I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps (http://www.pitt.edu/~jmf29/). I'm curious what you think and what you are exposed to.

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps (http://www.pitt.edu/~jmf29/). I'm curious what you think and what you are exposed to.

HUH??? Dude I know poor primary care docs that pratically rely on reps to eat a good lunch. Im serious. Take your self righteous Taliban-esque cause to Iran. Here we have something called "Liberty", look it up. Its the freedom to chow down on a free Subway sandwich while staring at a hot blonde drug rep and its the freedom our forefathers fought 2 world wars to ensure. Thanks for coming out.

Next.

HUH??? Dude I know poor primary care docs that pratically rely on reps to eat a good lunch.I agree there are many who rely on the food and other gifts, but my whole point is that this stuff isn't really free.

Take your self righteous Taliban-esque cause to Iran. Are you serious? Can you discuss something with maturity or do you have to degrade a discussion by making stupid jokes?


By the way, you may want to correct the grammar in your movie-quote signature. "...a hot older women..."

By the way, you may want to correct the grammar in your movie-quote signature. "...a hot older women..."

hey, it could be a hot rep who's a guy ;)

That's a nice presentation with a ton of info. I think the bottom line is that these are some of the most profitable companies in the US and they simply wouldn't spend the money to influence physicians decisions if it didn't work. I imagine most physicians can honestly deny a conscious influence, but it's working at some level so it's naive for anyone to think they're immune. The one bright spot mentioned in the Atlantic Monthly article is that the cause to reform this system has been taken up mostly by med students and young physicians.

Next time you pick a tree to bark up make sure it doesn't cost me my lunch, literally. thank you for your time and efforts (not really) :D

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.

SHEESH, why not be activist on issues that matter like the piss poor reimbursements from Medicare for primary care docs.

You are seriously out in left field.

And again, thanks for coming out. Bye.

The saddest part is some liberal activist admin type will listen to your crap spewing and sure enough some family med doc making less $ than the local Starbucks barista will have their free bagels and coffee taken away. Grats, grats on f'ing up medicine even more. Im sure you are super popular at UPitt. :rolleyes:

Not all academic programs are willing (or able) to pay for lunch during noon conferences. Only dicks who promptly forgot what it was like to be a med student/resident when they graduated think this is not a big deal. When you've been up and running around nonstop since 6 am, a nice lunch that doesn't cost you $10 in the hospital crapeteria is a gift from heavens (also from GSK/Merck). The shpiel takes 1-2 minutes tops.

The studies may show the prescribing patterns are influenced. So effing what? I don't recall anyone showing that the outcomes were influenced. The majority of drugs within any given class at equivalent doses are the same.

As for device reps, they are absolutely necessary because they are the on-site tech support for that "laser" beam, that new fancy ortho tool, etc.

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps. Also, the samples they provide greatly help out those patients who have no prescription coverage.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.

Interesting that you react with such anger! :eek:

If you honestly think that docs are not influenced by those sales reps and free lunches, then why do you think Drug Companies give them, to feed poor residents/family docs/etc and give them helpful medical advice?

For ever $1 that Drug Companies invest in Drug Reps, they make back $10 and change. (Look it up in a recent article in the Atlantic Monthly).

Indeed there are more important issues in Medicine, and that getting free lunches (in my opinion) is not a big deal.

I suppose this is a question as old as the discussion board itself, but why do so many threads devolve into childish name calling? I have no problem with disagreement between colleagues, but why not keep it civil? I tend to agree with the OP's opinion, but I'm eager to hear what others think. For instance, a good point is raised regarding whether outcomes are actually affected, but calling the OP is a "dick" just takes away from the argument. I'm sure in posting this I'm setting myself up for a barrage of insults, so let's get on with it.

I am in a gizmo and device heavy field. Without the companies constantly working on making a better mousetrap, we would still be in the stone ages of medicine. Yes, these are some of the most profitable businesses around these days, but since when has that become a bad thing ?

The device reps are part of the mechanism. You have them around for tech-support, you use their gizmo, you listen to their talk, you eat their food. Then you look at the literature (no, not the 'hired gun' articles the rep gave you) and decide whether the mousetrap is indeed better or whether it is just another dead-end in the device market. For half of the stuff I use I don't even know the manufacturer, the gal doing the ordering does and thats enough.


(I do think that company sponsored lunches should be separate from their talk. If a resident/student doesn't want to hear the talk, they should be able to get the lunch without it. This was the policy where I did my residency, and I believe it makes sense.)

This is america..

1) making a profit even a huge one is not a crime

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet ***** perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business.

Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.

I am in a gizmo and device heavy field. Without the companies constantly working on making a better mousetrap, we would still be in the stone ages of medicine. Yes, these are some of the most profitable businesses around these days, but since when has that become a bad thing ?

The device reps are part of the mechanism. You have them around for tech-support, you use their gizmo, you listen to their talk, you eat their food. Then you look at the literature (no, not the 'hired gun' articles the rep gave you) and decide whether the mousetrap is indeed better or whether it is just another dead-end in the device market. For half of the stuff I use I don't even know the manufacturer, the gal doing the ordering does and thats enough.


(I do think that company sponsored lunches should be separate from their talk. If a resident/student doesn't want to hear the talk, they should be able to get the lunch without it. This was the policy where I did my residency, and I believe it makes sense.)
Do you think gizmos and meds need to have separate treatment? I can see your point about needing tech support, etc., but the same doesn't seem to apply to drugs. As you say, it's our obligation to do a little lit reading.

I'm not foolish enough to think that drug money will ever be off the scene, but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?

This is america..

1) making a profit even a huge one is not a crime

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet ***** perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business.

Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.

1) I don't have a problem with profit. By stating they're some of the most successful companies I meant to imply that they wouldn't be careless enough to spend their money on something that doesn't work.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making, and that takes me back to point #1. We'll just have to agree to disagree.

3) I'd guess most drug companies don't care whether their drug is better or not. In fact, if they knew theirs to be inferior they'd still push hard. It is business, but it's our job to give informed input. I'm not ready to be a pawn just yet.

Do you think gizmos and meds need to have separate treatment? I can see your point about needing tech support, etc.,

It is not only the tech support. This ain't rocket science, there is nothing the rep has to tell me that I couldn't find in the manual if I cared to read it.
But they will bring equipment around, give your hospital s##% on consignment and bust their ### to get something to you if a patient needs it. These are not the usual call-center drones that you have to deal with at major corporations, they have a vested interest in you being happy and that is why they support you the way they do.

but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?
Well, they must have an opportunity to peddle their product. If they don't think they get their moneys worth, the lunches will go away.
For the common scenario of the drug-rep lunch at residency programs, I think one potential solution could be to have 3-4 companies sponsor a weeks worth of food and in return they each have a 10 min slot to 'inform' about their product during a designated time slot.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making,

Under no circumstances whatsoever can we allow to participate in some sort of kickback scheme. If you get a fancy dinner in recognition of your prescriptions for antihypertensive X going up by 60%, you have turned yourself into a whore (and a cheap one at that).

Btw. If I attend a fancy rep sponsored dinner but bring home some dessert for my wife, that dessert will go on my CC. It won't break the bank but at least nobody has to go to prison for it.

P.S.

I find it mildly amusing if a cardiology fellow is railing against money. Wait another year until you are in practice and listen how the tune you are whistling has changed ;) .

A well-respected attending once told me, "If the drug rep is giving you information about a drug that you don't already know, then you aren't keeping up with your reading."

I tend to agree. I know it's a high standard, but we are responsible for knowing the drugs we use. And we really need to throw whatever literature the drug rep provides in the trash. Just my 2 cents.

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps (http://www.pitt.edu/~jmf29/). I'm curious what you think and what you are exposed to.

How else are we going to get free pens and food?

My student loans are already high enough!







