Is Your Doctor’s Advice Bought and Paid For?

In this episode of The Savvy Patient, cohosts Erin Stein and Dr. Gillian Goddard lift the curtain on the side hustles, consulting gigs, and industry ties that many physicians take on behind the scenes. Dr. Goddard breaks down why so many doctors step outside the clinic—from writing books and hosting podcasts to working with pharmaceutical companies as "Key Opinion Leaders" or brand ambassadors. While clinical work isn't always as lucrative as people think, these side endeavors allow doctors to share their expertise on a larger scale. But as we point out, where there’s money involved, there’s always potential for bias. We dive into the subtle line between genuine medical advice and clever marketing and take a close look at the supplement aisle. We discuss why "proprietary blends" are a major red flag, and Gillian shares her own experience serving as a medical advisor. By the end of the episode, you’ll know how to spot financial conflicts of interest, and how to evaluate health recommendations with a healthy dose of smart skepticism.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Visit www.thesavvypatient.com/podcast for episode transcripts.

Watch full podcast episodes @TheSavvyPatient on Youtube.com.

Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

00:33 The Role of Doctors Beyond Clinical Practice

02:45 Doctors in Industry: Consulting and Advisory Roles

04:51 Understanding Compensation: The Financial Landscape for Doctors

07:23 Navigating Ethical Guidelines and Restrictions

09:42 The Impact of Financial Incentives on Medical Recommendations

11:55 The Distinction Between Medical Advice and Marketing

14:30 The Role of Medical Advisors in Supplement Companies

16:32 Evaluating the Quality of Supplements and Products

19:23 The Importance of Evidence-Based Practices in Supplement Development

21:58 Personal Experiences and Ethical Considerations in Supplement Work

25:59 Understanding Proprietary Blends in Supplements

28:53 The Importance of Transparency in Health Products

29:41 Financial Involvement and Ethical Considerations

31:42 Navigating Trust in Medical Recommendations

34:45 Doctors and Their Side Incomes

38:34 Innovations in Medical Equipment and Patient Experience

Erin Stein: Hello everyone and welcome to The Savvy Patient.

Gillian Goddard: Hi.

Erin Stein: Today we're going to talk about doctors and doctors being experts, when they are paid or not paid to weigh in with their expertise. And that happens in a lot of different ways. They may be working with a company, they may be weighing in on a study, they might be testifying in front of Congress. Who knows? We'll talk about all of these things because lots of doctors do this. Gillian herself is an expert here talking about these things. 

Gillian Goddard: This is true.

Erin Stein: She wrote a book. It's called The Hormone Loop. You should buy it. Okay. Maybe, we just start with some doctors are with patients in some sort of clinical setting, and then there's doctors who are researcher academic types in a research university kind of setting…

Gillian Goddard: Yep. And then there are doctors whose entire job is to work in an industry setting. So pharmaceutical companies, for example, have doctors as part of their staff. They usually have a chief medical officer along with some other physicians on staff. I think a lot of times we think though that if a doctor is a clinical doctor seeing patients in an office that that's like their whole job and sometimes it is. But a lot of those doctors, myself included, are engaged activities that use their expertise. And I think that people would be surprised if they knew how many of us do that.

Erin Stein: Let’s surprise them, because this is a pretty wide-ranging list of activities you might be involved in. I mean, certainly writing books and having a podcast and being on social media, writing a Substack, all those things is one thing.

Gillian Goddard: Yeah, and there are lots of doctors doing that in lots of different fields.

Erin Stein: Right, because you think there could be more information, better information, answering questions…

Gillian Goddard: Yes, you can reach a lot more people writing a Substack, writing a book, having a podcast, than you can reach seeing people in the office, even if you see people in the office, you know, eight, nine hours a day.

Erin Stein: I don't want to martyr you because maybe someday you will make some money from these endeavors, but you know, there is a goal to help people and get more information out there.

