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Find Out If Your Doctor Is on the Take with Just Two Clicks

A long-time editor of a prestigious medical journal started his editorial on physicians’ conflicts of interest by describing a fantasy: “Doctors treat patients using simply the best evidence and their experience. They are not influenced by money or self-interest.”

“This is, of course, nonsense,” he wrote. There is a reason “pharmaceutical companies spend billions of dollars on the influencing, education, and entertainment of doctors around the world.”

As discussed in my video Find Out If Your Doctor Takes Drug Company Money, the vast majority of physicians in the United States take gifts from the pharmaceutical industry, and, ironically, cardiologists, whose practice centers around diseases that can largely be prevented and treated with lifestyle changes, receive the most payments of all. A previous compilation of surveys from the 1980s and 1990s found that, on average, doctors met face-to-face with drug industry representatives about once a week. Today, your family doctor may meet with drug company employees on average 16 times a month. There are only 20 workdays a month, so that’s nearly every day.

What does the public think about this? Only about half even appear to know what’s going on. Therefore, “if 83% of doctors receive gifts, it is likely that a significant percentage of patients are not aware that their personal physician receives industry gifts.” We’re not just talking about a token Viagra paperweight or soap dispenser. For marketing, pharmaceutical companies spend $15,000 per physician every year, making conflicts of interest one of the most pressing problems in American health care.

How do doctors feel about it? Most generally approve of the gifts. However, tellingly, physicians don’t want gift relationships made public. “Physicians’ disagreement that it is inappropriate to accept gifts, but their reluctance to disclose the gift relationship to the public, suggests that they must recognize that the public would not appreciate the practice.” To analyze how doctors resolve this contradiction, researchers conducted a series of physician focus groups. It turns out physicians use a variety of denials and rationalizations, including avoiding thinking about it, and denying responsibility. Physicians readily acknowledged the inherent conflict of interest, but this didn’t stop them. In fact, some complained that the gifts were getting more modest.

“We [doctors] tend to deny that we have any conflict of interest if a pharmaceutical company buys us a nice dinner. We tend to insist that it won’t affect our judgement in any way”—as if drug companies just like wasting money for the heck of it. Most physicians contend that their colleagues are susceptible to industry influence…but not them.

Though physicians don’t want these gift relationships to be public, that’s just too bad. Thanks to Republican Senator Chuck Grassley, the Sunshine Act was inserted into Obamacare. “For the first time, patients will now be able to see what, if any, financial ties their own doctor has with a drug or device maker.”

Doctors can’t hide anymore.

The Sunshine Act was designed to give patients some insights when choosing a provider, and law enforcement agencies can also use it to see who’s getting money from industry to investigate illegal kickback schemes. Right now, it might just be embarrassing, but this could allow attorneys general to go after doctors to see the kinds of incentives they may be getting for writing a lot of prescriptions. The database is live right now at openpaymentsdata.cms.gov/search/physicians or, for a more user-friendly version, Propublica’s Dollars for Docs page. The drug industry spends billions trying to influence doctors, and, for the first time, you can see if your physician, or any physician, has their hand out.

Senator Grassley hoped this would help save our nation money. It could reduce healthcare costs if patients viewed such doctors as less trustworthy and chose doctors less in bed with industry. It could also change physician behavior: Physicians may want to avoid financial relationships with companies to guard against patient distrust or becoming the target of an exposé or investigation.

Or they could just try to cover it up.

The American Academy of Family Physicians advised physicians how to “avoid getting burned” by the Sunshine Act. For example, drug companies now have to report when they give doctors free meals valued over $10. So, should family physicians just stop accepting free food from drug companies? No way! You just have to give the drug sales reps the right head count to ensure that the meal cost dips below $10 per person.

The former long-time editor of the New England Journal of Medicine said it best: “Although the spotlight has been on the failure to disclose (or adequately disclose) financial relationships with industry, the problem with [conflicts of interest] is not the lack of disclosure but the existence of the conflict itself.” Rather than just disclosing them, the best approach to financial conflicts is to have none.


No wonder physicians undervalue lifestyle interventions! See The Actual Benefit of Diet vs. Drugs and Why Prevention Is Worth a Ton of Cure. Inundated by Big Pharma without so much as a free mug from Big Broccoli, Physicians May Be Missing Their Most Important Tool. And, even worse, sometimes the drugs can do more harm than good. See my video on How Doctors Responded to Being Named a Leading Killer.

Financial arrangements can affect prescribing behavior for more than just drugs. See my video Should We All Get Colonoscopies Starting at Age 50?.

PS: I have never knowingly accepted gifts from the pharmaceutical industry, but “knowingly” is an important caveat. If you search for my name in the Dollars for Docs database you’ll see I apparently accepted money from a vision care company five years ago. I was giving a continuing medical education lecture at an optometric physicians conference and unbeknownst to me they had the corporation pay for my travel and lodging.

In health,
Michael Greger, M.D.

PPS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

 

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


84 responses to “Find Out If Your Doctor Is on the Take with Just Two Clicks

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  1. I knew that the doctors were getting sample drugs, but hearing that they are meeting with them 16 times per month, per doctor.

    That is a significant relationship.

    I remember that my grandmothers doctor would hand out free samples to her, but when she transitioned to having to pay, the drugs would be so expensive and they wouldn’t be covered.

    She would get a letter saying we are rejecting coverage of this dementia patch and the pills they wanted her to take made her worse, so I took her off of everything and she wasn’t that bad, but she had liked that one patch made her feel more awake, but it would have cost her whole social security to use it.

  2. The fact that you are so against the gifts ams made the list without you knowing that you received a gift, it might be a good idea to be nice to your doctor and talk with them instead of accusing them.

    I suspect though that my grandmother’s doctor having free pills to hand out as samples to his poor fixed income patients might be one motivation as to why some doctors do it.

    Let’s face it, 16 free meals with a salesman is half gift and half torture. The free pill samples are why I might go if I were a doctor.

    My grandmothers social security was $8000 per year. She died two years ago, but many elderly people really are living in poverty and $8000 per year was barely enough to pay for food and taxes and utilities, so the doctor gave a lot of free meds over the years.

    1. Medicare is not allowed to competitively bid pharma prices by law.

      Likely if there were… many prices elderly pay would be significantly lower.
      The industry is responsible for this disallowance through lobbying effect upon politicians .

