The physician and writer Abraham Verghese makes a good point about physician-owned medical facilities--and what it will take to get rid of them:

As a confession, in those days when we all had close and cozy relationships with pharmaceutical companies, I took honoraria, spoke at conferences in beautiful resorts and had many free lunches. Of course I told myself, that all my professors and colleagues were doing it so it had to be OK; and I actually thought I could certainly separate the free lunch from any tendency on my part to prescribe a drug produced by that company. Looking back that was naive.

What brought about change was public scrutiny. Universities became hyper aware and now of course we all treat pharma contact with great caution. My point is, until public sentiment, embarrassment and finally our good conscience kick in to tell us something is wrong, we will keep dipping into that trough.

I think legislation needs to put an end to doctors profiting on businesses to which they can funnel patients--that is business not medicine. If you try to call it medicine then it is corruption. Without legislation, it will keep happening.

I guess the question is, could this be done absent legislation? On the one hand, the cozy relationships between physicians and pharmaceutical companies changed, in part, because doctors themselves decided to change it, with grassroots movements like "No Free Lunch." On the other hand, it did take legislation--spurred, in part, by the grassroots movement--to make the change broad-based. You have to hope that some of the doctors currently profiting from physician-owned medical facilities will be shamed out of the practice of doing so. But then you read articles like this one in the NYT, about the fight these doctors are waging on the Hill to keep their golden goose, and you realize that some people are immune to embarrassment.

--Jason Zengerle