A practice model that sells no supplements and marks up no labs, so every recommendation can be trusted as medicine rather than merchandising.
Incentives shape medical advice quietly, constantly, and without anyone deciding to be dishonest. A practice that profits from the supplements it sells will, on average, recommend more of them. A practice that marks up its own labs will, on average, order more of them. The bias does not require bad actors. It only requires a business model, and that is what makes it so hard to see and so important to design against.
This is the idea I built my practice around, before the diagnostics and before the ideas on the rest of this site. It is the foundation the rest stands on, because judgment cannot be trusted if the person offering it profits from a particular answer.
The conflict is structural, not personal
It is tempting to think of conflicts of interest as a problem of character, something that afflicts dishonest people and spares the rest. That framing is comforting and wrong. The pull of an incentive does not announce itself as corruption. It shows up as a slightly lower threshold to recommend the thing you sell, a marginally easier yes, a reason that feels clinical and happens to align with the register.
Multiply that small tilt across thousands of decisions and it becomes the character of a practice, regardless of the intentions of the person inside it. I do not trust myself to be immune to it, and I do not think anyone should trust their physician to be immune to it either. The honest response is not to try harder to resist the pull. It is to remove the pull.
What clean incentives actually means
At PrimaryMD, clean incentives is a specific and checkable claim, not a slogan. The practice sells no supplements. It marks up no labs. It is paid to deliver care, and it does not profit from the volume of products or tests that care involves. When I recommend a supplement, which is rarely, you can buy it anywhere, and I make nothing either way. When I order a test, the practice does not mark it up. When I recommend against something, nothing is lost but the margin someone else would have charged you.
That structure means every recommendation can be read as medicine rather than merchandising, because there is no merchandising to confuse it with. The patient never has to perform the quiet calculation that shadows so much of healthcare: is this advice, or is this a sale?
The cost, and why it is worth it
Clean incentives are not free to the practice. Product sales and lab markups are real revenue, and giving them up means the model has to be honest about how it is paid, which is directly, for care and attention and time. That is a harder business to run than one propped up by margins on pills and panels. It is also the only version I could defend without flinching.
How to check any practice
You do not have to take my word for any of this, and you should not have to. Clean incentives are checkable, and the questions are plain enough to ask anywhere. Does the practice profit from the supplements it recommends? Does it mark up the labs it orders? Is it paid for the volume of tests and products, or for care and attention? The answers tell you which direction the quiet pressure runs.
I would rather you ask those questions of every physician you see, including me, than trust any of us on faith. A practice with clean incentives has nothing to hide in the answers. A practice that does have something to hide is worth knowing about before you take its advice, not after.
The payoff is trust of a particular kind. When the only thing a practice sells is judgment, the advice and the interest of the patient point in the same direction by construction, not by willpower. You do not have to wonder whether I am recommending something because it helps you or because it pays me, because the second reason has been designed out. That alignment is the point, and it is worth more than the revenue it costs.