:laugh:

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps. Also, the samples they provide greatly help out those patients who have no prescription coverage.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.
:thumbup: :thumbup: :thumbup:

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps (http://www.pitt.edu/~jmf29/). I'm curious what you think and what you are exposed to.


What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

1) I don't have a problem with profit. By stating they're some of the most successful companies I meant to imply that they wouldn't be careless enough to spend their money on something that doesn't work.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making, and that takes me back to point #1. We'll just have to agree to disagree.

3) I'd guess most drug companies don't care whether their drug is better or not. In fact, if they knew theirs to be inferior they'd still push hard. It is business, but it's our job to give informed input. I'm not ready to be a pawn just yet.
1) Good
2) Its good to have your opinion. I am curious what yr you are in in your training. I have seen the studies but my experience is that residents make students go to the lectures and then come and eat when the non drug rep lecture starts. Lets say it does influence my prescribing? Is it effective? If it is then I am doing my job, if it isnt ill get sued.. Thats where the real influence is.
3) Its cool to be all full of hubris but if you think they dont care you are missing the point. Nothing makes a doc prescribe meds more than proof that they work. Believe what you will about this drug rep stuff but even at programs that have no drug rep sponsored stuff they have to use certain meds, the hospitals only stock so many things on formulary.. Do you think the hospital admins get wined and dined.. and of course offered "discount" prices. Lets be serious..

So if you arent gonna be a pawn I assume you will do Path or Rads where you dont really have to prescribe meds. Otherwise no matter what you prescribe you are nothing but a pawn.

Its like believing you have control.. its just a figment of your imagination. My 2 cents..

I guess we will have to agree to disagree..

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.
:thumbup: We are trained to question everything, trust no one, and be independent.. I hope that some person with their wheelie and free meds doesnt totally change my life.. Of course in the ER I wont have to worry as much about this.

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

Yes, let's eat our free lunches and listen to the presentations and judge the information in a completely unbiased manner. Because no matter how much conclusive research there is to show that it's human nature to be consciously or subconsciously influenced by people handing out perks, WE are clearly above all that, we are clearly "morally centered" and are "uncorruptible by sales people". And clearly, those research results are skewed by those people sitting next to us, who have weak characters and easily tempted, like the original poster, or the French.

Paris delenda est, indeed. Let's not forget to salt the ground.

No one is calling the OP names, but the whole "No Free Lunch" movement makes its proclamations from a verrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrry high moral ground. The connection to reality is a wee thread. Hungry tired residents don't go to drug lunches because they need Viagra pens or because they are mindless sheep.

No one is calling the OP names, but the whole "No Free Lunch" movement makes its proclamations from a verrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrry high moral ground. The connection to reality is a wee thread. Hungry tired residents don't go to drug lunches because they need Viagra pens or because they are mindless sheep.

The connection to reality also becomes tenuously thin when you deny that drug lunches and other perks don't have insidious effects on prescription patterns. What really need to happen is that, on a residency level, programs should be better at about feeding their residents, as a lot of programs are beginning to do already. On a medical education level, there needs to be mroe discussion about how doctors can be influenced by things such as free lunches, and make students aware that these influence can be subtle but effective. I applaud the OP in raising more awareness and debate on this.

As to the more important question of how much regulation there should be on marketing by companies, that is a more complicated issue.

Oops I posted on a friend's account by mistake. Please direct flames for electrikbang's post here. ;)

So what if it changes your prescribing habits?

Q: is patient cured/treated properly?

A #1 = yes, then good you are doing your job

A# 2 = no. then we have a problem but as most of you know or maybe you dont they cant come and pitch a drug for any off label use. Anyways... take your moral high ground elsewhere cause I promise I dont care.. Feel free to keep discussing..

I've recieved plenty of free stuff from drug reps. Do you think I actually listened to them when they were telling them about their meds? No I was busy deciding which goodies I wanted to take.

I've been to a few luncheons sponsored by drug reps as well. I normally chat with the person next to me or just send text messages to friends.

Drug reps are harmless. Let them keep doing what they do, so I don't have to ever step a foot in Office Depot.

I cant 100% agree with OSUdoc but the general part of this is right.. FWIW I think the whole anti-drug rep contingency would be better off spending their energy pushing for *real* tort reform..

If I want to prescribe some drug leave me alone.. I worked my butt off through med school so i can prescribe whatever drug I want. :p

So what if it changes your prescribing habits?

Q: is patient cured/treated properly?

A #1 = yes, then good you are doing your job

A# 2 = no. then we have a problem but as most of you know or maybe you dont they cant come and pitch a drug for any off label use. Anyways... take your moral high ground elsewhere cause I promise I dont care.. Feel free to keep discussing..

You forgot:

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).

or . . . A# 4=yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed Nexium instead of Prilosec. Astra-Zeneca's Prilosec patent ran out and it went generic. So by isolating the S-enantiomer from Prilosec . . . voila . . . you have Nexium. Which, of course, is just barely enough of a chemical change to approve a new patent.

However, by looking at the ads now for the "Purple Pill" you'd think Prilosec was the devil incarnate, at least if you believe what A-Z is selling.

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.

Thus, i vote that they stay.

This of course assumes that $$ is not an unlimited resource.

I just got a look at healthcare from the 'billpayers' end of the stick, makes you think twice about ordering that 'heme-onc panel' when a CBC and a K would have done.

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.

This is a flaw in the healthcare system that should be addressed by the people running and regulating the racket (--> your friend, the goverment).

If it was about giving away drugs for free, a program run by the pharmaceutical industry to provide a limited formulary of generics for financial need patients at nominal cost would be a far better way to spend their money.

They give us the samples bc they want us to prescribe the stuff to paying customers. This is certainly no charity and it doesn't justify the 'drug-rep' as a marketing strategy. They are in the business of making money, and that is good. But we have to keep them at arms length.

You forgot:

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).
Thats why someone as smart as I am always checks generics ok.. Nice try.. now try again..

As far as getting the FDA to rescind stuff... well they are just protecting their business. you might not like it but almost all of medicine is a monopoly including physicians. imagine if getting into med school was like law school? Too many lawyers so some of them have to work crappy jobs making little to no money shooting commercials for slip and fall cases and suing docs and others for no reason. You could have any idiot who "wanted to help someone" become a doc.. Ill pass.. im happy with the monopoly.. IMO if the govt wants to mess with pharma thats cool with me. I def wont stand up for them but its not my plight...

Also most residents have to pass what drugs are prescribed by their attending.. most attendings dont even go to the same meals as the residents.. there is a little bit of a disconnect there.

This is a flaw in the healthcare system that should be addressed by the people running and regulating the racket (--> your friend, the goverment).

If it was about giving away drugs for free, a program run by the pharmaceutical industry to provide a limited formulary of generics for financial need patients at nominal cost would be a far better way to spend their money.

They give us the samples bc they want us to prescribe the stuff to paying customers. This is certainly no charity and it doesn't justify the 'drug-rep' as a marketing strategy. They are in the business of making money, and that is good. But we have to keep them at arms length.
I dont mind keeping them at arms length... its the sandwich or pasta I want a little closer.. I would rather bend my elbow there.. :laugh:

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.
The fact that people don't care is part of the reason we need to discuss this. We all should practice evidence-based medicine and there is plenty of evidence that rep involvement has a negative impact on care.

SHEESH, why not be activist on issues that matter like the piss poor reimbursements from Medicare for primary care docs.
There are many issues in medicine which can be improved. I am interested in this one. Perhaps your interest in Medicare will lead you to do something to reform Medicare.

Not all academic programs are willing (or able) to pay for lunch during noon conferences. Only dicks who promptly forgot what it was like to be a med student/resident when they graduated think this is not a big deal. When you've been up and running around nonstop since 6 am, a nice lunch that doesn't cost you $10 in the hospital crapeteria is a gift from heavens (also from GSK/Merck).
As I mentioned in my first post, I am a fellow. That means I still get paid the minimal wages of a resident. So, no point in talking like I’m a rich doctor. Also, no point in looking for sympathy saying you’ve been up since 6 am. No matter how hard you work, there will ALWAYS be someone working harder.