Gillian Goddard: There is, but there's also the recognition that doctors, like other people, typically have to make a living. And there was a time when clinical medicine was quite lucrative. Now I would say that time has passed and that doesn't mean that doctors still aren't compensated well. But I would say from a financial point of view being a clinician is not the most lucrative activity a doctor can engage in. A lot of times when it's these sorts of things that doctors do on the side of their clinical practice, it involves doing some sort of consulting or advising. And some of that work is voluntary. I actually have had two or three different positions that have been voluntary work for not-for-profits to help with some of their initiatives around perimenopause and women's health in the workplace, which is an active area at the moment. But typically, in not-for-profits, you're bringing your expertise and your contacts because you believe in the mission of the not-for-profit and your time is your donation, right? You're giving your time away for free. 

Erin Stein: Mm-hmm, mm-hmm.

Gillian Goddard: But other types of advisory work in industry are typically paid advisory work and that can look like a lot of different things. You could just do speaking for a pharmaceutical company as part of their sales activities, pharmaceutical companies will set up educational dinners for doctors, and they will bring in a physician speaker who gives like a branded talk about medication. It can be helpful especially early in your practice or if there's a new type of medication out there to hear about how other people are using it and so there's definitely value in these. The speaker is typically compensated for their time, and they do usually have to go through training to make sure that they know what types of things they can and cannot say when they're representing a pharmaceutical company because there are restrictions around that. Pharmaceutical companies also have advisory boards. They'll have these people come in for meetings and they'll talk about research and ask them to share their experience or expertise with their medications. That's something that's usually compensated at a very standard rate. So, every doctor going is compensated X number of dollars per hour to attend these types of meetings. There are these other areas that you can get involved in and there's a lot of overlap in them. So, you can be a medical advisor who reviews formulations, and claims, and educational materials, and product development for like a direct-to-consumer company.

Erin Stein: Mm.

Gillian Goddard: Whether that's a company that makes like a supplement or a company that makes consumer good, a product, like a wearable, for example, it certainly has medical advisors advising them. You can be a key opinion leader, which means that you speak at meetings and industry events, you write articles, you might be a guest on a podcast or do educational videos. I've definitely done some work in this space, mostly non-branded in my particular situation. But I've done some work for GoodRx doing educational videos, which I think are quite good actually. I'm not just tooting my own horn. They have a good full production staff at GoodRx. They're the ones doing the heavy lifting there. But I have collaborated with them in the making of those videos, thinking about what the topic should be and how we should discuss, you know, those topics.

Erin Stein: Mm-hmm.

Gillian Goddard: And that is interesting and is, you know, paid work that people do. You can be a brand ambassador. This might be more like a surgical product that surgeons are going to use in the OR [operating room]. If you're a brand ambassador, you go out and show other surgeons how to use the product. [You] train other surgeons to use it, right? So that they can use the product in the OR safely and effectively for whatever it's for. Brand ambassadors share content. They'll appear in ads to some degree, although there's definitely restrictions around doctors appearing in advertisements. Most people who do this kind of work end up doing like a whole grab bag of different things for different companies. You might do key opinion leader work with one company, and you might be a medical advisor for another company.

Erin Stein: Key opinion leader clearly is a term, a title, and how is that different from these other things? Does it just mean you're speaking to a specific topic?

Gillian Goddard: Typically, it means you're speaking to a specific topic and you're recognized as an expert on that. It’s very common in the pharmaceutical industry in general.

Erin Stein: Okay.

Gillian Goddard: But all this stuff gets compensated in different ways. Like some of it's hourly, some of it is we'll pay you X number of dollars for this one project. if it's developing a new product, sometimes you get a stake in the company. So then if the product goes well and the company gets bought, you make your money at that point, for example. I think that the reason that it's important to understand that doctors are doing this work is because we're getting paid to do this work. And any time you get money for doing something, it can affect your opinion. So, you may sign on to a project because you really believe in it.

