Dear Dr. Roach: Your recent column said that the “law” prohibits doctors from getting money from prescriptions. However, they get perks from pharma reps like dinner, golf, etc., and many push supplements on TV. Many “doctors” across the country make their income from prescribing supplements to patients for chronic fatigue syndrome or COVID. — D.K.

Answer: There are statutes that prevent physicians from directly profiting from prescribing certain medications. The Stark Law prevents doctors from referring their patients to entities where the physician has a financial interest. The Federal Anti-Kickback Statute prevents any remuneration (including not only cash but dinners, trips, flights on private planes, and anything else of value) for referrals or for generating business of any sort that is payable by Medicare or Medicaid. While it is possible that some physicians may be doing so illegally, the potential penalties include large fines and prison time.

However, drug companies do sponsor educational meetings, which often include free food and travel. They also pay speaker’s fees for the lecturers. By law, these payments must be disclosed, and Medicare allows the public to look up these payments by individual provider, teaching hospital or drug company (OpenPaymentsData.CMS.gov). As I believe that these meetings do have the potential for conflicts of interest, I do not participate, but many physicians do. Medical ethics guidelines do not permit accepting cash gifts.

A recent research letter in the Journal of the American Medical Assocation used the previously mentioned website to identify $1.28 billion in industry payments to physicians. The median general internist received $30 in payments, but the top 0.1% of orthopedic surgeons received an average of $4.8 million each over the 10-year duration of the study.

I also don’t agree with physicians who make an income by advertising, marketing or directly selling supplements (in office or through their website). To me, there is a clear conflict of interest in doing so. Physicians are supposed to put their patients’ interests above their own (including financial interests).