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Pay for Performance

Penalties for Doctors who Refuse to Sell Cholesterol Drugs

On Wednesday July 9,2008 the Garden Island Newspaper published my Letter To The Editor (Thank you Garden Isle)

I feel my patients and the people of Hawai‘i have the right to know some of what goes on behind the scenes at HMSA, our island’s number one health insurance company. This week, I will participate in a teleconference about a new initiative program created by HMSA as part of what they call “quality of care.” If you have diabetes, your doctor will be paid more if he or she convinces you to buy a cholesterol-lowering pill. How much more? If I get all my diabetics on these pills, I calculate that I may earn up to $20,000 more next year. Sounds great for me, and you might think I’d be an idiot to question such an easy cash gift. But I don’t think I’ll go for it. I don’t think there is enough scientific evidence that this practice will help all my diabetic patients, and I can’t justify such mindless, mass prescribing.

For more information on what’s happening behind the scenes, check out And if you are a paying customer of HMSA, you might want to join the discussion by contacting HMSA’s vice president/medical director John Berthiaume. Catey Shanahan, M.D.

On Friday, HMSA Fired Back:

Pills recommended for a reason
A recent letter (“Recommending pills to pop,” Letters, July 9) discussed the use of cholesterol-lowering drugs, called statins, by people with diabetes. Statins have been shown to help diabetic patients reduce their risk for stroke and heart attack and are recommended by the American Diabetic Association and the American College of Cardiology as a “best practice.” The HMSA Practitioner Quality Service Recognition program rewards doctors who follow such best practices because the appropriate use of health care services benefits our members, the health care delivery system and the community as a whole.
Ron Fujimoto, D.O.
HMSA Medical Director

This Irishwoman loves to get the last word, and I didn’t like the insinuation that I wasn’t aware of what doctors are being told to do by organizations like the ADA and the ACC. So I sent one more letter to the Garden Island Newspaper. But no luck this time, they didn’t print it. Here’s what I wrote:

I thank Dr. Fujimoto from HMSA for responding to my letter. As trained medical practitioners, we doctors are capable of reading the research and drawing our own conclusions – but we must read the data first. HMSA’s medical directorship outsources this responsibility to consensus panels and organizations such as the American Diabetic Association and the American Heart Association – and that’s a problem. These organizations have strong financial ties to industry and their conclusions are far from unimpeachable. The conflicts of interest run so deep that they have been repeatedly exposed by major players within the medical establishment, including The New England Journal of Medicine’s editor Dr. Jerome Kassirer, Harvard University’s Dr. John Abramson, the Center for Medical Consumers, and many others. Patients are best served when doctors read the research themselves and remain free to make decisions without corporate interference from insurance plans.

I’ve read the research data on the use of statins in diabetics in all its monotonous detail, not just the consensus panel summaries. The data shows that some diabetics benefit and some are harmed. There’s no such thing as a drug without side effects, and statins may cause memory loss, depression, nerve damage, bacterial sepsis, muscle damage (including heart muscle) and cancer. To say that all diabetics will benefit is truthiness, not the truth. In my opinion, this national trend toward paying some doctors less than others for treating patients in accordance with the best available scientific data will lead to predictable harms.

Catey Shanahan, MD
West Kauai Clinic Kalaheo

Here are a links to some of the people who inspired me to think for myself:

Harvard’s Dr. John Abramson

The New England Journal of Medicine’s former editor, Jerome Kassirer

Ray Moynihan and Alan Cassels, Authors of Selling Sickness

And the creators of this video:

And for any doctor out there who wants to know why a growing number of scientists and physicians are skeptical of the benefits of these medications, a few more links:

Dr. Duane Graveline, author of Statin Drug Side Effects and many articles. This site is full of technical and interesting information that doesn’t make our medical journals.

Cardiologist Peter H Langsjoen, MD, FACC

Uffe Ravnskov, MD and author of The Cholesterol Myths

Malcolm Kendrick, MD and author of The Great Cholesterol Con

The International Consortium of Cholesterol Skeptic

Dr. Cate

With over two decades of clinical experience and expertise in genetic and biochemical research, Dr. Cate can help you to reverse metabolic disease and reshape your body.

This Post Has 3 Comments

  1. Thanks for posting. I am a first-year med student at the University of New England, and I have some reservations about the statin drugs based on my studies of the importance of cholesterol in the body and observations of family members and friends who are taking these drugs or have in the past. I wanted to discuss this subject with my academic advisor-who teaches pharmacology-but he dismissed it by saying that the drugs are perfectly safe and that the problems I’ve noticed in others are due to other causes. He may be right to some degree, but I, as a future physician, would have serious concerns about prescribing statins to patients. Thanks for getting the word out-we need more skeptical voices!

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