Erin Stein: Yeah.

Gillian Goddard: I would like to think that most doctors are signing on to projects that they really believe in. But you should know, if your doctor is recommending something, if they have a financial stake in that thing because it could be coloring their opinion.

Erin Stein: Yes. And at worst they could just be trying to make money. 

Gillian Goddard: At worst they could just be trying to make money. Yeah. Yeah.

Erin Stein: We don't want to suggest everybody's doing that, but it is possible. What are the restrictions around what doctors can and can't do? And I assume you mean practicing physicians not necessarily someone who no longer works in a practice with patients but tell me.

Gillian Goddard: Yeah. So, it really depends on your practice, and it really depends on who employs you. Doctors who work for a hospital or hospital system have more restrictions around what they can do that are part of their contract than someone like me who works in a small private practice that is privately owned. I have fewer restrictions. There are some things that are viewed differently than other things. Speaking in an informational way, even if it is for a specific brand, is pretty widely accepted as an activity that doctors and clinical practice can do. Certainly, speaking in an educational way, even if you're paid for it. So, something that has nothing to do with a specific pharmaceutical, whether you're talking about like a whole class of drugs, for example, is absolutely not only acceptable, but kind of expected because it is a way to share your expertise with other people in the field. Where it gets squishy is [when] we're almost a mouthpiece for a product. And when I say that, I mean, you're appearing in a scripted commercial for a product.

Erin Stein: Mm.

Gillian Goddard: And you'll notice there are not a lot of direct-to-consumer commercials that have doctors in them. Because it's a scripted commercial, your ability to control what you say may be restricted.

Erin Stein: Yes, and it doesn't mean you're not seeing commercials without doctors in them, but those are paid actors wearing a doctor's coat in many cases, and it's usually in very tiny print.

Gillian Goddard: In many cases.

Erin Stein: If you're a practicing physician, are there ethical guidelines you have to follow regarding this or just like honor system what's generally accepted and what's not?

Gillian Goddard: It's more honor system. It's what's generally accepted and what's not. Now, the other thing that is important to note is that anything that a doctor is doing that is not directly connected to seeing patients in the office is not covered by malpractice insurance. So, if you go out and give a talk to a non-medical population—that's why we're always so careful to tell you this is a general information talk. I'm not suggesting a specific treatment for you. You should be talking to your doctor about what's right for you because every person is different. And the reason you hear that caveat so much is because the activities that we do outside of the office are not covered by our malpractice insurance. So, in theory, someone could say, got this medical advice from so and so and they could sue you.

Erin Stein: Yes. Also, it is true you need to talk to your doctor about your individual situation, but yes.

Gillian Goddard: Right. Listener, I adore you, but I don't necessarily know you personally and I don't know anything about your personal medical history. And so how could I possibly give you specific medical advice for you? You need to see a doctor who has all that information.

Erin Stein: We want to give you the things to talk to your doctor about, but you have to talk to your doctor. 

Gillian Goddard: Correct. Correct.

Erin Stein: And any expert out there should be saying that to you. 

Gillian Goddard: Yeah, exactly.

Erin Stein: They should not presume to know everything about your situation and or say, yes, this is the medication you need to take. No one should be making those absolute statements you should be suspicious of that from anyone. Just going to step in here and say that. So, they might say, “you might be a candidate for this. This might work for you.” You should check this out. That's all fine. But if they're like, “yeah, you absolutely need to be on this,” mmm… [skeptical noise]

Gillian Goddard: Mm-hmm.

Erin Stein: Have they looked at your bloodwork? 

Gillian Goddard: Right, right, right, exactly. Yeah. Yeah.

Erin Stein: So, we had a whole episode where we talked about medications and pharmaceuticals and supplements, so it makes sense that those kinds of companies should have somebody on staff who's an actual doctor.

