consumers’ interests. The health care industry, like any industry, is built for catering to the needs of its consumers. And despite a vague expectation of ethics, this culture pervades UCLA’s top-ranking health and medical programs, leaving students and faculty vulnerable.

And it becomes even harder when the hierarchical nature of the medical field gives those physicians all the power.

Kosuke Inoue, a graduate student at the UCLA Fielding School of Public Health and a co-author of this study, said the study was conducted because of an increased sense of uneasiness about industry dealings in the public.

“There has been concern about the relationship between physicians and the pharmaceutical industry,” Inoue said. “We are concerned because the industry marketing might affect physicians’ behavior.”

That is a valid concern for students at UCLA – especially considering the recent opioid crisis hits in their own backyard. In 2017 alone, there were 454 opioid overdose-related deaths in Los Angeles County. College students are an increasingly vulnerable population, as they are more at risk of becoming addicted to drugs than the general public – with one in four college students meeting the standard for substance abuse in 2018.

The opioid epidemic has been fueled by complacent physicians and a ruthless pharmaceutical industry that profits from more prescriptions.

And UCLA is guilty of dealing in both.

Pharmaceutical companies are exploiting a flawed system – and UCLA has never been hesitant to profit off that. Ingrained power dynamics, such as the saturation of male doctors and the consistent dismissal of their female counterparts, can determine how this industry will run.

Whether it be ignored sexual abuse cases or blatant pregnancy discrimination, the university has more than a few issues with power dynamics.

Tajah Tubbs, a medical student at the David Geffen School of Medicine at UCLA, said she recognizes there are problems in the medical field.

“At baseline, there is a problem with gender and elitism in medicine. … In general, I think it is just a known problem,” Tubbs said.

Change might be on the horizon, but it was only in 2017 that female enrollment in medical schools outnumbered male enrollment. Unfortunately, this may be too little, too late, as power dynamics have become too deeply entrenched over the years – and from this recent study, it is clear the effects of these dynamics are still damaging to women and patients in 2019.

The very nature of this industry creates a vicious cycle – one in which those at the top are sustained by industry payments, while the industry continues to take advantage of the system that put them there.

When decision-making among physicians becomes less about health and is influenced by gender, status and the reach of pharmaceutical companies, there is no way to ensure patients are getting the best treatment. And with junior physicians mimicking those at the top, patients are the ones left to suffer.

“Intuitively, the high concentration of these payments is problematic, because it shouldn’t be such a very small amount of physicians getting a lot of money,” Inoue said. “We think that the industry is trying to approach opinion leaders and influencers.”

Until there is a major culture shift within the medical field, it won’t take much for bad actors to manipulate the health care industry in their favor.

Cindy Moreno, a third-year art history student, said the prospect of money having such an influence in health care is pretty worrying for her as a patient.

“You would think that it should be something that is purely scientific and just concerned with individual health,” Moreno said. “But more and more, it seems that clearly isn’t the case, and that means I have to put in more effort into doing research for my health.”

Granted, it isn’t clear from this study whether these payments are positively or negatively influencing clinical practice – more research must be done. But, the potential for exploitation will always be there if these payments are happening in a flawed system. After all, if these payments weren’t nefarious in nature, industries wouldn’t be trying to target physicians they believe have influence.

A change in culture is vital, but it doesn’t mean punishing the hard-working at the top. It’s about altering a system that gives the minority of physicians control over the majority of patients.

More money certainly creates more problems, but so does a flawed system that favors those at the top and puts profits over people.

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Andrew Raychawdhuri | Opinion columnist
Raychawdhuri is an Opinion columnist.
Raychawdhuri is an Opinion columnist.
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