The studies may show the prescribing patterns are influenced. So effing what? I don't recall anyone showing that the outcomes were influenced.
Actually, you are mistaken here. If you define outcomes based on prescribing habits and expenditures of a hospital, the interactions with reps clearly show an impact. If you define outcomes based on patient expenditures, again the reps show an impact on patient costs. If you define outcomes based on morbidity and mortality, I am not aware of data relating to reps, but there is data referring to industry behavior and negative impact on patients (e.g. hiding data regarding antidepressants and suicide, as well as COX-2’s and MI’s).

As for device reps, they are absolutely necessary because they are the on-site tech support for that "laser" beam, that new fancy ortho tool, etc.
I agree there needs to be a company rep on-site for tech support, but they don’t need to provide free lunches or other free items. Their scope should be limited to working on their devices -- not their promotion.

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps.
We need to be responsible and educate ourselves without depending on drug reps. Is there anyone who really believes a rep is going to provide unbiased information? Of course not, because it doesn’t make corporate sense – their job is to make money. Consequently, we need to educate ourselves, such as with Medical Letter, which provides information nonbiased information from pharmacists. The guidelines are also available from our respective societies and, again, we need to take responsibility to keep up on the guidelines. Being an MD means learning all of your life – not just in school.

Also, the samples they provide greatly help out those patients who have no prescription coverage.
There is extensive data that samples are problematic. I address this in depth in my talk, so I’ll only mention a couple points. The samples are typically the “latest ‘n greatest” drugs, which means they are more expensive and likely not covered by insurance. For example, Crestor samples are all over clinic shelves, but it’s quite expensive and not covered by UPMC insurance. There are real alternatives, which I outline in my talk, such as providing poor patients with vouchers or generic-only samples.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.
I agree completely. The use of direct-to-consumer marketing is quite harmful to the doctor-patient relationship. There can be other methods of educating our patients and we need to do better. However, again, learning about a disease from an unbiased source such as a drug company is NOT wise.

Indeed there are more important issues in Medicine, and that getting free lunches (in my opinion) is not a big deal.
I wouldn’t quite agree other issues are more important. Is our going to Canada to get medicine a reasonable solution? Of course not. The drug system in place in our country needs to be reformed, but the lobbying influence of the drug companies is too massive to allow this to happen without a huge fight. The problem with any gifts, be they lunches, pens, or payments for attendings to speak, they change our prescribing patterns inappropriately.

This is america..
1) making a profit even a huge one is not a crime
Agreed.

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet ***** perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.
The problem is that we are different in that we need to care for our patients and be their advocates. We aren’t like every other profession, because we have to think first about others before ourselves. Our patients trust us and have faith in our decisions. So, that’s why we should be different.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business. Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.
Should they be able to advertise? Absolutely. The problem is that I think their market should be limited to only professional media (e.g. NEJM, JAMA, etc.). No need to advertise to the lay person.

I'm not foolish enough to think that drug money will ever be off the scene, but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?
This is the whole issue. We know they wouldn’t just throw massive amounts of generic money into pools without getting real credit, but perhaps they may be willing to spend a fraction, so long as it was known they were contributing. The point is that we need to separate the person who gives the money and the person who receives it.

I find it mildly amusing if a cardiology fellow is railing against money. Wait another year until you are in practice and listen how the tune you are whistling has changed ;).
I hope I don’t.

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.
Thanks flighterdoc. I was waiting for someone to say what you did, as this is one of my favorite responses. There’s an amazing amount of arrogance among bright people. There is a tremendous amount of data saying that regardless of how you judge my moral character, the reps do affect how we practice.

So what if it changes your prescribing habits?
The problem is that if it does change prescribing habits, then you are not making unbiased, informed decisions in your patient’s best interest. We need to be advocates for our patients and ensure we aren’t pawns of the drug companies.

Drug reps are harmless. Let them keep doing what they do, so I don't have to ever step a foot in Office Depot.
That’s what they want you to think. That’s why what they are doing will work and be in place for a long time. We keep taking their stuff and keep saying it doesn’t affect us.

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.
I know there are plenty of people out there who need help. My talk outlines at least three different options people can get expensive meds. Also, we need to come up with other options about how to get medicines to the poor.

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch (http://www.nofreelunch.org/)

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch (http://www.nofreelunch.org/)

Yeah right, like anyone is going to turn down a free lunch. Give me a break. The food doesn't contain special drugs that convince you to prescribe their meds. Just tune out what they are saying, and think about which nurse you're going to take home that night.

Thats why someone as smart as I am always checks generics ok.. Nice try.. now try again..

Well, you didn't offer that option in your little Q/A.

Also most residents have to pass what drugs are prescribed by their attending.. most attendings dont even go to the same meals as the residents..
They don't care so much about the 3 prescriptions you write in your residents clinic (where most patients are on the medicaid HMOs formulary anyway and end up with a gneric substitution). They try to form your young malleable mind so your prescribing pattern once you are out in practice is skewed towards their product.

It is ok if you want to be the uncritical stooge of the industry, just don't try to tell me that this without consequences and therefore not a problem. I am not saying that I am not influenced by their tactics, I am just trying to remind myself that they are sales reps and here to make a sale.

The fact that people don't care is part of the reason we need to discuss this. We all should practice evidence-based medicine and there is plenty of evidence that rep involvement has a negative impact on care. Have a cite for this? the only studies show that there is an increase in prescriptions and not anything else..

There are many issues in medicine which can be improved. I am interested in this one. Perhaps your interest in Medicare will lead you to do something to reform Medicare. Uhh thats good..

As I mentioned in my first post, I am a fellow. That means I still get paid the minimal wages of a resident. So, no point in talking like I’m a rich doctor. Also, no point in looking for sympathy saying you’ve been up since 6 am. No matter how hard you work, there will ALWAYS be someone working harder. oh my god... r u serious?

Actually, you are mistaken here. If you define outcomes based on prescribing habits and expenditures of a hospital, the interactions with reps clearly show an impact. If you define outcomes based on patient expenditures, again the reps show an impact on patient costs. If you define outcomes based on morbidity and mortality, I am not aware of data relating to reps, but there is data referring to industry behavior and negative impact on patients (e.g. hiding data regarding antidepressants and suicide, as well as COX-2’s and MI’s). Uhh right the patient outcome.. morbidity and mortality. no change.. nuff said...FWIW the studies I have seen on the prescribing changes are sketchy at best...


I agree there needs to be a company rep on-site for tech support, but they don’t need to provide free lunches or other free items. Their scope should be limited to working on their devices -- not their promotion.
Why shouldnt they have the right to promote their business like any other business?

We need to be responsible and educate ourselves without depending on drug reps. Is there anyone who really believes a rep is going to provide unbiased information? Of course not, because it doesn’t make corporate sense – their job is to make money. Consequently, we need to educate ourselves, such as with Medical Letter, which provides information nonbiased information from pharmacists. The guidelines are also available from our respective societies and, again, we need to take responsibility to keep up on the guidelines. Being an MD means learning all of your life – not just in school.Clearly they are biased.. whether or not I listen is a different story..

There is extensive data that samples are problematic. I address this in depth in my talk, so I’ll only mention a couple points. The samples are typically the “latest ‘n greatest” drugs, which means they are more expensive and likely not covered by insurance. For example, Crestor samples are all over clinic shelves, but it’s quite expensive and not covered by UPMC insurance. There are real alternatives, which I outline in my talk, such as providing poor patients with vouchers or generic-only samples. Different strokes different folks...