Gillian Goddard: Typically, typically, so depending on the size of the company, they may not have a full-time like chief medical officer type person who's a full-time employee. A lot of times they have a medical advisory board that might be made up of a couple of different doctors and other people with other types of expertise like a pharmacist or something like that. If it's a really small company, they might just have a consulting medical advisor, especially in early days. And that's okay as long as they are doing their due diligence. And when you're talking about supplements, you know, some of these companies are huge companies and they have a chief medical advisor, but a lot of supplement companies are small or a lot of medical foods products are small, they're startups, and they'll have a medical advisor who does other things as well. that is important to know.

Erin Stein: And what kinds of things are you advising on when you're doing that kind of role for that kind of company?

Gillian Goddard: It depends on what stage of the game you actually join the company. But a lot of times you're talking to them about their formulations, what's in their products. You might be helping them assess the market and look for what products might be needed that they might think about developing, right? What market is there that we could make a supplement tailored to those people and why is there a hole in the market and how can we fill it? A lot of times you're answering questions about research. People developing these products may not have the same background as far as reading papers that are the clinical evidence on which their product is made. And so, they may need some assistance sorting through what the actual data says and how that applies to their product, but also to some degree part of what you are doing is giving them some legitimacy. 

Erin Stein: Right.

Gillian Goddard: And so, I think this is where you want to be, where I have always been very careful about, this kind of thing. 

Erin Stein: This is really what it boils down to, is if you are putting your name out there as a doctor, as an expert, and associating yourself with this company, regardless of what kind of company or what kind of work, you're essentially saying that you've looked over what they have and approved it. 

Gillian Goddard: You're endorsing it. Yeah. Yeah. 

Erin Stein: Yeah, I mean, whether you actually did that or not…That’s the assumption people will make.

Gillian Goddard: Yeah. No, it's true. Now, I do want to take a second here to talk about supplements and branding of supplements because there's sort of two different things that happen here. So one is that you might have a small, newer supplement company who's coming out or a company that's a supplement company coming out with a new product and they have a doctor who's advising them around the process of developing and bringing that product to market. But then a lot of times you'll see doctors' names on supplements and that is often a different situation. A lot of large supplement manufacturers will allow you to create self-branded supplements. So that means you take their existing formulations, and they make a custom label for you that they then manufacture the same magnesium glycinate, for example, that they're manufacturing for everyone or the same collagen powder that they're manufacturing for a brand. They're also manufacturing and packaging in a package that says, you know, Dr. X's collagen powder. And in that case, the doctor actually doesn't have a say in the formulation. Typically, they're taking an existing off-the-shelf product and just putting it in a different package. And that is a really important distinction.

Erin Stein: Mm-hmm.

Gillian Goddard: That is usually because the doctor is selling that product as a part of the services that they offer, and they're essentially making a cut of what they sell. So, if they sell more collagen powder, they make more money from selling the collagen powder and then the manufacturer also gets their cut, obviously. And so, a lot of times when you see doctors selling the doctor's brand of supplement, then oftentimes that is the process that has taken place and that's the financial arrangement.

Erin Stein: Right.

Gillian Goddard: Versus working as a medical advisor to a company and usually getting some sort of compensation for that, which may or may not have anything to do with your direct ability to sell the product, depending on your agreement.

Erin Stein: Yeah, obviously that's an important distinction, but it's also something that's common in other product areas that maybe we don't necessarily think of as applying to supplements. Because you know, every celebrity slaps their name on some perfume or some jeans or some shoes or some wine …

Gillian Goddard: Or cosmetics or skin care.

Erin Stein: Yes, cosmetics for sure. Yeah. And it's all already being made. It's just the packaging being designed with their name on it so they can promote it and sell it, and they are presumably getting paid to put their name and likeness on it because it will sell more. But I would say in most of those cases they're not sitting in a lab coming up with s specific things…

Gillian Goddard: Right? Most often I think that's true. Yeah.