  3. Wow that was an eye ooener and as you indicated my cardiologist received some whopping payments. Could there be any justifiable reason to excuse this?

    1. I saw a couple of things and I’m not _too_ worried. I mean.. “Hi, Doctor so-and-so, I see you were interested in our new valve assist device. We’re doing a conference out in This and That valley by the mountains this weekend, why don’t you come on out and enjoy the surroundings on us, find out more about it, and get the opinions of other doctors there?” Yes, it’s nice to know when this happens for certain drugs and devices if they have been pushed on you, but in general it’s probably just regular sales tactics. That is, unless your doctor receives gifts from the same company regularly.. then, I’d get suspicious. So, I’m glad there is now some transparency and THANKS Dr. Greger for the web site links. But, we’re citizens of the modern economy, with products pushed on us every day, with sales here and there, zero down loans offered, etc. The naive of us are influenced by it, but wise consumers know that even with a hot commodity in hand, you’ll want to first shop around and do your research. Doctors know that, too, right? hope so.

  4. Physicians, heal thyselves! What a disgusting mess, although Deb makes a good point above about freebie meds. Doctors who accept stuff for that reason may or may not be in the minority, though.

  5. The money isn’t the biggest issue. These people often become friends and lend a sympathetic ear. Worth much more than money.

    Even worse, have you seen the typical pharma rep. Most look like fashion models or near pro athletes. Often wining and dining doctors twice their age, stroking their egos. I know, I dated one and have worked at several pharma companies.

    No chance that will influence what is at their top of mind.

  6. It may be worst than that. Many hospitals are publicly traded (stock). For example, a traded company may own 160 hospitals. This means that hospitals represent investors. Which means that the top goal is to pipe money. Meetings are about money and pushing new levels. Now, take a sky high picture of the ‘design’ of healthcare. It looks just like a bacteria growth in a dish because its purpose is to grow. Is there a problem if your health becomes the income of anonymous investors?

    1. True actually.”Which means that the top goal is to pipe money. Meetings are about money and pushing new levels.

      I have invested in such companies and found it moderately unnerving in a written report on the investment prognosis a bad flu season being directly equated to more profits.
      The new federal administration due to hits on Obamacare however has entirely devalued this sector. They all are a fraction of value of what they once were.
      Obamacare did provide for a relatively guaranteed revenue stream to hospitals when in the past that did not exist. Companies appreciated as to what state they operated in and expected impact on that state.
      None of these hospital companies, about five are active nationally, are really investable anymore.

  7. Big Pharma and the American Medical Association are currently the two greatest killers on Americans, except for natural death itself.

  8. The two greatest killers OF Americans, not ON Americans. Poor diet is what brings people into the Dr’s office usually, so include Agri-Business into the mix.

    1. I disagree. Experience in other countries suggests that government intervention actually brings costs down. The US has the highest expenditure on health in the world, the most bankruptcies caused by medical costs (I believe) and one of the poorest health outcomes among all developed countries.

      The problem in the US appears to me – an outsider – to be too little government intervention. Hospitals, pharmaceutical companies, medcal device suppliers and doctors themselves are much freer to charge what they want In other countries, governments can negotiate with hospitals, drug companies and doctiors to get the best prices and the best services for their citizens. Governments at all levels in the US are less able to do that.

      That’s one reason why doctors’ associations, hospital groups and drug companies rail agaiinst more government involvement. It’s likely to curtail their profits. They also spout the same propganda about HMOs because they too act as a brake on overservicing, overprescribing and overcharging by suppliers of medical services and supplies.

      1. This is why I do not encourage people to go into medicine! Thinking doctors make too much and HMO’s are good, shows lack of understanding. Our reimbursement from insurance companies and the Govt plans have not even kept up with inflation. Insurance companies stuck money out of the health care system and contribute nothing. HMO’s stifle and delay healthcare. I have had to get permisssion from an insurance company to get tests that I know the patient needs and even to go to their oncologist for their final treatment when the previous treatments have been approved. I have someone on the phone everyday trying to get approval for a test, a referral, or a generic drug that the patient has been on for years with good results. Healthcare in America is a mess!

        1. Yes, Dr Stedman, but doctors in othet countries also complain that reimbursements have not kept up with inflation….. and everybody everywhere complains that their salaries/pensions etc have not kept up with inflation. These probles are not unique to US physicians or even to physicians in general.

          And yes, HMOs etc do have checks and balances on tests, drugs and procedures. Isn’t that a good thing overall given the reports we see about doctors overprescribing eg opioids, or prescribing brand name drigs intead of generics, or ordering too many tests?
          https://www.usatoday.com/story/opinion/2017/08/04/doctors-stop-opioid-crisis-quit-overprescribing-marty-makary-column/504860001/
          https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2557061?redirect=true
          http://time.com/3754900/doctors-unnecessary-tests/

          It is however a bureaucratic pain in the backside and an increase in your costs to meet HMO etc requirements. I can imagine how irritating it is. But you and your patients still have the option of going compleletely private and nixing HMOs completely. But presumably you don’t because overall it benefits your patients and you.

          As for avoiding medicine as a profession, i think you’ll find that every othet profession has its own bureaucratic nightmares, problems and inconveniences.

          Medicine also has a couple of strong advantages – it is possible to make large amounts of money by practising medicine. And as long as you are prepared to travel and meet local registration requirements, a doctor is never going to be unemployed except by choice. That security of employment is in itself worth a small fortune.- at least in my opinion – when you consider how pervasive unemployment and job insecurity are, and how risky business start-ups are..

          And I think many people would feel that an average compensation of $217k per year for a primary care physicina is an adequate recompense for having to deal with HMOs.
          https://www.medscape.com/slideshow/compensation-2017-overview-6008547#2

          healthcare in America may be in a mess as you say but giving physicians free rein to prescribe what they like, charge what they like and order tests and procedures without let or hindrance wouldn’t necessarily improve matters. Most physicians may be highly competent, highly caring and highly ethical but a minority is not.

      2. There is truth to this..”Experience in other countries suggests that government intervention actually brings costs down.

        Judging by several facts such as amounts of prescribed meds and the inability of the military to secure even minimally fit individuals for service(they continually are degrading their standards)….
        Americans are in very very poor health.
        Of course they pay more per capita for health care….they are much more ill.

