Your doctor has less freedom of choice to care for you than you probably realize. Physicians are esteemed members of a cartel or guild system licensed to practice medicine. It is an elite group. You enter your doctor’s office and discuss some of your deepest, darkest health secrets with him or her. Yet, increasingly, other parties control the care you receive.
Insurers. Physicians complain that prior authorization limits or slows what treatments patients have access to. To some degree that is the prerogative of the party paying the bill. Patients willing to pay out of pocket for direct primary care have more options.
Hospitals. Doctors report that their hospital employers often require them to practice medicine in ways that increase patient’s bills. Physicians have even said the electronic medical records systems, used to document care, order therapies, and bill patients, sometimes prompt them about services their employer expects them to order under certain conditions. Say your doctor examines you for low energy and the EMR system suggests the doctor order expensive blood tests. If she decides blood tests are not necessary, she may have to justify her decision in the EMR record, which will alert her boss that she is not following the procedures. Hospitals also regulate the care allowed in their facility. An example is fecal transplants from human donors for C difficile, a hard-to-treat, often deadly intestinal infection.
State medical boards. Medical boards govern the practice of medicine. Some are more rigid than others. My wife had a doctor she loved years ago named Dr. Rose. Dr. Rose was a doctor of osteopathy, who practiced both standard (allopathic) medicine and some alternative medicine if her patients wanted it. The Texas Medical Board took exception and began investigating her about some alternative therapies she provided. A dozen years ago the Texas Medical Board tried to prevent physicians from treating patients over the phone, who they had not previously seen in person.
U.S. Food and Drug Administration. Most care is provided through drug therapy. The federal agency must approve drugs before patients have access to them. Thus, the FDA regulates which drug therapies your doctor can prescribe. The FDA also bans drug companies from communicating so-called “off label” uses for their drugs, treatments other than those for which they were approved to treat. Nearly one-quarter of prescriptions are off-label (21%), while more than half of oncology drugs are (56%) are. Yet, drugmakers are not allowed to talk about it. For example, Gabapentin is the 5th most prescribed drug in the United States. About 95% of prescriptions are for conditions other than it was approved for. The FDA wants drug makers to conduct expensive clinical trials for new indications rather than communicate what other doctors and researchers have found.
The FDA has recently turned its guns on the health & wellness clinics. A direct primary care physician in Arizona explains novel therapies which use synthetic versions of substances that occur naturally in your body, many of which decline with age. She can teach you about them on YouTube. She can discuss conditions they treat with her patients in person. She cannot prescribe them to her patients because the FDA has banned compounding pharmacies from manufacturing them. She could potentially face disciplinary action from the Arizona Medical Board if she were to provide unapproved versions for her patients. The FDA is trying to stop not just her but other doctors like her. More about FDA’s overreach on compounded peptides:
Peptide therapies like BPC-157, TB-500 (Thymosin Beta-4), CJC-1295, and other short proteins have exploded in popularity across med spas, telemedicine platforms, and wellness clinics for their touted benefits in healing, longevity, and performance. These compounds – often naturally occurring in the body – promised patients novel treatments for injuries, inflammation, and age-related issues. However, recent actions by the U.S. Food & Drug Administration (FDA) have severely restricted the compounding and prescribing of many such peptides. Providers are now grappling with whether the FDA’s crackdown is a legitimate safety measure or an overreach that undermines patient access and medical freedom.
Some of the FDA’s recent actions are understandable. Doctors were ordering weight-loss peptides from compounding pharmacies to save money on the costly patented versions. In these cases, the FDA isn’t telling your doctor not to prescribe GLP-1 drugs, just only prescribe the approved versions. Who stands to benefit from the FDA’s recent crackdown on peptide therapies? Big Pharma is likely to benefit, while consumers (patients) will be the loser.
Read more at: FDA’s Overreach on Compounded Peptides: Legal Battles and How Clinics Can Push Back