I agree completely. The use of direct-to-consumer marketing is quite harmful to the doctor-patient relationship. There can be other methods of educating our patients and we need to do better. However, again, learning about a disease from an unbiased source such as a drug company is NOT wise.I dont think many of us learn about the disease as we pretend to listen to their talk about what their drug does.


I wouldn’t quite agree other issues are more important. Is our going to Canada to get medicine a reasonable solution? Of course not. The drug system in place in our country needs to be reformed, but the lobbying influence of the drug companies is too massive to allow this to happen without a huge fight. The problem with any gifts, be they lunches, pens, or payments for attendings to speak, they change our prescribing patterns inappropriately. How about the lobby of plaintiffs attorneys? Or any other lobby. They hope to influence people, I just dont see the problem. The problem is not with the drug rep or their lunches but rather with the MDs who dont keep up with research.. Maybe your focus needs to shift.

The problem is that we are different in that we need to care for our patients and be their advocates. We aren’t like every other profession, because we have to think first about others before ourselves. Our patients trust us and have faith in our decisions. So, that’s why we should be different. This is not much different than business. You get clients by showing them how you will help them. Then of course you profit by it..Sounds a lot like medicine to me.

Should they be able to advertise? Absolutely. The problem is that I think their market should be limited to only professional media (e.g. NEJM, JAMA, etc.). No need to advertise to the lay person. I actually agree with you here. Lay people think they know more than they do.. thats a problem.

This is the whole issue. We know they wouldn’t just throw massive amounts of generic money into pools without getting real credit, but perhaps they may be willing to spend a fraction, so long as it was known they were contributing. The point is that we need to separate the person who gives the money and the person who receives it. That wouldnt provide a good ROI.

Thanks flighterdoc. I was waiting for someone to say what you did, as this is one of my favorite responses. There’s an amazing amount of arrogance among bright people. There is a tremendous amount of data saying that regardless of how you judge my moral character, the reps do affect how we practice. I just dont believe it.. sorry.. The way I have seen medicine practiced shows there is a disconnect.

The problem is that if it does change prescribing habits, then you are not making unbiased, informed decisions in your patient’s best interest. We need to be advocates for our patients and ensure we aren’t pawns of the drug companies. As opposed to pawns of everyone else? We are nothing more or less than pawns. You can believe otherwise and thats cool but your PD and any attending you work with has his own "agenda" for you. You are their pawn, then you will gain the knowledge and thought processes they feed into you and then you make someone else your pawn.

That’s what they want you to think. That’s why what they are doing will work and be in place for a long time. We keep taking their stuff and keep saying it doesn’t affect us. I am saying I dont care I just want a free lunch, a free pen, a free book, a free reflex hammer, a free thing to hold my ID, and a free Sanford or Pharmocopeia.

I know there are plenty of people out there who need help. My talk outlines at least three different options people can get expensive meds. Also, we need to come up with other options about how to get medicines to the poor. Good luck..

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.
Stupid thread.

Hey, I really like your signature, fighterdoc.

Well, you didn't offer that option in your little Q/A. I didnt think I had to offer a step by step process. You are in Rads.. so..

They don't care so much about the 3 prescriptions you write in your residents clinic (where most patients are on the medicaid HMOs formulary anyway and end up with a gneric substitution). They try to form your young malleable mind so your prescribing pattern once you are out in practice is skewed towards their product. Right.. cause Ill remember the talk they gave me as a student or the talk they gave me as an intern.. My mind is totally screwed, I guess they are wasting their money with me... and you of course since I dont think Rads guys give out prescriptions..


It is ok if you want to be the uncritical stooge of the industry, just don't try to tell me that this without consequences and therefore not a problem. I am not saying that I am not influenced by their tactics, I am just trying to remind myself that they are sales reps and here to make a sale.Yes the name calling has started.. I am very critical of the industry I just think this is the most retarded way of going about it and I am glad 99% of people think this is stupid. I know who they are and why they want to talk to me. I simply tune them out. Its really not that hard since I usually eat, then work on my notes or chat it up with friends. Maybe you are the stooge who hasnt learned how to tune out BS.

Stupid thread.

Hey, I really like your signature, fighterdoc.
Dumb thread... thats why I cant wait for my next free meal! :thumbup:

We had Pompeii last time.. that was sweet.. I dont even remember which drug was there.. I do remember it was Elan Pharma and they gave me a free pharmacopeia..

Right.. cause Ill remember the talk they gave me as a student or the talk they gave me as an intern.. My mind is totally screwed, I guess they are wasting their money with me...
Apparently the brainwash is working quite well.

and you of course since I dont think Rads guys give out prescriptions..
I guess you'll die ignorant then.

Apparently the brainwash is working quite well.

I guess you'll die ignorant then.
Yeah they installed a little microchip in my head. :thumbdown f_w you are the sheep my friend, think a little for yourself its good for you.

I guess I will but I wont be any worse for it.

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch (http://www.nofreelunch.org/)
Why is there not a push to limit drug rep dinners and free gifts to hospital pharmacy and therapeutic committees?

The drug reps can wine and dine those physicians and pharmacists on the committee, and while they may give substantial discounts to the hospital for using their products, it causes a vast majority of patients to be discharged home on the same medicine. Therefore, drug companies make a lot of money off this.

Wooing the P&T committee of a hospital affects prescribing practices way more than wooing a private physician in the community.

Why is there not a push to limit drug rep dinners and free gifts to hospital pharmacy and therapeutic committees?

The drug reps can wine and dine those physicians and pharmacists on the committee, and while they may give substantial discounts to the hospital for using their products, it causes a vast majority of patients to be discharged home on the same medicine. Therefore, drug companies make a lot of money off this.

Wooing the P&T committee of a hospital affects prescribing practices way more than wooing a private physician in the community.
QFT.... :thumbup:

OP, you are correct. No free lunch.

Your presentation is in powerpoint, which is a non-generic language. Are you trying to force me to buy MicroSoft PowerPoint and further enrichen the most wealthy corporation in America? Why didn't you make the presentation available in a generic standard language like HTML? Are you trying to influence me to give up Linux and buy products I know are inferior and cost more? :rolleyes: :rolleyes: :rolleyes:

Everyone and everything is biased. One need read and properly analyse a few published studies to see this. Knowing that biases exist help understand and correct for them. A drug rep lunch/gift/seminar will be biased, we know that and compensate. What about the talk at the national meeting where the investigators have a vested interest (not financial, but ego) and no apparent personal gain. There's bias there too. Years of work going into research yield poor results or we massage the data to make it say what we expected in the first place. It's just more transparent when they come to grand rounds give out coffee and bacon and eggs. They are buying a few minutes of your time with their lunches and cheap pens. Personally, I'd prefer cash at whatever the going hourly rate is. If your time is worth so little or so much that you don't want a drug rep to be in your hospital/office, fine. But we pay for the lunch with the few minutes we spend humoring the reps.

Next, the drug rep dinners do give valuable information, particularly if you have experience with a drug that doesn't work as described or worse, people have a hard time tolerating it. You can be the one to ask the embarrassing question and listen to the detail men scramble to cover the issue and at the same time educate the crowd on the problems that are glossed over.

Next, I read somewhere that in the United States, a free press is highly cherished, or maybe even guaranteed and if a drug company wants to pay for a minute of superbowl time to advertise an expensive alternative, who am I to stop them? If they want to buy me lunch to do the same, so what? I have to explain to 30 patients why the commercial doesn't apply to them with the same Brief/Focused office visit in the 7.2345 minutes allowed by the HMO for patient direct contact time.

Finally, how come rich Canadians are coming to the states for treatment that their own health care system won't can't provide at the price they've decided to pay for it?

Dear drug reps: I think we should have more tai food at our next meeting, err maybe some sushi.

Why is there not a push to limit drug rep dinners and free gifts to hospital pharmacy and therapeutic committees?