        Costs decline by scale so yes that infers governmental involvement which covers all populations in a place would decline costs.
        But will American even that considered be equal in costs overall for health care per capita basis…..due to poor diet lack of exercise and other negatives….I do not think so.

        If government involvement considered preventative actions such as improvements to diet and exercise and lifestyle as part that would probably prove out. But what is to say concerted interests like the food industry would allow that inclusion in any federal health care plan…nothing is to presume that would be allowed.

        Lots of jobs on the line making and selling those greezy burgers. More media to watch and things to be sold on it….leaving a thing of exercise a thing not greatly endeavored.

    2. government intervention is the reason why healthcare is so bad/expensive in the first place

      Prove it..study statistical basis anything…show it,,,

  9. Dr. Gregor: Can you state categorically that you receive NO money from interested parties except individual contributions from folks who have no significant financial interest in plant-based agriculture? As a vegan and migraineur I simply found plant-based hurt me more than helped, although ethically appealing. If you have already clarified your response to this question, please excuse my repetition.

  10. Finance affects every, every, every thing.

    I say that, because I listened to a woman years ago, who was wealthy from abortion clinics and she said that they went to the schools and handed out condoms and knew that they would have more business within a few months.

    She said that they would intentionally put down the parents as “naïve” and point to them using “nicknames” instead of the true names of bodily parts and things like that to separate them from the influence of their parents and she told them that everybody does it and that it is natural and she admitted that inwardly it was a sophisticated “fishing” to get young people to become sexual, knowing that eventually, they wouldn’t have condoms or would forget to take a pill and they would get a customer. It was an eye-opening interview in many ways. Mostly, it was about having health things become money generating concepts.

    Going was also a way of advertising and handing out cards and they would offer rides and other things, but in her own conscience, she said that she was a business person trying to be successful and didn’t admit it until she couldn’t handle her guilt about it anymore.

    1. What I remember is that I was someone who was handed a condom by one of those speakers in high school and three of my friends had abortions and none of them ever got over it.

      I have a friend who is ten years older than I am and she still feels like a murderer.

      I am not saying this as a political thing. I am saying that doctors probably all do the same “fishing” and some may be just like that woman – who went so far into salesperson mode that she lost her sense of that she could destroy people.

      1. The reality of my friends aside, what I remember was that there was a type of adult on young person peer pressure, which I felt getting the condom and I didn’t like it.

        Mine never got used, because I was rebellious enough to not want to be manipulated by anyone in any direction, but I do think I did a mental math process for a few weeks, before throwing it out.

  11. You know Dr Greger, this article makes me very sad. I am a great fan of yours and follow you closely. I am also a physician and your comment about the vast majority of us taking money from the drug companies really hit me hard. I personally do not know any physician who takes money from drug companies, there is a lot of doctors in my family and I have a lot of friends. I work very hard to treat my patients the best I can, always thinking about what is on their best interest and you are right those insurance companies are very pesky. I get drug reps in my office every day and I hate that. However I do like the fact that they bring me samples to give to my patients in need and that is why I allow them. You are right they offer to bring food but I could care less about their food. As a matter of fact they know they cannot please me with that because of my whole food, plant based diet. And do we really think that a doctor cannot afford a 10 dollar lunch? Also I do not know if you ever practiced medicine but for many years physicians have not been allowed to get gifts, not even pens, let alone dinners or any kind of trips, its the law. And believe me most of us are happy about that. There is nothing more annoying than a drug rep who thinks you owe him something. However it makes me laugh every time I think about how our politicians who have the well being of millions of people at hand are able to get all kinds of financial gifts from lobbies. I know our medical system is biased. I completely agree with you about the medical system being driven by financial forces but please do not make doctors look like crooks. Most of us are actually honest people that are looking to help others. Maybe our educational system has not led us the right way by focusing on treatments and not prevention but making the doctors the bad guys doesn’t help anyone. With all due respect.

    1. Thank you, I was thinking this article might be offensive to some. I enjoyed the respectful way you handled your response. I just discovered that my Dr took 68 dollars from 2013 to 2016 so I realize whether a Dr knows it or not they receive some sort of kick back along the way. My Dr helped me to go from prediabetic to being free of it by encouraging me to continue with my wfpb diet and exercise regimen.

    2. There is a systemic bias to this thing…
      This was evidenced clearly with the AMA and their response to tobacco years ago… a quote….

      After three decades, the AMA finally admits smoking is harmful
      After the 1964 Surgeon General’s landmark report on the dangers of cigarettes, the CTR stepped up its work, providing materials to defend the tobacco industry against litigation. The same year — three decades after medical research demonstrated the dangers of cigarettes — the American Medical Association finally issued statement on smoking, calling it “a serious health hazard.” It was not until 1998 that the CTR was shut down — and only after the tobacco industry lost a major court case brought forward by states across the country.

      Allan M. Brandt, a medical historian at Harvard, writes about the role that medical research played on both sides of the smoking debate in his new book, The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America. After reviewing research, court transcripts and previously restricted memoranda from tobacco companies, Brandt summed up the misleading nature of “expert” medical testimony in tobacco litigation: “I was appalled by what the tobacco expert witnesses had written. By asking narrow questions and responding to them with narrow research, they provided precisely the cover the industry sought.”

      Who does the AMA represent…docs by my read. They are a collective agency whose responsibility is in the main to represent those who practice not those who receive treatment and care.
      So who should we trust in things…..personal comment or a proven track record of special interest favorance?

      Sort of as if we were to say the NRA does not represent by majority the industry…..well yes there are exceptions but largly they do represent the gun industry. Not that all in it are dim and corrupt but by majority that is the fact. The AMA their track record is not as bad as the gun industry but nevertheless it is less than stellar.

      Good docs exist but bad ones as well. Income drives peoples and interventional treatment rather than lifestyle choice is after all the income of most docs.

      My father in law following a AMI in the hospital was given meds a medical treatment and a 5 page cartoon book on improving diet……in English when he read no English.

      Per proportion how much revenue was involved with producing the cartoon book and how much was retrieved from the procedure…?
      The system favors corruption of the docs…..more consultation with patients is frowned upon and a negative in performance review..less patient contacts results. Docs are judged by contacts not consultations or patient interview.
      The UK provides for payment to docs of nontreated healthy patients..our system does not favor that.

      The nicest people in the world still have to make a living.

