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At lunch today with some colleagues, my cellphone rang and I recognized the number of a doctor I ceased going to a couple of years ago. I answered, and a woman said: This is Dr X’s office. Dr X thought you should come in for a visit to etc. ..”

“I’m sorry, I’m at a meeting right now,” I said. “Can I call you later?”

I was surprised. A few years ago I went to Dr X, a dermatologist, for a checkup. He was very personable. When I was ready to leave, he recommended that I should use some particular cream he had. I figured it was a prescription medicine, and I agreed. When I went to the checkout counter (that’s what it was, it turns out), there was one bill for the visit, with a form to submit to my insurance coverage, and another bill for the cream which came unaccompanied by the any insurance form. I took a good look at the cream and saw that it was made by a company run by Dr and Mrs X whose name was an acronym of their initials. Being the reasonable guy I am, I asked only a question or two, and then paid up. I didn’t have the guts to say “You shouldn’t use your position as a doctor I consulted for help to sell me auxiliary services.” Instead I paid for it and chalked it up as one of the little NYC ripoffs that you more or less have to accept if you want to lubricate your way through life. Eventually I switched to another doctor. I didn’t like having to be courageous when I went to the doctor in order to avoid being squeezed. My courage is in scarce enough supply that I don’t want to waste it on unnecessary issues.

The same thing happened to me about fifteen years ago at an opthalmologist, who, at the end of the visit, recommended that I take some vitamins which are supposed to be good for your eyes. Not a bad idea, and more popular these days. Then he tried to get me to subscribe to a vitamin distribution service he was part of — some organization somewhere packaged these vitamins and then stamped the particular doctor’s name on the bottle, and he marketed it as his own overpriced concoction. I didn’t like this conflation of categories — doctor and marketer — and so I didn’t buy them. Later on I stopped going to him too .

This is bundling. People accuse financial firms or investment banks of bundling too — putting together unrelated securities and charging more for the package than its parts may be worth, because of what structurers refer to as “the optics.” But that’s not that egregious — you want to buy one thing and they’re trying to sell you two at premium, like getting a belt together with your trousers, or a rustproofing or a satellite radio with your car. Caveat emptor. But a doctor using his position of trust and authority with a patient to bundle in a medicine he’s marketing is a different and dislikeable kettle of fish.

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