Who says there isn't ? The companies know exactly who to target in a given hospital. The margin might not be as good as in outpatient sales, but winning a listing in a hospital formulary will create plenty of volume to make up for it.

Sorry if this has been mentioned, but medicine is not simple business. People can (and do) die because they do not have access to medicine that they need. The thing that bothers me about drug companies is that all of these free lunches, pens, etc. are driving up the cost of medication. I'm not exactly a moral saint, but if my mother couldn't afford her medication, I probably would be less inclined to take all the free crap.

I agree there needs to be a company rep on-site for tech support, but they don’t need to provide free lunches or other free items. Their scope should be limited to working on their devices -- not their promotion.

They are there for 'free' because they are wearing their salesman hat at the same time. If you reduced them to pure support technician, they wouldn't show up.

Look at your imaging equipment. After the sale is done, you are pretty much dead for the manufacturer. Only after paying them either $250/hour or a 50k annual maintenance contract, the mechatron at the call center will be willing to send you a support tech (but not until you have lost an hour of your life you won't get back on arguing over the timing for this service call).

this topic is major bait.
I am enjoying the show.
Please continue.
:D

...if my mother couldn't afford her medication, I probably would be less inclined to take all the free crap.
When you practice and prescribe more, you'll run into more episodes where people can't afford the medicine you want to give them. No, it doesn't happen every day or every week, but it still happens enough to be irritating. This is part of the stimulus for my pursuing this issue.

They are there for 'free' because they are wearing their salesman hat at the same time. If you reduced them to pure support technician, they wouldn't show up.

Look at your imaging equipment. After the sale is done, you are pretty much dead for the manufacturer. Only after paying them either $250/hour or a 50k annual maintenance contract, the mechatron at the call center will be willing to send you a support tech (but not until you have lost an hour of your life you won't get back on arguing over the timing for this service call).
Would they be there as often? No. Is that a bad thing? No, because having reps around has been shown to waste time and detract from patient care (e.g. at least two hours a week for outpatient care). However, they would need to be responsive to any place which would generate repeat business.

Would they be there as often? No. Is that a bad thing? No, because having reps around has been shown to waste time and detract from patient care (e.g. at least two hours a week for outpatient care). However, they would need to be responsive to any place which would generate repeat business.
They waste exactly as much time as I am willing to give them.

Your presentation is in powerpoint, which is a non-generic language. Are you trying to force me to buy MicroSoft PowerPoint and further enrichen the most wealthy corporation in America? Why didn't you make the presentation available in a generic standard language like HTML?
I posted an .htm version, but I certainly it isn't as good as the original .ppt file. For some reason, a couple tables didn't transfer over very well. Regardless, at least it gets folks a chance to look at most of the slides without having PowerPoint.

They waste exactly as much time as I am willing to give them.
The problem is that all they want is face time, because it's that face time that has been shown to make a difference in what we do. Them giving gifts pretty much is entirely designed to ensure they get to talk to you. So, our chosing to give them time is less volitional than we may realize, because of the complex interactions associated with gift-giving. We are all smart enough to believe we are choosing to spend time with them, but the reality is that there is less choice and more obligatory response due to being a gift recipient.

Sorry if this has been mentioned, but medicine is not simple business. People can (and do) die because they do not have access to medicine that they need. The thing that bothers me about drug companies is that all of these free lunches, pens, etc. are driving up the cost of medication. I'm not exactly a moral saint, but if my mother couldn't afford her medication, I probably would be less inclined to take all the free crap.
Well Im a free market type of fellow. You realize that every free meal including those by gas execs, grocery chain execs and any one else drives up the cost of living for these same poor people which then decreases their ability to pay for meds. Maybe big time execs shouldnt fly in their private planes, maybe docs shouldnt drive 100K cars and instead buy a honda and donate the rest. Maybe we should cut all this out as well? :laugh:

I posted an .htm version, but I certainly it isn't as good as the original .ppt file. For some reason, a couple tables didn't transfer over very well. Regardless, at least it gets folks a chance to look at most of the slides without having PowerPoint.
Hey does Al Gore get a cut of the .htm since he invented the internet? Does anyone know if he has a patent on it? :D BTW thanks for no longer supporting MSFT.

Them giving gifts pretty much is entirely designed to ensure they get to talk to you. So, our chosing to give them time is less volitional than we may realize, because of the complex interactions associated with gift-giving.

I don't take gifts. I'll take their food and give them the 12 minutes I have for lunch to tell me about their better mousetrap. Then I say something noncommittal like 'looks interesting, why don't you give some to our stockroom gal and we'll try them if a case comes around that we need this'.

By the way. If you add the letter 'g' to the end of the second verb in the headline of your thread, it becomes much more a slice of reality than in its current form.

1) Good
2) Its good to have your opinion. I am curious what yr you are in in your training. I have seen the studies but my experience is that residents make students go to the lectures and then come and eat when the non drug rep lecture starts. Lets say it does influence my prescribing? Is it effective? If it is then I am doing my job, if it isnt ill get sued.. Thats where the real influence is.
3) Its cool to be all full of hubris but if you think they dont care you are missing the point. Nothing makes a doc prescribe meds more than proof that they work. Believe what you will about this drug rep stuff but even at programs that have no drug rep sponsored stuff they have to use certain meds, the hospitals only stock so many things on formulary.. Do you think the hospital admins get wined and dined.. and of course offered "discount" prices. Lets be serious..

So if you arent gonna be a pawn I assume you will do Path or Rads where you dont really have to prescribe meds. Otherwise no matter what you prescribe you are nothing but a pawn.

Its like believing you have control.. its just a figment of your imagination. My 2 cents..

I guess we will have to agree to disagree..

I'm a tweener, i.e. between med school and internship. My chosen field is peds, with a subspecialty to follow. I'll stay in academic peds, FWIW. If any of this allows further evaluation of my position, then have at it. I suppose it could be that I'm still young (academically anyway) and naive, we'll see what happens to my hubris over the next 6 years. (I'd put a smiley emoticon here, but I've decided to take a firm stance against them for purely moral reasons.)

You raise an interesting point about the hospital's formulary. I hadn't thought about that, and you're right that we're limited to what someone else decided, for whatever reason, was a good drug. I'll have to chew on that for a while.

Back to the pawn issue . . . I again agree that we're stuck for the duration of our training. I guess I hope to develop good habits for when I'm out of training. But as someone interested primarily in inpatient peds, I guess I may never escape the Big Brother Formulary

In all seriousness, thanks for the discussion, I'm getting a lot out of it.

By the way. If you add the letter 'g' to the end of the second verb in the headline of your thread, it becomes much more a slice of reality than in its current form.
:laugh: :laugh: This has been exactly my take. Outside of the office she doesn't even mention Crestor.
By the way did any of you guys see the daily show interview with the former Miss Florida who is now a drug rep. ? Freaking hilarious. Now, back to covering up my free nexium pens with medical tape so as not to be influenced when writing scripts for GERD.

You raise an interesting point about the hospital's formulary. I hadn't thought about that, and you're right that we're limited to what someone else decided, for whatever reason, was a good drug.
Getting a drug on the formulary of an insurance plan or hospital is an important accomplishment for a drug company. That's why attendings are solicited in hospitals, because they are the ones who request changes to a formulary. Data I reference in my talk shows that time spent by a rep with an attending has a direct relationship to drugs being requested as additions to formularies. Even when attendings knew they were being watched, there was an increase in nonformulary drug use and increase in requests for formulary changes.

Reps primarily target trainees to get them used to working with reps, but they target attendings to make real changes in policy (e.g. adding a drug to a formulary). That's why attendings can make an extra $10,000-$80,000 annually speaking on behalf of drug companies. Doctors who attend lectures given by other doctors, as opposed to lectures by reps, are more likely to use the drug at the focus of the lecture. Companies know that and that's why they want doc's to give the lectures.