      1. And a bit more recently….the AMA on chiropractic care.. tried to remove a competitor it seems….
        On September 25, 1987, Getzendanner issued her opinion that the AMA had violated Section 1, but not 2, of the Sherman Act, and that it had engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession.” (Wilk v. American Medical Ass’n, 671 F. Supp. 1465, N.D. Ill. 1987). She further stated that the “AMA had entered into a long history of illegal behavior”. And, she then issued a permanent injunction against the AMA under Section 16 of the Clayton Act to prevent such future behavior.: from Wikipedia.

        To the extend of appealing this all the way to the supreme court…not once not twice but three yes three times…

        Seems the AMA represents the political arm of docs…….the claim then is they do not?
        Nice to hear all these reports of good docs and all but if the AMA was not representing their interests…would they exist?
        Seems they would and this what they do..protect their interests sometimes to the detriment of public health outcome.

  12. Dr. G, This is a little over the top! I immediately looked myself up and low and behold, I have received a total of $533.00 over the three years listed in the form of meals brought in for myself and my staff from around a dozen companies. If they want to have my time for me to listen about their drug, then they have to schedule a lunch, which includes my staff. I looked down the list of drugs for which the lunches are bought and I use 2 of them occasionally ( not ever as my first choice) when I can’t convince my patients to go on a plant based diet, which you know is most of the time (at least down here in central Texas). I am all about plant based diets, but to villianize doctors is inappropriate. There are those that do get larger payments usually in the form of speaking fees or grants, but I would say that they are the minority. The problem is in the education system as you well know. Drug companies fund the education and so doctors are taught to put out the fires instead of turn off the gas. Just like with antibiotics, most bronchitis and sinusitis is viral (like 90%), but doctors are continuously over prescribing antibiotics. I have even had patients call the “nurse hotline” from their insurance companies and be prescribed antibiotics over the phone without the patient being seen. Why don’t you recommend that patients look up their doc when they are prescribed a drug instead of implying that we are all a bunch of thieves. Maybe just change the tone of it a little.

    1. I am not a doc of course by any means. but I was a professional in my field of expertise..
      I ask why is this number not this…”I have received a total of $533.00 over the three years listed in the form of meals brought in for myself and my staff from around a dozen companies.

      but zero.
      In my field of study I would be completely considered corrupted if I admitted even one penny by sponsorship interest.
      And it is admitted and assumed to be not a thing at all……says a lot that.

    2. Horis,

      Thank you for sharing about why doctors take lunches, because the only time they have free is lunch and that the staff have to eat, too.

      I would not be worried over $553 necessarily, it is more the relationship, in that case.

      There are people on the list in the link who have millions of dollars by their names.

      There might be a reason for that, too, but certainly it is right to ask and I agree that the sentence, “Is on the take” is an aggressive way to word it.

      The reality of “death by doctor” related to over-diagnosing and over-prescribing does need to be addressed, but I genuinely appreciate when people handle things respectfully in conversations and doctors are people, too.

      I ponder the whole “influence” thing. I have some friends who sell essential oils and being in proximity with them and liking them and wanting them to be happy, I have ended up buying essential oils, even though I don’t use them. Having charismatic, supportive people, who we really like, can affect our behaviors.

      I remember years ago, when I worked in California, there was a woman who worked at an insurance company, who my company dealt with, and people would talk about not wanting to let her down.

      Public radio has a commercial about not accepting lunches, because today’s lunch could be tomorrow’s story.

      I don’t know if there is a profession that exists that is free from “influence” affecting how people do their jobs.

      I have talked to police officers, and there is still a “code” where if their relatives get pulled over, they mention the name and don’t get a ticket and it is not a hidden thing. I have been to gatherings where it is being discussed. (And I have had multiple relatives who are police officers and they were not the ones who discussed it and I got a ticket once, when I was trying to figure out how to adjust the air conditioning on my new car and was on a very straight road with a very low posted speed limit.) I didn’t say it, but I like that my relatives never discussed it, but I probably also would have liked not getting a ticket, but would have been too humiliated to “drop a name” at a moment like that.

      But the gatherings where people were doing that, none of them were ashamed of it. I am the one who would have been ashamed.

  13. Perhaps the doctors on here who are upset with the tone of this article should think seriously about how they can influence their fellow doctors, and the medical associations that represent doctors, to stop allowing (and defending) these unethical influences.

    One has to ask: Why does any doctor ever need a medical rep to educate them about medication or treatment options? How can it possibly be “good medicine” to have a person who is employed as a sales person, with presumably precious little medical training, who is paid on commission, “educating” medical professionals (who have spent at least 7 years being trained as doctors) and who should be attending continuous education conferences/events to maintain their professional abilities? Or do you believe that reps are less biased and better informed than say the NEJM or JAMA?

    Doctors, ask yourself this: If you were getting your car repaired, and found out that your mechanic had just had his lunch paid for by a particular spare parts provider, would you be more or less inclined to trust his opinion that you needed to get X part replaced, to be provided by that same parts supplier? How do you expect your patients to trust you if you are not taking the time to educate yourself adequately and keep up to date with your professional standards, but instead rely on pharmaceutical reps to bring you up to speed?

    Free samples that you can give to your financially disadvantaged patients don’t sway your opinion about prescribing that particular drug? Really? And if you are able to convince yourself that you are personally above this, do you really believe your fellow physicians share your superhuman incorruptibility? Look up the “halo effect” – doing good in one area of your practice does not excuse even the possibility of corruption in another.

  14. This is a completely biased argument filled with miss leading facts. You should be ashamed for making statements and bashing an industry that does so much good for patients. Sure there are some bad players but this is true in any industry.

    To correct your lies. Pharma companies can’t give gifts out. Period. It is the most regulated industry around. A sales professional can not give even a pen to doctor or staff member. They are prohibited from taking doctors out to dinner. They can provide a reasonably acceptable lunch to a doctor or it’s staff as long as a conversation or presentation is centered around educational content. If pharma companies violate these rules they get fined 100’s of millions of dollars. The government loves going after companies with big pockets. Additionally, because this industy is the most regulated industry the sunshine act mandates that all pharma companies report on any costs that would apply to an HCP. So yes, if you had your travel paid for to go speak who do you think paid for that? The event? No it’s the sponsors of the event and if pharma is a sponsor then they paid for it and are obligated to report it. You should do some research on how the event planning business works. Lastly, Some of those large “gifts” as this article states are to pay the doctors for conducting clinical trials. This is a required mandated reportable expense under sunshine. There is extensive amount of work, time to enroll patients, track and report on them over 1 year or however long the trial is being studied. Should the pharma industry not do clinical trials anymore? Should they not pay a MD for there time to conduct the trial? Give me a break.