Erin Stein: …even if they might say that. that's important to note that this is the same thing. The doctor is not in a lab coming up with the formulation themselves. They're hopefully looking at the supplement that's already being made and saying I think this is a good enough formulation, I will put my name on it and sell it to you directly.

Gillian Goddard: Sell it to you directly. Exactly.

Erin Stein: Yeah.

Gillian Goddard: And that's a different calculus, right? It's a different way of thinking about it. So, I recently agreed to start working with a company that makes a supplement. I have been approached by a number of different companies designing products for women and for the vast majority of those products I've said no. This company came along and what they were doing was completely different and how they were doing it was completely different and I really liked what they were doing and so I did something that I wasn't sure I would ever do which was I, became the medical advisor of a company that makes a supplement.

Erin Stein: I know, it's shocking, everyone! It's shocking. Because as you may have gathered by now, supplements are a gray area, to put it nicely, and Gillian has always had strong feelings about it, which I think is good. She should, as a doctor, have strong feelings about it. We literally just talked about this in the previous episode. Some supplements are effective, some supplements do work, some supplements are necessary. I mean I need to take calcium, which is formulated the same way a supplement is. My minerals. So there have to be some companies out there doing this in a respectable way.

Gillian Goddard: Yes, and I think that there are. So, the company I'm working with is called Plainspeak and they really saw a hole in the market. And what I like about it and why I felt like their ethos was one that I could endorse was because they wanted to make a supplement that only contained things that were evidence-based for women in midlife. You've heard me say before you don't need to take a multivitamin. But I think what people like about that is it's like a one thing that you swallow every day and then you're done and you don't have to think about it and you're not thinking about like I need this supplement and I have to take it at this time and I need this supplement and I have to take it at this time. And that would be great but for the fact that multivitamins haven't been shown to be beneficial for the vast majority of people. But I sit in my office and I'm like, well, if you're having brain fog and you might think about creatine, there is real evidence for creatine for women in midlife. You need to increase your protein intake. if you're concerned about X, Y or Z, some collagen might be helpful. Oh, and yes, you're a woman of a certain age, so you need calcium and you might need vitamin D too. 

Erin Stein: Mm-hmm. Yes.

Gillian Goddard: And so, all of a sudden, you're telling someone to get this laundry list of supplements and you're saying only buy supplements that are high quality and if I hadn't done my homework, you know, how am I supposed to tell you even which ones are high quality?

Erin Stein: Mm-hmm.

Gillian Goddard: What Plainspeak is looking to do is to put all those things I just mentioned that are evidence-based things that women can benefit from in many cases into one product. But they did it in a way that is like even better than that, which is they really did their legwork on their suppliers for the individual ingredients. they had all the factory reports, and they had really done the legwork to make sure that the ingredients that they were sourcing were really high-quality ingredients. And the product has…like half a dozen ingredients in it total. I know what all of them are.

Erin Stein: That's good.

Gillian Goddard: None of them are things that are weird or like you know, chemical names that are five miles long that you don't know what it is. And it has no proprietary blends, so there's no like, here's this nebulous blend of stuff that we're not going to tell you what it is. It doesn't have that.

Erin Stein: Okay, wait. Let's pause and talk about proprietary blends.

Gillian Goddard: Yes, proprietary blends. It's basically a way to put something in a supplement and not tell people exactly what it is. It has like an intellectual property protection and so they basically don't ever have to tell you what it is. And they can make all kinds of claims about proprietary blends because how could you refute their claim? Our proprietary blend will, you know, make you feel like you're 25 again. Who can dispute that? You don't know what's in that proprietary blend.

Erin Stein: It's like the secret recipe to Coke. But they're claiming benefits.

Gillian Goddard: But they're claiming like health benefits. Coke, these days, is not claiming health benefits. They used to, but it's been a while. It's been about 100 years.

Erin Stein: I hope not. It should not. It's been about a hundred years, and I think the recipe was different then. 