As trainees, we may benefit from meals, books, and some travel expenses, but we don't really have access to the big bucks attendings see. The only chance big money can influence trainees (ie. residents and fellows) is that some drug and device companies actual fund training spots for programs strapped for cash. Think a program and/or individual is biased when they know a given company is funding a residency or fellowship spot?

I again agree that we're stuck for the duration of our training. I guess I hope to develop good habits for when I'm out of training. But as someone interested primarily in inpatient peds, I guess I may never escape the Big Brother Formulary
As I mentioned above, reps talk to us as trainees to get us used to working with them so that once we finish training we enjoy visiting with them and think well of them and their company. So, habits you learn during training should help you once you're out in the real world.

By the way. If you add the letter 'g' to the end of the second verb in the headline of your thread, it becomes much more a slice of reality than in its current form.
There has actually been an interesting transformation on what makes a rep. It used to be that reps were somehow trained in medicine or science (e.g. nurse or science background in college), so they had a better chance of providing a clinician with information that was important. Now, reps are being hired as more of a salesperson with little/no science or medicine background. They are being hired for their personality and/or good looks. How often do you see an ugly rep or one whose personality you couldn't stand? Not very often. That's not by accident. Yet another way they can get you to spend time with them. Think that brushing of your elbow or shoulder was truly incidental? Of course not. If they are a little flirty, you'll be more likely to visit with them.

I think this comes down to a fairly pedestrian issue: back in the era of medicine being predominantly men, the occasional female drug reps werent an issue at all...but now with a huge surge in women MDs, these far younger, more attractive reps are a big threat to their sexual currency in the medical world.(especially when you consider the attractive young nurse icon has been obliterated, now replaced with the new icon of the very unattractive old nurse from the Phillipines etc.) So subconsciously, they begin rationalizing why reps are bad, evil when in fact the whole issue revolves around them being attention whores.

Sad but true. I really feel sorry for the OP. :(

I think this comes down to a fairly pedestrian issue: back in the era of medicine being predominantly men, the occasional female drug reps werent an issue at all...but now with a huge surge in women MDs, these far younger, more attractive reps are a big threat to their sexual currency in the medical world.(especially when you consider the attractive young nurse icon has been obliterated, now replaced with the new icon of the very unattractive old nurse from the Phillipines etc.) So subconsciously, they begin rationalizing why reps are bad, evil when in fact the whole issue revolves around them being attention whores.

Sad but true. I really feel sorry for the OP. :(
That's just disgusting. Sentiment like that keeps female physicians from the respect they deserve in the workplace. To suggest the OP is doing this out of jealousy is not only beside the point, it's just childish. If that's how you really feel, then it's you that deserves the pity.

Yep, crazy. if most drug reps were middle aged balding men we wouldnt be arguing this. Sad...very sad. If the OP is in fact a man, then I stand corrected. But I think not.

Hey I agree with you, this IS disgusting. So much more important issue plaguing modern medicine than this crap.

..dont turn too green on us!

By the way did any of you guys see the daily show interview with the former Miss Florida who is now a drug rep?

Gimme an Rx! Cheerleaders Pep Up Drug Sales (http://www.mindfully.org/Industry/2005/Cheerleader-Drug-Sales28nov05.htm)

The funniest line in the whole article,
But pharmaceutical companies deny that sex appeal has any bearing on hiring. "Obviously, people hired for the work have to be extroverts, a good conversationalist, a pleasant person to talk to; but that has nothing to do with looks, it's the personality," said Lamberto Andreotti, the president of worldwide pharmaceuticals for Bristol-Myers Squibb. :laugh:

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps (http://www.pitt.edu/~jmf29/). I'm curious what you think and what you are exposed to.


Does it get in the way when you sit down?

The stick in your ass I mean.

Just a note to our young friends: As a resident at a major academic teaching hospital I prescribe what is on the hospital's formulary, eat free lunches and listen to the "wonk wonk wonk" (as an ealier poster put it). MOstof what I write are generics. I hardly even know brand names and only consider writing for them if the patient asks for them, they are equivalent to what I was going to prescribe, and there is an indication.

Just a note to our young friends: As a resident at a major academic teaching hospital I prescribe what is on the hospital's formulary, eat free lunches and listen to the "wonk wonk wonk" (as an ealier poster put it). MOstof what I write are generics. I hardly even know brand names and only consider writing for them if the patient asks for them, they are equivalent to what I was going to prescribe, and there is an indication.

Yes but while you were chowing down you didnt notice the OP foaming at the mouth when she saw the rep had better shoes than her...

There has actually been an interesting transformation on what makes a rep. It used to be that reps were somehow trained in medicine or science (e.g. nurse or science background in college), so they had a better chance of providing a clinician with information that was important. Now, reps are being hired as more of a salesperson with little/no science or medicine background. They are being hired for their personality and/or good looks. How often do you see an ugly rep or one whose personality you couldn't stand? Not very often. That's not by accident. Yet another way they can get you to spend time with them. Think that brushing of your elbow or shoulder was truly incidental? Of course not. If they are a little flirty, you'll be more likely to visit with them.

Actually, the device reps around here are for the most part are former techs and RNs. And yes, some of the reps are middle aged balding men. A creepy personality of course won't fly in the rep arena, they won't make the sales and eventually weeded out by their employers. The ones with a training background are the ones that are actually useful to have around. They are able to pick up on the little tricks that some of your colleagues at other institutions use and might share them with you.

Btw. Your specialty would not exist if we were in that perfect world of purely evidence based medicine and goverment funded studies. You would still work with 7Fr diagnostic catheter systems, there would be no coronary stents and pacemakers would need q6month battery changes.
Yes, there is a certain degree of corruption in our relationships with vendors. But it is this corruption that creates the opportunity for revenue that advances the device sector. I have the greatest respect for the swedish medical system. And while their medical device and pharmaceutical industry is innovative, the money to fund these enterprises is raised through their sales in the US, not through the goverment controlled buying policies in Sweden.

Yes but while you were chowing down you didnt notice the OP foaming at the mouth when she saw the rep had better shoes than her...

I don't know, just reading from all the posts, I'm not sure if the OP is the one foaming at the mouth in this thread. His or her tone has been pretty moderate and reasonable. Others however...

I notice quite a few people says they are not influenced by the drug rep presentations at all. I respect that. But that does not refute the data that has been cited about the pervasive and systemic inpact of this kind of marketing.

I agree the lunches are a small issue in this debate, compared to the other things mentioned (direct to consumer marketing, formularies). but as residents it is worth thinking about how it is already impacting us.

The fault lies with the idiot physician, not with the drug reps.

Learn the frickin' pharmacology. Make friends with your Pharm D. Look at literature for drugs you commonly prescribe (PPIs, antihypertensives, etc.) and draw your own educated conclusions.

The reason we have rampant fluoroquinolone resistance is NOT because drug reps push it. It's because brainless docs write "levo 500" for every damn thing without pausing for a half a second to think about it. How many UTIs have you seen treated with levo when cephalexin or nitrofurantoin or TMP/SMX would work just as well? There was another great quinolone (forget the name) that was run off the market because everyone and their mom used it for everything.

There is a couple of places where generics don't work safely. Antiseizure meds is one -- if you stick to a brand you have guaranteed consistent bioavailability and kinetics. Pharmacies tend to change from one generic manufacturer to another from month to month and I've seen bad things happen with that. SSRIs is another place -- I've seen rapid paroxetine withdrawal when a pharmacy changed from one generic mfr to another.

The fault lies with the idiot physician, not with the drug reps.

Learn the frickin' pharmacology. Make friends with your Pharm D. Look at literature for drugs you commonly prescribe (PPIs, antihypertensives, etc.) and draw your own educated conclusions.

