Doc: Doctors promoting drugs is not off-limits
Dear Dr. Roach: Are the drug companies asking you doctors to push their new stuff? I hear all the time from various people that they wonder if doctors get kickbacks for prescribing certain medicines. I think the general public wonders if that is the case.
Dear C.M.: It is illegal for physicians to accept money or gifts in exchange for prescribing a medication. That doesn’t mean it never happens, but the consequences of being caught are so great for both parties that I don’t think that actual “kickbacks” occur very often. However, pharmaceutical companies can and do pay physicians to promote their products, often as a paid speaker. The difference between being paid to prescribe something and being paid to promote it may seem subtle. In the past, these payments and gifts often became large and ethically questionable: There is less abuse now, I believe, than 10 or 20 years ago.
Thanks to independent investigative reporters, you can look up whether your doctor accepts money from pharmaceutical companies at projects.propublica.org/docdollars/. The U.S. government also has a tool at openpaymentsdata.cms.gov/. Just accepting a lunch or educational conference may show up on this website, and may not be an ethical violation at all; however, as I look at this list, there do seem to be some doctors who accept large amounts of money, with the potential for conflict of interest.
Personally, I do not accept money or gifts from pharmaceutical companies. I think there is too great a potential for conflicts of interest, especially in my role as a writer.
Dear Dr. Roach: My 66-year-old husband is a metastatic colon cancer survivor. It brought on diabetes, and he takes 5 mg daily Tradjenta for it. His A1C is 7.1 percent. I wonder if chromium picolinate would be a good alternative. I’ve been taking it for over five years, and my A1C is excellent.
Dear D.A.: Linagliptin (Tradjenta) is in a class of diabetes medication called DPP-4 inhibitors. They are moderately effective in lowering blood sugar, with most people having a decrease in their A1C between 0.5 and 1 percentage point. Unfortunately, a 2015 review of studies on this subject showed that chromium picolinate does not have a significant effect on A1C. I would not recommend that he stop the Tradjenta, nor that he start taking chromium picolinate for treatment of diabetes.
People respond very differently to medications sometimes, so one needs to be cautious about applying one’s own experiences to other people.
Dear Dr. Roach: On a recent exam, I was found to have a low urine specific gravity (the normal range was 1.010 to 1.030, and my level was 1.005). What does this mean? Is this a problem?
Dear S.M.: Urine is water with the metabolic byproducts that your body wants to get rid of, along with a certain amount of salts, depending on your consumption. The specific gravity is a way to look at how concentrated the urine is. A very high number (1.030 or higher) indicates that the kidney is trying to conserve water: It’s likely that the person needs fluid. In people who drink a lot of fluid, the kidney must make a dilute urine: 1.010 or lower. With your result, it is clear that you drink a lot of water, and it’s very likely that your kidneys work well.
It takes work for the kidneys to make an extra-dilute urine as well as to make an extra-concentrated one, and diseased kidneys can do neither well, which is why fluid management is so critical in people with many kinds of kidney diseases. Healthy kidneys can keep your body regulated under a huge variation in water and salt intake.
Email questions to ToYourGoodHealth@med.cornell.edu.