Gillian Goddard: Yes, it had cocaine in it, in fact.

Erin Stein: Oh, to be alive during that time. There are some celebrity or doctor endorsed proprietary blended supplements out there. I'm pretty confident I've seen this advertised. I, Dr. So and so, or I, celebrity actress so and so, have put together this exclusive proprietary mixture of these things that I find the most effective. There are a million Instagram advertising videos that basically say this.

Gillian Goddard: Yeah.

Erin Stein: So, if you're looking at an ingredient list on a proprietary blend, is it just the amounts that are proprietary or are some of the ingredients left off?

Gillian Goddard: Some of the ingredients can be left off depending on what they are, but typically it'll give some sort of vague sense of what's in it without a lot of specifics.

Erin Stein: [That’s] Unsettling.

Gillian Goddard: It is, and that is why I tell people not to use products that contain proprietary blends.

Erin Stein: Mm-hmm. Would it always say this is a proprietary blend? Typically, on the packaging it will say so?

Gillian Goddard: Typically. Yeah. And it might list like botanicals or something after this.

Erin Stein: Just random botanicals?

Gillian Goddard: Yeah, usually. I know, they'll say that they've done their own research and they've got studies that show this to be true, but oftentimes those studies are very short. They're not placebo controlled. Their endpoints showing benefit are not always so amazing.

Erin Stein: I interrupted your list of good things about Plainspeak.

Gillian Goddard: So, I guess the other thing I would say is one of the things that they're hoping to do is to provide education about the components that are in it and why they're beneficial. To me, that is a more compelling story than an influencer, holding up a package and saying that they love the product.

Erin Stein: So, you should perhaps disclose your financial involvement with them.

Gillian Goddard: Yes. [I have] a teeny, teeny tiny stake in the company. Very very tiny. I will not be controlling anything anytime soon. And that's it. I have not made any money from them at this point.

Erin Stein: Nope.

Gillian Goddard: Someday I might if the product is successful and the business becomes very, very successful, my teeny, teeny, teeny, teeny portion of the company could potentially be worth something. But it might not ever be worth anything. So, it's a gamble.

Erin Stein: A gamble. They didn't pay you like a flat fee?

Gillian Goddard: That's not usually how startups work. Usually, you get a nominal stake in the company because they don't always have a lot of funding. They're startups. Yeah, they're trying to be lean.

Erin Stein: Yep. I think it's important to know these things and be aware of them because if you see someone in the media or you see someone speaking and they're associated with something you trust, you will learn to trust what they say or what they endorse, but you need to have some perhaps, savvy…

Gillian Goddard: Mm-hmm.

Erin Stein: …awareness of what might be happening, how they might be benefiting financially, if they're willing to disclose their financial stake in something,

Gillian Goddard: Yeah.

Erin Stein: That to me is always a big sign. Like, yes, I will make some money, but also, I believe in it. And if you're like, well, it's not about making money but maybe it is a little bit about making money.

Gillian Goddard: In all fairness, everybody's time and expertise have some value.

Erin Stein: Right.

Gillian Goddard: And I don't think that it is wrong to be compensated for your time and expertise in a way that is commensurate with that as long as, what you're getting at, is that it's about being upfront about it.

Erin Stein: Yes. Transparency. I am not suggesting that no one should be paid for their time or their effort or their expertise. I actually think women should probably be paid more for all of that across the board.

Gillian Goddard: Probably.

Erin Stein: But I do think like everything else, it's on a spectrum.

Gillian Goddard: Yes, 100%.

Erin Stein: I'm not saying it's bad to have a branded supplement. That may be fine, but you may have more questions about it just to make sure that the ingredients are high quality and whatever else. But you should be aware that they get more from selling you the supplement with their name on it than endorsing some other one.