The reason we have rampant fluoroquinolone resistance is NOT because drug reps push it. It's because brainless docs write "levo 500" for every damn thing without pausing for a half a second to think about it. How many UTIs have you seen treated with levo when cephalexin or nitrofurantoin or TMP/SMX would work just as well? There was another great quinolone (forget the name) that was run off the market because everyone and their mom used it for everything.

There is a couple of places where generics don't work safely. Antiseizure meds is one -- if you stick to a brand you have guaranteed consistent bioavailability and kinetics. Pharmacies tend to change from one generic manufacturer to another from month to month and I've seen bad things happen with that. SSRIs is another place -- I've seen rapid paroxetine withdrawal when a pharmacy changed from one generic mfr to another.

The fault lies in the idiot physicians, AND the system. To use an unrelated example, when surgeons operate on the wrong site, or leave gauze or instruments in the patient, you can argue that the fault lies with the individual surgeon. But if you improve the system, by having sign outs, or make sure that there is double counting of instruments and gauze, you reduce the errors. It is NOT a question of blaming/improving the individual vs. the system, but how to do both.

I think this comes down to a fairly pedestrian issue: back in the era of medicine being predominantly men, the occasional female drug reps werent an issue at all...but now with a huge surge in women MDs, these far younger, more attractive reps are a big threat to their sexual currency in the medical world.(especially when you consider the attractive young nurse icon has been obliterated, now replaced with the new icon of the very unattractive old nurse from the Phillipines etc.) So subconsciously, they begin rationalizing why reps are bad, evil when in fact the whole issue revolves around them being attention whores.

Sad but true. I really feel sorry for the OP. :(
:laugh:

Seriously... They might pitch it to docs but I had a drug rep come a while back and tell me how they gave the hospital a "30% discount" on Zosyn or Unasyn.. I dont think the attendings asked for this..

The stick in your ass I mean.
:laugh:

After ACLS today this thread is making my day..

The fault lies in the idiot physicians, AND the system. To use an unrelated example, when surgeons operate on the wrong site, or leave gauze or instruments in the patient, you can argue that the fault lies with the individual surgeon. But if you improve the system, by having sign outs, or make sure that there is double counting of instruments and gauze, you reduce the errors. It is NOT a question of blaming/improving the individual vs. the system, but how to do both.
The thing is the drug reps are nothing more than parts of a business. The fault lies with the physician. Most docs prescribe about 20 different meds. I dont think it is too much to ask of docs to know what they are prescribing. The sales reps "educate" based on what their med is FDA approved for.

This is a raging battle in our program. We are allowed to go to drug rep dinners but there is a big divide among residents and attendings (some on each side) of this issue.

I tend to think that it is exceptionally niave to think that banning med students/residents/fellows/attendings from drug reps is going to solve the problem of profit-mongering of drug reps.

The monetary power of drug companies will not be solved by no more drug rep dinners or pens.

Also, as it stands now, if an academic setting bans drug reps (which are currently a reality of practice), then those in training have no net under them to guide them in thier practice (or alter any potential 'sway' that free dinner might have had). Residents function under attendings and will be forced to justify drug choices (or should be). In theory, academic settings that ban drug reps offer no training or counter to what will become a reality of thier practice.

I personally view them as sport. I love to go and start questioning the research methodologies of the studies presented. Anyone who is going to these things to completely guide practice has more serious problems than drug companies.

With all of the VERY SERIOUS issues facing medicine right now, drug rep dinners rank right up there with the color of the walls in the hospital.

This is a raging battle in our program. We are allowed to go to drug rep dinners but there is a big divide among residents and attendings (some on each side) of this issue.

I tend to think that it is exceptionally niave to think that banning med students/residents/fellows/attendings from drug reps is going to solve the problem of profit-mongering of drug reps.

The monetary power of drug companies will not be solved by no more drug rep dinners or pens.

Also, as it stands now, if an academic setting bans drug reps (which are currently a reality of practice), then those in training have no net under them to guide them in thier practice (or alter any potential 'sway' that free dinner might have had). Residents function under attendings and will be forced to justify drug choices (or should be). In theory, academic settings that ban drug reps offer no training or counter to what will become a reality of thier practice.

I personally view them as sport. I love to go and start questioning the research methodologies of the studies presented. Anyone who is going to these things to completely guide practice has more serious problems than drug companies.

With all of the VERY SERIOUS issues facing medicine right now, drug rep dinners rank right up there with the color of the walls in the hospital.
Thank u for being the voice oif reason

With all of the VERY SERIOUS issues facing medicine right now, drug rep dinners rank right up there with the color of the walls in the hospital.

:thumbup: :thumbup: :thumbup: :thumbup: :thumbup:

This is a raging battle in our program. We are allowed to go to drug rep dinners but there is a big divide among residents and attendings (some on each side) of this issue.

I tend to think that it is exceptionally niave to think that banning med students/residents/fellows/attendings from drug reps is going to solve the problem of profit-mongering of drug reps.

The monetary power of drug companies will not be solved by no more drug rep dinners or pens.

Also, as it stands now, if an academic setting bans drug reps (which are currently a reality of practice), then those in training have no net under them to guide them in thier practice (or alter any potential 'sway' that free dinner might have had). Residents function under attendings and will be forced to justify drug choices (or should be). In theory, academic settings that ban drug reps offer no training or counter to what will become a reality of thier practice.

I personally view them as sport. I love to go and start questioning the research methodologies of the studies presented. Anyone who is going to these things to completely guide practice has more serious problems than drug companies.

With all of the VERY SERIOUS issues facing medicine right now, drug rep dinners rank right up there with the color of the walls in the hospital.

The irony of academic types exposing the evils of drug companies when these same self-righteous aholes are perfectly happy ruling their own little world of corruption.

Seriously, academics prohibit residents from free dinners to protect them from corrupting influences while they use their own sperm to secretly fertilize patients' eggs, take kick backs to move wealthy patients up the tranplant list and collect HUGE government salaries using complex reimbursement scams, all the while raising medical school tuition to obscene levels..classic.

I just laugh at academic docs, such tools in general.

I tend to think that it is exceptionally niave to think that banning med students/residents/fellows/attendings from drug reps is going to solve the problem of profit-mongering of drug reps.
Is it going to completely solve all the problems in the world? Of course not. Will it help remove an unbiased source from our workplaces? Absolutely. My residency program banned reps from interacting with us in the hospital and it was great to go to lunch and meetings without the nuisance of reps and their branded products. Heaven forbid -- we bought our own pens.

Also, as it stands now, if an academic setting bans drug reps (which are currently a reality of practice), then those in training have no net under them to guide them in thier practice (or alter any potential 'sway' that free dinner might have had).
So you're saying you actually want reps to provide training to resident? You're pretty much ignoring all data saying the reps provide a negative influence (e.g. nonrational prescribing, decreased generic use, etc.), not to mention a clearly biased standpoint.

In theory, academic settings that ban drug reps offer no training or counter to what will become a reality of thier practice.
Actually, there is a new process being instituted in some centers called counter-detailing. Detailing is the original term referring to what sales reps do. Counter-detailing is teaching provided by pharmacists, or other non-biased instructor, at your institution and some schools are actually including this type of teaching in med school curricula with a positive influence on prescribing habits. Furthermore, some clinicians actually do ban reps from their office, so you don't have to expect that reps will always be present.

With all of the VERY SERIOUS issues facing medicine right now, drug rep dinners rank right up there with the color of the walls in the hospital.
It's clear not everyone agrees this is an important issue, which I don't have a problem with. Hopefully we each will find some way we want to impact, and improve, the environment in which we work.

Some of the comments made by those here are quite comical. It's as if you are personally threatened that somebody dare suggest that you might be influenced by drug money. Anytime you see somebody ignorantly respond with vehement denials and sarcastic comments you know that that person is or will be a drug whore.

