Don’t peddle products, AMA tells physicians

Practice likened to snake oil’ sales

The American Medical Association has adopted by a six-vote margin a new policy discouraging doctors from selling health-related products such as dietary supplements, skin creams, and child-safety seats in their offices for profit.

The practice is akin to the "snake oil" peddling of the 1800s, maintains former AMA President Robert E. McAfee, MD.

However, practices can distribute such products for free or at cost under the AMA’s new guidelines, adopted at a Board of Trustees session in Chicago. The new policy also says physicians should inform patients about their financial arrangement with the manufacturer or supplier.

According to the AMA, health-related products include such items as vitamins, dietary supplements, over-the-counter medications, safety devices such as child seats and bicycle helmets, skin creams, sun block, and special foods.

In-office sale of such products "presents a financial conflict of interest, risks placing undue pressure on the patient and threatens to erode patient trust and the primary obligation of physicians to serve the interests of their patients before their own,’’ according to a report by the AMA’s Council on Ethical and Judicial Affairs.

Many doctors, however, complain the policy is unfair to physicians who supply needed products or who practice in areas where such items would otherwise be unavailable.

"As I read and understand it, this policy precludes me as an orthopedic surgeon from selling a patient a pair of crutches if I’m to make even a dollar on that pair of crutches,’’ says Thomas E. Price, MD, of Roswell, GA.

In another matter, the AMA’s Board of Trust ees is considering whether the organization will lobby for the imposition of penalties and interest on health plans that refuse to reimburse provi ders for emergency on-call services. Also, the AMA is being asked to oppose mandatory universal emergency room coverage as a requisite of hospital medical staff membership.

The American College of Emergency Physi cians (ACEP) backs the measure, saying action is "urgently" needed. In turn, look for the AMA to give the measure its support. However, official AMA support will probably have to wait until the next House of Delegates interim meeting in December.

Due to a shortage of providers in some specialties, many hospitals already have a "widespread problem" filling emergency on-call rosters with the required physician specialists, says ACEP spokesman Harold Vincent, MD.

Under federal law, medical staff back-up coverage must be available via specific call rosters representing all of the services ordinarily available in each hospital. "But we just can’t get the doctors," Vincent says. "If the AMA waits until December, I’m concerned some legislative body will deal with the issue in a way that we won’t be happy with."