Gillian Goddard: Exactly. That's correct. That's exactly right. I think you just have to understand, and this is why we're doing this episode, is because a savvy patient understands that their doctor may be involved in all different kinds of things and you just want to think about how that may or may not be coloring their recommendations to you. And I would say most doctors are doing their best to give their patients honest advice and honest recommendations. But everybody has biases.

Erin Stein: Everybody does and also, I just went to the dentist. Yay me. I got my dental appointment done and I got my pap smear done. I'm checking my things off the list.

Gillian Goddard: It's been a busy week.

Erin Stein: It was a busy week. But I went to the dentist, and they recommended something for my gums and they were like, “You can buy it here. We have it. You can't buy it at the drugstore, so if you're interested, let me know.” And she's like, “You can think about it.” And I appreciated that there was not this pressure, like one the hard sell.

Gillian Goddard: The hard sell.

Erin Stein: I walked out the door without anyone else mentioning it or someone bringing it up when I checked out, you know, she mentioned it. It's here, it's available if you're interested. Otherwise, good-bye. And that is how I prefer to have things mentioned to me. You can think about it, you can come back. I don't like getting the hard sell. You know, a lot of dermatology offices sell various hair supplements or skincare or sunscreen, whatever, and probably they're selling it because they think it works really well. 

Gillian Goddard: They're also making money off of it.

Erin Stein: But if they're making some money out of it, so if they're pushing it too hard, I as a person I am going to resist because I feel like they're just pushing it to make money and not because it would be best for me.

Gillian Goddard: Yeah, yeah.

Erin Stein: Right? I like my dermatologist because I know they sell that stuff, I see it, but it has never been mentioned to me because it's not appropriate for me. I think it's the same as being savvy about any other advertising and marketing tactics. You have to be aware that if someone is presented as an expert, you might want to look into that person. You might want to consider if they're being paid or not. And that's it. You know, I'm still interested in Cate Blanchett's skincare.

Gillian Goddard: Who wouldn't be?

Erin Stein: If you would question a celebrity makeup line, perhaps question a celebrity supplement line.

Gillian Goddard: Agreed.

Erin Stein: Any other weird things doctors do to get money?

Gillian Goddard: I mean doctors do, do some other weird things to get money.

Erin Stein: Ha ha ha.

Gillian Goddard: Testifying in court.

Erin Stein: Yes, let's talk about this. I want to be a medical expert testifying in court.

Gillian Goddard: I've never done this.

Erin Stein: I mean, I think there's probably not a huge call for endocrinologists testifying in trials.

Gillian Goddard: No, not at this point. No, never been an expert witness. But there are people who make a healthy side income, working as a medical expert in legal proceedings. And that might not be just, you know, in court or in depositions or as an expert witness but also reviewing medical records. Medical record review is a big thing that doctors do in the context of legal proceedings, giving an opinion about the medical records and how something was handled in the case of things like medical malpractice. I would say that is another area where doctors use their expertise.

Erin Stein: We see it in the true crime documentaries all the time. And shockingly enough, no one has tried the perimenopausal rage defense, you know? We had a Twinkie defense. Maybe your day is coming!

Gillian Goddard: Interesting, interesting. Maybe my day is coming yet. Yeah.

Erin Stein: Hang out your shingle now. [laughs]

Gillian Goddard: I'm pretty busy right now. [laughs] The other thing that we do sometimes, and I have done this in the past, is consulting with investment companies where basically they just want to ask you questions about different company's products and your opinions about them. You can't do that kind of work if you work for the company obviously or have any inside information. Investors just want to get a sense of how clinicians are using a product and take that into account in their investment strategy. So, they will pay for your time to give your opinion on that. So, it's probably the least interesting.

Erin Stein: Maybe, but maybe not. I mean, I feel like that's not an obvious one that investors would want to speak to doctors 'cause pharmaceuticals are big money.

