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Question:

From a physician in New Jersey, USA:

I was surprised to hear recently of several cases where endocrinologists are recommending a single brand of insulin pump to their patients, without mentioning to their patients that there are three pump manufacturers currently making this product here in the USA.

Is it ethical for a doctor to recommend only one brand, when several essentially equivalent brands exist?

Answer:

I could imagine that occasionally such a recommendation might be based on the doctor's knowledge of what brand the patient's insurance covers, but I somehow suspect that that's not the entire story.

Is it ethical? Well, just as ethical as giving a recommendation for any other name-brand product or drug. In fact, the pump manufacturers would try to underscore the differences in their pumps rather than their similarities. For some patients, those differences may be important for example, two pumps are reportedly waterproof while another is not. That may be very important to an individual patient, prompting a recommendation of that brand pump.

Our office approach, to the chagrin of the pump folks who want the business, is to outline our views of pros and cons of pump therapy in general, let the patient watch videos provided by the companies, and then, if a pump is to be prescribed, let the family decide which one.

DS

Additional comments from Dr. Matthew Brown:

In my practice, I give the patients information on the two leading pump manufacturers and allow them to choose. I also make sure that they are aware of the advantages or disadvantages of each particular brand. I have encountered only one insurance company that insisted on a particular brand of pump because of an existing contract with that company.

When you take a detailed look at the pumps that are available, they frequently are not "essentially equivalent" especially when you look at price, insulin cartridge vs. reservoir, size, color (quite important to many pediatric pumpers), water resistance, time to prepare an insulin infusion set, ease of priming and bolusing, etc. A well informed patient is the best person to make the choice of which pump to use -- after all, they have to wear it every day.

MSB

Additional comments from Dr. Larry Deeb:

My practice is as follows.
  • Know the patient. -- there are differences in pumps and also pump support available to the patient which must be taken into account.
  • Yes, there are "contracts" with insurance companies that sometimes compel certain pumps.
Offer the choices that fit the above criteria.

LD

DTQ-20010414082855
Original posting 23 Apr 2001
Posted to Insulin Pumps

  
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Last Updated: Tuesday April 06, 2010 15:09:22
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