    Pharma job is to discover medicine and yes it is a business, there is no business is studying lifestyle or eating habits so go attack an other organization or the government to conduct a clinical trial that would meet the same standards the FDA requires for new drug to prove your theories.

    I was a follower of this site and enjoy eating whole food plant based but now I have to unsubscribe since you have taken such a partisan view on this topic.

    1. Rob James,
      I agree with much that you say about Big Pharma, but they are raping Americans! You can buy the same medications in Canada, Great Britain and many other countries for half the price or less from the same manufacturers here in the US, because the other Governments won’t let them rape their citizens. Another example is generic drugs. Erythromycin which has been out for over 50 years, is over $100 for a course of therapy. Doxycycline was about$30 for a course then went up to $300 for several years and has finally come back down. Steroid inhalers for asthmatics, that have been out for years, are between 2-300 dollars for a month so someone can breathe. They are not a Lilly white industry.
      H

    2. From Med cert….
      “- Nearly 70% of Americans are on at least one prescription drug, over half of Americans take two prescription drugs, and 20% of Americans are on at least five prescription drugs – Mayo Clinic

      – For every $1 pharmaceutical companies spend on R&D for a new drug, they spend $19 on advertising that drug – BMJ

      – 51% of drugs prescribed to Americans are generics, but they only make up 8% of the country’s total amount spent on drugs. The other 49% are the drugs with exclusive marketing rights, which makes up 92% of the total drug spending – IVN

      – The percent markup of the prescription drug Xanax is approximately 570,000%. That means that the consumer cost per 100 tablets is roughly $137.79, while the cost of the active ingredients is $0.024 – LiveStrong

      – In 2013, the total amount spent on drugs topped $329.2 billion. That’s roughly $1,000 per person – Last Week Tonight

      – In the United States, the cost of prescription drugs rises 12% every year – Weedist

      – In 2012, of the 12 new-to-market drugs approved by the FDA, 11 of them were priced above $100,000 per-patient per-year – Alternet

      – The worldwide pharmaceutical market revenue in 2013 was $980 billion, almost twice as much as it was only 10 years before ($498 billion in 2003) – Statista

      – Over 70 million Americans take mind-altering drugs – WND

      – 1 in 4 senior citizens skip doses of their prescribed medications in an attempt to reduce the amount of money they have spend on drugs – Business2Community

      Transparency has been enhanced due to the influence of Obamacare. The industry does not voluntarily endorse transparency nor governmental restriction on gifts….they actively lobby against both.
      Usually around 30 percent of americans agree big pharma is not a problem in the US.

      1. Ron,

        The statistics is what this is about and you have shared some powerful ones.

        I add the deaths from doctors, which is covered in the is it worth it getting an annual health check-up.

        I understand if some doctors get upset by how this is worded, but people who hear that they are dying faster by getting over-diagnosed and over-treated are frustrated too and there already has been voices saying to “fire your doctor” and I prefer, conversational conversations, but I already fired whole hospitals, because they were trying to force meds on my relatives and said, “We won’t listen to you or her” about my grandmother.

        https://nutritionfacts.org/video/is-it-worth-getting-annual-health-check-ups/
        https://nutritionfacts.org/video/is-it-worth-getting-an-annual-physical-exam/

        Not to mention the various cancer series, like the Mammograms and Prostate Cancer drugs.

        I do understand you unsubscribing, and I agree that Dr. Greger could have been nicer in how he communicates, but so could you.

        This issue is so big and the conversation needs to happen and the money needs to be shown and the influence needs to be exposed.

        I am not even sure if there isn’t a whole bunch of organized crime involved somewhere.

        There is in politics and everything with big money tends to be political.

        1. Even more than the “death by doctor” is the reality that doctors don’t give the solutions.

          I have a friend whose relative just had a stroke, 10 years after another stroke and 20 years after a heart attack.

          He had never heard of Dr. Ornish or Dr. Essylsteine.

          All these years later, I am the one giving their answers.

          That part is what frustrates me more than anything.

  15. Rob James,
    I am upset at this as well, but I won’t leave the site because there is more good than bad. Dr. G, I think it is time for you to pipe in!

    1. Horis, he already did “pipe in.”

      “PS: I have never knowingly accepted gifts from the pharmaceutical industry, but “knowingly” is an important caveat. If you search for my name in the Dollars for Docs database you’ll see I apparently accepted money from a vision care company five years ago. I was giving a continuing medical education lecture at an optometric physicians conference and unbeknownst to me they had the corporation pay for my travel and lodging.”

    2. Dr. Stedman.

      Thank you for being a peacemaker.

      I do not know what Dr. G would say about it if he did say something again.

      I know that he is emotional about this issue.

      I don’t know that it has to be as dramatic.

      Some people will have to talk with their specialists about their meds.

      In my state, I didn’t see as many doctors as hospitals getting money.

      Looking at the list, I pondered the people making 5 million.

      That would cause me to have a very long conversation.

      Lunch with staff doesn’t upset me so much.

      Doctors pushing meds does upset me.

      Drug companies also being the one selling supplements also upsets me.

      1. Reminds me of one of my early indicators of perhaps self serving interests in the medical community…this quote from that article..”She also calls attention to the results achieved in Cuba from the national emphasis on providing community health workers, which was instituted by the Castro regime in the second part of the last century. Regardless of the many seriously negative results of that regime, the national health care system has been a remarkable success, such that both infant mortality and life expectancy in Cuba are now superior to those health indices in most of the rest of Latin America, and nearly on a par with those in the US

        Castro initiated that as in excess of 60 percent of docs had left the country with the revolution.

        I always wondered on that…yes they may certainly not have wanted to live under communism but…..would they not have better served their peoples by staying enduring that and continuing with caring for them???

        They left…. Castro was forced to provide a new system which provided docs without the normal obstacles to training…he had no choice really.

        1. I completely fail to see why organizations such as the AMA who proport to care for the health of patients first always…has never taken one step to stop the completely absurd working conditions of those interning for a medical doctorate.