Gillian Goddard: They are, and many pharmaceutical companies are publicly traded, and so there may be a fund or something where they're thinking about investing more or selling some of their shares in one of these companies and so they are just trying to get a little bit of the lay of the land around prescribing practices because they just want to understand how doctors view the product and do their future casting about what that might mean for the value of the company. It's not the physician advising them to do that. I have never once given my recommendations around investing in a particular pharmaceutical company. That is not in my wheelhouse.

Erin Stein: I think pharmaceuticals are probably the most likely for investors to be interested in, but also there are companies that make medical equipment, medical supplies…

Gillian Goddard: Yes. Yeah, unless there's sort of like a new piece of medical equipment on the market that's going to be paradigm shifting. And this has not been the case in a while. I mean, drug-eluding stents, which we talked about in the last episode, which are used when people have blockages in the arteries of their heart, was probably the last time people got super excited about medical devices. That was quite a while ago.

Erin Stein: But you know, we're still holding out hope for that new speculum to come out. Right?

Gillian Goddard: Yes.

Erin Stein: I'll invest in that company.

Gillian Goddard: Ha!

Erin Stein: I went to a medical museum, and they had a display case that was a variety of speculums from history. These were all antiques. 

Gillian Goddard: Mm-hmm. I think they're specula.

Erin Stein: Okay, thanks. I did take Latin, but who cares? They all look exactly the same as the modern speculum. There's no difference.

Gillian Goddard: That's correct.

Erin Stein: It has not progressed whatsoever.

Gillian Goddard: Nope. No, it hasn't. There's actually a company out there marketing a speculum that is supposed to be more comfortable. It looks the same to me. But what's interesting about it is they're marketing it as something that a patient would buy and bring to the doctor's office. Which I have so many issues with. No.

Erin Stein: No, I'm not bringing it. B Y O S? No, not happening.

Gillian Goddard: First of all, don't we put enough burdens on women that they shouldn't have to bring their own specula to the doctors? Speculum, because presumably they're only bringing one to the doctor's office, first of all. Second of all, they weren't cheap. I can't remember how much they were, but they weren't cheap. And third of all, a speculum is a device that you use with one hand. And one of the biggest differences from one speculum to the other is the mechanism by which you prop it open and then the mechanism by which you release it so that it closes. And the key to giving a painless or less painful pelvic exam or pap smear, cervical exam, is the way you remove the speculum while closing it at the same time without pinching the walls of the vagina in the sides of the speculum. The key there is that your gynecologist is familiar with the release mechanism… 

Erin Stein: Yes. Practiced.

Gillian Goddard: … and is comfortable, you know, deploying the release mechanism. And so, I don't know that I would want my gynecologist using a new speculum that she had never used before on me.

Erin Stein: That is a strange but very excellent point to make. Having just had my pap smear, the other thing I realized is she used a plastic, one-time use speculum that went in the trash after my appointment. So, I just thought, oh good, more plastic.

Gillian Goddard: Yeah. Some people like those because the temperature situation is better, but they make exam tables that have like a little drawer that heats up metal specula so that they're the right temperature. So, they're more body temperature and not icy cold.

Erin Stein: Okay, well that's fascinating. I don't think anyone's ever warmed up my speculum before my appointment.

Gillian Goddard: Seriously? they're the best.

Erin Stein: I really don't think so. It's been a while since a metal one was used also. Listen everyone, you got a bonus mini episode here all about speculums and cervical exams. You're welcome. So, we talked about doctors. What do they do? How do they get paid? All these weird other extra things other than just being a doctor. But you spend all that money on medical school. You might as well use it.

Gillian Goddard: If we want new and interesting and innovative products that are beneficial for our health, doctors are the ones that can help make sure that those products are actually beneficial and serve a need and that they're safe and effective.

Erin Stein: Yeah. Touché. it's like everything. Obviously, you want an expert to look at it and make sure things are done right and it's done well.

Gillian Goddard: Of course you do.

Erin Stein: And like everything else, it depends on the experience and credibility of the expert looking at it. Well, if you have any weird random questions about this or about speculum, please share them with us.