Winkelstein picked up his briefcase and left the building by the back stair. He wanted to avoid the waiting room: it wasn't any of his patients' business when he left--and besides, he always felt a strange, reproachful, and unpleasant contrast when he saw many of his Health Group patients at once. Here in the Health Group, his patients were elderly or disadvantaged, single mothers and young girls without education, the unemployed, the mentally deficient, the foreign-born or hopeless or down-on-their-luck or alcoholic. There were a lot of blacks and Puerto Ricans. Their children were always with them, usually wandering unsupervised in the waiting room, getting in people's way. The vast majority didn't carry insurance. Winkelstein couldn't understand how people could live like that.
Nevertheless, these people got sick, and it was possible to help them when they did. The state paid most of their bills, and it was often possible to get them on one program or another from one of the pharmaceutical companies. One thing about family practice was that there was always an enormous variety in terms of illness displayed, which the pharmaceutical companies loved because they were always producing a vast number of new chemicals that needed approval.
New birth control pills--Winkelstein did a lot of business in those. Other methods of birth control. Pills to relieve arthritic swelling. New methods of asthma relief. Pain relievers. Experimental antibiotics. New hormonal treatments. Interferon. An enormous flow of medicine to help treat heart conditions. Most had never been tested before, except supposedly on animals. The companies needed human subjects, and were willing to pay any qualified M.D. who provided them.
Filomena Hernandez was a good example. Winkelstein was being paid forty thousand dollars by Tempel Pharmaceuticals to produce twenty-five case studies complying with FDA formalities--which in this case were purely formalities, since Winkelstein happened to know that the FDA had given approval before receiving all the follow-up studies, and that Tempel was mass-marketing the drug within the next six months. All that Winkelstein's study really meant was that Winkelstein would make sixteen hundred dollars from Mrs. Hernandez alone, and during that time all he had to do to earn the money was sign a few forms, hand out the drugs, and give a free pelvic exam once a month for the next six months.
On top of the Tempel study, Winkelstein was also getting $32,000 from The Baum Company for the second product Mrs. Hernandez was testing, which meant another $1,250 for the same patient, with no extra work except signing a few forms after having the clerical staff fill them out.
Mrs. Hernandez was typical. Winkelstein could usually get his patients onto more than one program, the heart patients in particular because there were so many new products jumping onto the market all the time. The Family Health Group was turning record profits.
Which was good, because though the profits from Winkelstein's regular practice on Long Island were still higher than those of the Health Group, they were declining. There was no denying that people in general--those who could afford to take care of themselves, anyway--were healthier than they had been. Better diet, more exercise, more care about overwork...
It was too bad health was so bad for business.
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