          How their treatments can be valid suffering hours upon hours of no sleep and what supposed aim that could have in their training..is completely beyond me.
          But it continues and has for years upon years with the AMA and the industry without a peep in concern for the most part.

          A barrier for single moms and such and at times with those with limited incomes and families from consideration of that profession.
          I know many a physician assistant/RN who would have made great docs without the artificial barriers such as that and gross additional other costs added into the equation.
          Favoring then a certain class and type for entrance into the field at this level.

    1. Important point aside the topic a bit.

      I was prescribed years ago in treatment for pneumonia a antibiotic.
      Till I checked the facts of the antibiotic I did not know it had significant chance of impaction on connective tissues with muscles and joints, a common side effect.

      As my hobby at that time and day was powerlifting training…..I supposed this may have a major impact upon me. And conducted myself and expectations accordingly.
      But did any doc or other mention this to me….not at all. One personal experience I know,but really in todays day and time docs and others,just do not have the time to do complete patient interviews.
      With the time and opportunity probably a thing like that would have been mentioned.

      The system essentially prevents that.

      1. My personal doc at that time was a incompetent F&^%wad..

        My HMO required me pretty much to stay with him as so few were available that were accepting patients and were remotely close to my home.

        Aside the topic completely that. Nice guy he was just incompetent. Training does not assure competency in any field.

        1. My situation was already a proven..but to bad two clicks could not tell you if your personal doc was fairly resembling a idiot…:)

      2. All medications have side effects that may occur rarely. It’s a risk/benefit world in medicine. With the internet and easy access to information, it’s hard not to blame the patient when they don’t research their own medication.

          1. I know so many people who can’t afford internet in any form.

            I don’t have it at my house.

            On top of that, people don’t know which information on the internet is credible and people also don’t have enough understanding of the human body or statistics or risk factors or science to understand what things mean.

            I have been doing biology videos aimed at young people and honestly, a lot of what is presented is information, which they discovered after I grew up.

            There are still so many things they don’t understand.

            Most people get their information from television in this country.

            People spend an average of 5 hours per day watching television or something like that. That means they come home from work or school and spend 5 hours 7 days per week and those programs and ads have “spun” so much of the information that I am the only one in my whole social network who knows any of the things, because of this website.

            My friends have never heard about WFPB and they don’t know Dr. Ornish or Dr. Greger. They don’t know about the dangers of medications. Those are fine print things and some of us can’t read the fine print half of the time, because some of it is so small.

            I could use supplements as an example. SEARCHING full-time, I didn’t find the whole information in one place or 100 places. Dr. Axe says this. Dr. Oz says that. Dr. Mercola says another thing.

            My cousin is on so many meds and he told me that every single physician he has had disagrees on everything. There are so many voices pointing him in opposite directions about every topic. He has a complicated health condition with diabetes and needing dialysis and recovering from stroke and having skin conditions and he is a smoker, but not one of them have told him to try WFPB and not one of them has talked to him about cutting back on animal proteins.

      3. My cousin had the same type of product. It wasted away at his leg. He wasn’t told about it either.

        He just had another experience where he wasn’t pre-told the effects of something else, related to his eye surgery.

        He ended up having such problems and the doctor explained it on the wrong side of the procedure.

        I am sure that some of it has to do with the number of patients someone has.

        When I searched for a primary care for my grandmother, many, many of them either weren’t taking patients or they were telling me that they had no openings until November and it was the first week of July. Pain clinics and specialists were saying the same things back then.

        She was on Medicare and still wouldn’t have been taken by many of the remaining doctors if she didn’t have secondary insurance.

        It was so hard to find a primary care doctor and we needed one where we could get her to it with dial a ride and they only do one or two towns from where you live.

        The doctor she had left practice and he was actually amazing as a family practitioner. He was so good at talking everything through and would change any med if it was too expensive and would give samples to his fixed income people. He would discuss things in way where he would discuss the complexities. He listened carefully and didn’t overprescribe anything. He had other flaws, which is why he isn’t a doctor anymore is all I am going to say.

        By the end of her life, she was taking Lasix every other day and that was pretty much it.

        I never even put her on Morphine, because the relatives I saw go on it had such horrifying hallucinations and they all said that they hated it and begged to not have it.

  16. As a physician, I listen to the reps talk about their products and often food is available. Trust me, a sandwich does not persuade a doctor to use their product. Now if you are seeing 10,000 or more going their way, it may be a different story.

  17. My neurologist receives a dispproportionate amount if money from myoblock which makes sense why he keeps pushing. I insist on Dysport bc it works for my muscle spasms. He has said tgat if i get swallowing issues from dysport I will need to switch. So i have sone swallowing issues that i dont share with my doctor. I am currently seeking out another Dr. I have an hmo so it has been a long process to switching drs. I refuse to take myobloc bc the dysport works and i have heard alot if people in my dystonia support say that myobloc causes other problems. I have found that nowadays at least at my hmo algorithms r used to treat patients. In order to get decent care I spend a lot of time doing my own research. I feel like going to the dr is like buying car. Buyer beware. Drs are more like sleazy car salespeople. It is not the same as ur old honetown doctor. Its a business. It should be called health sales instead of care.

    1. My friend has had the same experience. She wanted to try a different med, which was cheaper and which her friend had used and had success with, but her doctor wouldn’t switch.

      Not sure whether they are bribed or even charmed or “spun” by the other company.

      I will say that my friends selling essential oils have already started, “spinning” about their product being better than every other product. I don’t mind, but I know that is a “sales pitch” which the people training them are teaching them.

      I know people who sold Amway where all of them went into the same “persuasion” pitch. Same language. Same entire process. It was like they became “Stepford salesmen” for it.

      I don’t know the answer to that as a problem, except doing every dietary change possible and see if somehow WFPB can help you get off your meds entirely. Not sure if it would work, but it is what is worth trying.

    2. As Dr Stedman writes, not all docs are the same.

      However, Dr Greger is not the only MD to discuss possible conflicts of interest in the treatment recommendations made by mediacl professionals. For example, see this article on WebMD by Dr Lundberg
      https://www.medscape.com/viewarticle/884009

      However, how true or how prevalent these practices are is not clear since no hardc data is presented.

