Tuesday, February 5, 2013

Beware of Doctors Bearing (Medifast) Meals!

When MDPrevent first opened in Delray Beach, Florida, I visited with many of the physicians whose practices surround us. One of those physicians was a cardiologist who expressed concerns about his expectation that we would emphasize supplements as his view of the world was that a preventive medical practice would push supplements. Of course given my disdain for such products, he had nothing to fear. Nevertheless, I was impressed at the time that he was concerned about his patients being subjected to a doctor trying to push unnecessary products on them.

So imagine my surprise when after having never heard from him again, I suddenly received a call two weeks ago.  He had heard about MDPrevent's success with running an intensive lifestyle intervention program for weight management and wanted to discuss a new undertaking in which he was getting involved.

He proceeded to explain how he had heard about the weight loss program created by Medifast and how he had found a way to not only help his patients lose weight, but also make more money for himself.  Over the course of two phone discussions, he explained how Medifast would sell his patients a '5 and 1 meal plan' that involved the patient buying five small daily meals from Medifast and preparing one on their own. Medifast would charge the patient $2 for each meal and  $10 in total for the five meals, which would be consumed every two to three hours. (Really, $2 a meal? What kind of quality food can you buy for $2??? None that I have ever seen.)

In return for peddling the product, the doctor would receive a fee of anywhere from 2 to 20% of the sales money that Medifast received from the doctor's efforts.  The doctor's efforts involved not only initiating the sale of Medifast's products, but also serving as a health coach to the patient and answering any questions about weight loss that may arise. The higher percentages would be paid for enlisting more doctors to sell products to their patients as well.

In this multi-level marketing like scheme, the more doctors a doctor signed to sell products to patients, the more money the doctor on top made, with each doctor in the pyramid at a lower level earning slightly less. If you are the only doctor selling, you only get 2%. He said that this plan had resulted in some doctors earning as much as an additional $80,000 a month in income.  I guess he thought it was impressive to throw out the potential of earning roughly an extra million dollars a year, which I suspect very few doctors if even more than one have ever achieved.

Nevertheless, I asked him a few basic questions.

My first question was is the food healthy?

His response was that studies showed that it helped people lose weight.  He couldn't answer the question if the food was fundamentally healthy or is the same processed food used by many similar programs. (Wondering myself, I launched an investigation into the ingredients used in their products.  I wish I could tell you that I was pleasantly surprised, but it would not be true. Their products were similar to many other commercially produced products that include artificial flavors, sugar, dyes, and other chemicals. I could never in good conscience recommend such products to my patients as a daily meal replacement plan. Shame on any doctor who would.)

The doctor also forwarded Medifast's propaganda package that included several studies.  Suffice it to say that in fact, many of the studies provided to support the effectiveness of the program were unpublished studies, studies published in unimpressive journals, or studies that proved little.)

My second question was how could he afford to be an unlimited health coach to a patient for $73 a year?  (I calculated that if the patient buys the $10 food for an entire year, that would generate $3650 in revenue for Medifast. The doctor's cut at 2% would be $73.)

His response was that he would hand off the coaching responsibilities to his nurses or assistants. He didn't have a good answer as to what qualified them to be health coaches under any circumstances, let alone for weight loss purposes.  Coaching is generally a skill that must be developed and it would be potentially harmful to give unlearned counsel to a patient expecting professional advice.

Finally, I asked since Medicare now pays 100% for Intensive Behavioral Therapy for Obesity, how can he charge his Medicare patients privately for weight loss coaching?

His answer was that there was no conflict as the programs could work together. Since I know he has never referred a patient to MDPrevent's program, the only known integrated primary care practice offering Intensive Behavioral Therapy for Obesity services here in South Florida and the provider of one-third of all such services in Florida in 2012, I believe he has no intention of doing so.

It is a very sad commentary that a doctor who initially impressed with his apparent ethical standards has decided to sell out to a scheme to embellish his income.  Between the doctor who recently tried to convince me of the merits of selling NuSkin's dietary supplement products to this one doing the same with Medifast's program, I can only fear for the future of the medical profession.  Doctor's are getting desperate to maintain their incomes and that forebodes poorly for patients' best interests. There is a rising tide of these get rich quick schemes that are detracting our doctors (I say "our" because I am also a health care consumer) from the basics of good patient care.

So if a doctor comes bearing processed food meals, I suggest you run as far away as possible. Actually, running may be the best part of the deal.

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