      Nevertheless, it adds to the argument that we should all be hard-nosed purchasers of medical services. The problem is of course that with doctors, las with car mechanics, financial advisers and plumbers, the knowledge differential between seller and buyer is so great that we very often rely completely on the expertise and integrity of those professionals. That is why it is so confronting when we see charges of cynical exploitation of customers (patients) by these professionals.

      1. Tom,

        I appreciate your links and insights.

        Yes, not all doctors are the same.

        That being said, there is an American culture and world trends and there are the statistics on all of the subjects, which the researchers have been exposing..

        One reality of our culture is money and power and politics and disinformation and confusion left and right and center.

        Look at all the lies and “spins” in our political culture from every side. That same culture is also in the medical communities. When Dr. Greger posted the mammograms series, the number of women who had their breasts cut off unnecessarily was appalling.

        We can’t trust television for our news. We can’t trust our politicians or our police officers or doctors or supplements. Look at SNOPES to see how much disinformation is on the internet.

        People are regularly ruthless and deceptive and competitive practices.

        That is our modern culture and it is so hard to keep up with any of it, because we also are in a too much information constantly bombarding people culture. We label people ADHD, but I am going to label the culture ADHD.

        Watching the food commercials in “Eating You Alive” they all are what my mother who died of Cancer was looking at and she didn’t know back then how much the commercials and news people were lying about all of it. There is almost no way to keep up. It isn’t the patients fault.

        If people want to keep up with the news and the changes in technology and the changes in medicine and whether their aloe product has aloe and maybe also raise their kids to be away from wifi and cell phones and not have their heads in the computer or on television all of the time, they will fail at something. I have been watching this now, but may someday feel like I have gained enough insight and maybe put focus on some other topic, and go away and maybe miss that my oatmeal has something toxic in it or something like that.

        I have had to look at 50 sites to even figure out whether I can buy nontoxic plates and I decided to go with Fiesta ware, because someone gave a few plates, which aren’t toxic, but my other friend said, “You have to research the glazes” because they used to be radioactive and I still haven’t found a website saying whether their glaze has been tested free from lead or cadmium, etc.

        That one process of finding glasses and plates and figuring out whether all plastics which used to have BPA are still dangerous is so time-consuming that you could do this all day long and not have a life and that is our modern culture, too.

        I will use “The Art of the Deal” and, no, I am not a political person and am not bashing the president. I am a Christian and pray for whoever gets elected.

  18. And I go back up to the point where Dr. Greger sometimes may make mistakes, too.

    He may not consider every argument from every side.

    Name one person in the universe who ever has been perfect at anything.

    God is my only answer, and I know a lot of WFPB don’t believe in God.

    I do believe in God and, aside from God, I don’t believe in perfect as a concept.

    And I am not upset that people will take a stance and care so much about a topic that they will unsubscribe to Dr. Greger. That has to be such an important belief system for them for them to unsubscribe for that. There has to be a wound there maybe or pride.

    Dr. Greger has to be so passionate about that issue that he presents that the way he did, too and I know that he is passionate, because people are dying.

    The reality of people dying from overprescribed meds trumps the way things are presented, for me.

    The search for WHY the doctors are over-prescribing is something that people need to try to figure out and THAT is why they are looking at the money and HAVE TO look at the money. The visiting almost every day is either they are developing so many drugs that doctors can’t keep up with the information or it is about advertising and INFLUENCE and that should be another category on that list on that link.

    Do the ten dollar lunches work at swaying doctors?

    Is that why they are over-prescribing?

    Is it a specific sales pitch, which the salesmen studied?

    These companies which generate billions study how to advertise and how to market and how to influence and it is technically working.

    There hasn’t been a study on why it is working.

    Maybe, because doctors don’t have time to keep up with the research?

    Maybe it is that simple?

    Teachers have to keep taking classes.

    Do doctors? Or is it all before they go into practice?

    1. What I am going to say about Dr. Greger is that he is trying to keep up with this site, while doing the speaking engagements listed, while writing his book.

      He has had a few times where he featured a study, and missed conflicting studies, which may have been newer than the ones he was using. Or his was the focus of the journal he was reading and a different source of information was presenting opposite information.

      THAT happens nearly every day all over the internet.

      Go to one site or one study or one poll and read one thing, go to another and it is literally opposite. Over and over and over again, I have seen that trend. Hundreds of times in the past year. We do this with every topic. No wonder people are struggling to understand things.

      Information is so polarizing and so impossible to keep up with and I respect that Dr. Greger is trying to keep up with it all.

      And those of us who also want to hear the arguments of the opposing side know what spin is.

    2. Doctors have to do continuing medical eduction (CME) to retain their licence to prctise medicine. The requirements vary from state to state in the US.
      http://www.cmeweb.com/gstate_requirements.php

      Perhaps the most powerful factor pushing doctors to overprescribe is defensive medicine

      “Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff.”
      https://en.wikipedia.org/wiki/Defensive_medicine

  19. The sentence of “the only time they can hear about the drugs is lunchtime” means that the only source of information about the drugs is from the people selling them.

    That is probably one of the answers.

  20. I am laughing, because I don’t see how Dr. Greger could even possibly keep up with his comment sections.

    Some of us take such a big process to analyze data.

    I do understand that busy doctors who already don’t have time to learn about the drugs, would get defensive about that whole topic.

    I also understand that drugs and supplements and tests like mammograms are all about the frustratingly passionate driving topic of saving people’s lives when they ended up eating too many bad foods and exposed to too many toxins and Dr. Greger is biased toward nutritional information and studies and they are biased probably to experience and that they think people really won’t do it.

    It is almost like a panning for gold process. Desperation for health and money. Looking for anything at all to not be fools gold.

    Things get simpler when the focus comes off these polarizing issues and turn to WFPB, but people are so far away from WFPB and they are sick and doctors want ways to help.

  21. It seems like there has to be a third party between the drug sellers and doctors, who has the studies.

    But that might cause a whole extra layer of power and corruption and influence or red tape or backlash.

    Pain meds is one in back lash.

    Over-prescribed, but now people who are in serious pain are saying that they aren’t having their pain managed.

    Err in one direction.

    Err in the other direction.

    That is also our culture.

  22. There isn’t enough studues for the answers to be easier.

    How do doctors even begin to evaluate all the data?

    And if the doctors don’t have time to do it, how do the people?

    Thst is why doctor shows end up being so big.

    There will never be simple answers to complex problrms ..,,,,,

    Unless somehow the studies become more conclusive or the drugs start costing less and having fewer side effects.

  23. We live in a culture where doctors don’t know statistics and don’t know that they don’t know how to analyze data and neither do the people.

  24. The doctors may not even see it as benefiting at all.

    They may see those meetings as doing their jobs or as keeping up with the newest information available.

    Maybe they should keep the lunches, but have the opposing arguments and data analysis as part of the weekly process.

    1. Unfortunately that is one of our sources for education on new drugs that out. They do bring the package and search which we can read that are approved by the FDA. However we’re back to the basic problem why we are all here it’s the food! I talk till I’m blue in the face with patients over and over about changing their diet. I challenge them to give me eight weeks on a plant-based diet and see how they feel and if they can’t do that I try to get four weeks. All you have to do is confuse a human being and they will not act!!

      1. That’s very true. The multiplicity of different diets out there probably does paralyse people and they won’t act. This is a fairly well known phenomenon in cognitive psychology (and marketing)

        “In a California gourmet market, Professor Iyengar and her research assistants set up a booth of samples of Wilkin & Sons jams. Every few hours, they switched from offering a selection of 24 jams to a group of six jams. On average, customers tasted two jams, regardless of the size of the assortment, and each one received a coupon good for $1 off one Wilkin & Sons jam.

        Here’s the interesting part. Sixty percent of customers were drawn to the large assortment, while only 40 percent stopped by the small one. But 30 percent of the people who had sampled from the small assortment decided to buy jam, while only 3 percent of those confronted with the two dozen jams purchased a jar.

        That study “raised the hypothesis that the presence of choice might be appealing as a theory,” Professor Iyengar said last year, “but in reality, people might find more and more choice to actually be debilitating.”
        https://www.nytimes.com/2010/02/27/your-money/27shortcuts.html

        1. Tom,

          That is fascinating!

          How fascinating that the 60% thought they wanted more choices and the other group bought the product!

          A parent once told me that with kids, you don’t give them open-ended decisions, you give them a few choices or you will end up wanting to yell at them for either being indecisive or greedy.

          And I bear witness to it in my adult life.

          I have spent a year trying to figure out my kitchen cabinets and the existence of on-line places like Barker Cabinets and local places and big box stores and places like Cabinets-to-go, I got so confused with my brain processing that I ended up not getting anything and I took it back up a year later, but genuinely needed to put it down for a whole year, because of the sense of overwhelm.

          We live in a society where there is over-over-over-stimulation in every topic. The young people are either bouncing off the walls or they are like the straw-might-be-just-about-to-break-the-camels-back.

          Vacation, to me, is going away from all of the societal noise and I like places without cluttered or noisy scenery even. Nature versus touristy places. Calm B&B’s versus other types of places.

          1. Talking about when people get confused, they don’t act, there is also a version of “When people get confused, they do act.”

            President Clinton left vegan to Dr. Hyman and Steve Jobs had left vegan, too would be simple examples.

            Analyzing data is so confusing and I put those men in the category of people who have a lot of experience analyzing data and they still got confused over such a basic subject as what to eat.

      2. Dr Stedman, I understand.

        I was talking to my friends who are both Keto the other day and I finally said, “I don’t want you to have an over-reaching concept of ‘going WFPB’ versus ‘going Keto’ I want to see if we can find you a few things that you enjoy eating.”

        That helped them. It made the process less daunting.

        I am going to be bringing over a few transition foods. Ones that I find close enough that I didn’t have to adjust to it.

        So far, the ones I think they won’t get turned off by are:

        Morning Star Chickn patties
        Morning Star breakfast sausage
        Veganaise, Vegan bologna and Follow Your Heart Cheese slices

        And So Delicious shreds for pizza.

        I have had some vegan bacon, which worked well on BLT’s, but it was the wrong texture and I don’t want them trying that first.

        Morning Star used to have excellent Italian Sausage and another brand used to have excellent vegan meatballs, but other brands were disappointing and I am trying hard to not have them get scared off.

        Morning Star Prime Grillers is the closest I found to tasting like hamburgers, but I am not sure it is close enough for them to not be disappointed.

        I have made lasagna and had it taste close enough to the real thing, that I think I can help them substitute lasagna and I am hoping the So Delicious will be good for pizza.

        Yes, you will notice that I am leaving fruits and vegetables out of this part of the equation, because they don’t eat them, but when the Farmer’s Markets start around here, I will try to get them to eat those.

        But right now, it is finding things that are close to what they like to eat.

        I haven’t tried the vegan cheese sauces yet, but I bought a store brand vegan alfredo sauce. It will help them if they can just buy things.

        I don’t know if it will work, but they aren’t afraid of me and they are willing to try things and that helps.

        I think I am going to be doing a taste testing of transition products with them and a few other people.

        Then, we can do a vegan recipe and vegan sauces after that.

        I haven’t learned vegan sauces myself.

        1. Dr Stedman,

          It might be that you suggest movies like “Forks Over Knives” or books like “How Not to Die”

          I hand out video links like crazy.

            1. That is cool that you do that.

              My friends all went Keto when I went WFPB and they wouldn’t listen to the arguments even once and argued loudly and pre-set boundaries against me, but something happened.

              A few of them recently had health scares.

              They may not succeed, but they are suddenly wanting to hear even one or two foods, which might be things they can swap.

              They can’t handle more than swapping a few things right now.

        2. I figure if I can get them to even just swap their chicken, that would be such a good thing.

          I talked them through how to cook without oil and even if that was the only thing they did, it might help some.

          It might just build a foundation, which they might not build on until their health gets worse, but suddenly, they might come back to it and do something else.

          1. I did get one other family to swap their chicken and even the kids like the vegan chickn well enough that they are not struggling with it.

            A year from now, they might swap something else.

            1. I am trying to get them to swap their bacon for the vegan breakfast sausage.

              If anyone has a vegan bacon, which is pretty close to real stuff, it would help, but the breakfast sausage is already close enough that I think they will be able to succeed.

              I still haven’t made the vegan tuna myself, but I have seen people say that jackfruit mixed with chickpeas and adding in kelp granules and something else approximates it. If I get that close enough, they would have a few lunch foods and they would be eating chickpeas and not know it.

  25. Analyzing data is the part of my brain, which got damaged, so if you are going to bring in volatile topics, I am going to be analyzing circles around you.

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