I admit that I am not perfect. I take pens. I take the free lunch b/c my cafeteria sucks. And really, I don't place the blame on the drug reps. I pretty much ignore them and barely acknowlege their presence. The problem is and always will be the doctors. They are the ones selling their integrity to ghost write, to take "payoffs" (yeah, I love the word "honoraria"), and to make easy money with vacuous lectures which are clearly biased.
I don't expect the drug reps to be "fair and balanced" any more than I would expect an Exxon executive to talk about gas prices fairly.

I once attended a great lecture by a doctor who was in industry and it was titled "I'm from Industry - Get Over It." His point was that as an industry employee he had no conflict of interest - you KNOW where he stands. But now, we have all these so-called academic experts who take money from the drug reps and nobody has any idea where they stand and what to believe when they talk.

I agree that banning residents/fellows/students from attending drug rep dinners is completely wrong if the same policy does not hold true for the attendings. In fact, I can imagine that if you're at a place that forbids you to attend, you will be more tempted to do so since it's forbidden.

I admit that I am not perfect. I take pens. I take the free lunch b/c my cafeteria sucks. And really, I don't place the blame on the drug reps. I pretty much ignore them and barely acknowlege their presence. I think this is where most of the posters on here are at (myself included) the op however thinks this is not possible and that we are bing subliminally influenced.

The problem is and always will be the doctors. They are the ones selling their integrity to ghost write, to take "payoffs" (yeah, I love the word "honoraria"), and to make easy money with vacuous lectures which are clearly biased.
I don't expect the drug reps to be "fair and balanced" any more than I would expect an Exxon executive to talk about gas prices fairly.
Right, but just because they are biased doesnt mean they shouldnt be allowed to provide their shpiel. like you mentioned the problem is with docs and how they (we) synthesize this information, nothing more nothing less.

BTW is there proof this effects how residencies change their prescribing habits? I would imagine this holds truer for the small private group who has little to no interaction with academics.

I once attended a great lecture by a doctor who was in industry and it was titled "I'm from Industry - Get Over It." His point was that as an industry employee he had no conflict of interest - you KNOW where he stands. But now, we have all these so-called academic experts who take money from the drug reps and nobody has any idea where they stand and what to believe when they talk. I agree with most of this but they are required to acknowledge that they are working for drug company X. They cant stand there and not tell you. If anything the academic "experts" who whore themselves is a much bigger problem but my libertarian side says so what, let them make money where they can.

BTW is there proof this effects how residencies change their prescribing habits? I would imagine this holds truer for the small private group who has little to no interaction with academics.
Yes, there is a clear influence on residents, regardless of everyone continually saying it doesn't affect them.

One study asked the question of whether or not going to lectures has an influence on drug choices. They looked at a group who went to a lecture vs those in the same program who did not attend and found a clear increase in the lecture-associated drug among those who went to the lecture.

The three things that are most often cited as being impacted in an academic setting by exposure to sales reps are:
1. Decreased generic prescribing
2. Nonrational prescribing
3. Increased prescription costs

Oh man why do I always have to straighten you guys out around here?

OK before I begin my rant, let me say first that healthcare is NOT a free enterprise business like selling cars. Thats a basic fact, and thats the reason we have Medicare, Medicaid, and a ****load of government interference. If healthcare was just pure free market economics, none of that stuff would exist. So dont argue this on grounds of business, because you have already lost that battle. No nation in the world (including the USA) treats healthcare as a free enterprise.

The stink on big pharma (rightly or wrongly) is just slightly less nauseous than the stench tied to used car salesmen. And you want to tie our profession to those greaseballs? You cant walk thru a pig farm without coming out smelling like ****.

For the record, multiple well documented studies have PROVEN that pharma marketing does the following:

1) Changes script habits
2) Increases cost of healthcare
3) Results in no improvement in healthcare outcomes

And for those of you who say "that doesnt affect me it just affects mediocre/poor doctors" please bear in mind that the people in the studies who changed their script habits SAID THE SAME DAMN THING!

Changing script habits is bad for medicine. It results in increased costs with no outcomes improvement.

For all the "advanced" technology that the USA has, there is very little evidence that it results in improved outcomes. I challenge you to show me studies proving that healthcare outcomes in the USA are better than other industrialized nations.

US patients are basically subsidizing marketing/research costs for the whole freakin world. Other nations are getting a free ride off our backs. This is bull**** and needs to stop.

Personally I favor getting rid of the private pharma sector entirely and having the whole thing run by FDA and NIH. Yes, we'll have less "lifestyle" drugs but we will have legitimate research with no marketing influence which is priceless. Furthermore, we'll see more development on drugs that affect billions of people around the world rather than just fat/happy americans who want Viagra.

Big pharma is a sinking ship. Its absolutely foolish to attach the reputation of doctors and the medical profession to a bunch of scoundrels.

Oh man why do I always have to straighten you guys out around here?


US patients are basically subsidizing marketing/research costs for the whole freakin world. Other nations are getting a free ride off our backs. This is bull**** and needs to stop.


I have been saying this forever. I completely agree.

AMEN

i love drug dinners
2 words: open bar
I'm usually too drunk to know what the hell they're talking about, and by morning i definitely don't remember

Personally I favor getting rid of the private pharma sector entirely and having the whole thing run by FDA and NIH. Yes, we'll have less "lifestyle" drugs but we will have legitimate research with no marketing influence which is priceless.

It is kind of a dreary rainy day around here, but this post really brightened it up. I had to laugh so hard, a piece of the drug-rep provided bagel got stuck in my larynx and I almost suffocated.

No thread is complete without an expression of sexual insecurity from LADoc and a rant against midlevels from McGyver. So, please indulge us. For starters, haven't you observed that PAs are easy prey to the marketing ploys of drug-reps ?

EF- *gasp* we actually agreed on something??? :eek:



NOPDM:


Is it going to completely solve all the problems in the world? Of course not. Will it help remove an unbiased source from our workplaces? Absolutely. My residency program banned reps from interacting with us in the hospital and it was great to go to lunch and meetings without the nuisance of reps and their branded products. Heaven forbid -- we bought our own pens.

An unbiased source? There is absolutely no unbiased source in the workplace. This is some of the niavete that I was speaking of. Any information given to you should be questioned, regardless of the source.

So you're saying you actually want reps to provide training to resident? You're pretty much ignoring all data saying the reps provide a negative influence (e.g. nonrational prescribing, decreased generic use, etc.), not to mention a clearly biased standpoint.

:laugh: How on earth did you get to this point? I never said that residents/etc should be educated by drug reps... What a preposterous conclusion! My point was (and your selective quoting certainly did a nice job of confusing it) that drug reps are a fact of life right now. If residency programs ban them, then virgin MD's graduate from practice never having been exposed to them. Residency is a great time to get exposed because there is the safety net of attendings/conference and education. Thus if a niave resident starts to quote a drug rep study, then someone is there to teach them about the inherint bias as well as hopefully how to READ and ANALYZE a study.

Regarding 'studies', surveys are NOTORIOUSLY weak studies. They have HUGE INHERENT flaws. To make broad sweeping generalizations based on weak studies flaws any arguement. Are some people influenced by drug reps? absolutely. Are ALL people? no.

Passing inefficient laws are not going to fix what some believe to be the intrinsic problem. Education will.

The depth of problems with drug companies are extensive. This just doesn't seem to be a very important one. Monopolies, high cost, excessive subsidies, lack of vaccinations because of poor profit margins... etc etc etc. I just havea hard time getting excited about such a minor issue.

For the record, multiple well documented studies have PROVEN that pharma marketing does the following:

1) Changes script habits
2) Increases cost of healthcare
3) Results in no improvement in healthcare outcomes

It should read, multiple poorly done studies..

For all the "advanced" technology that the USA has, there is very little evidence that it results in improved outcomes. I challenge you to show me studies proving that healthcare outcomes in the USA are better than other industrialized nations. This is a silly argument since no other nation is as obese, sedentary and unhealthy as ours. Its a miracle we are even in the ballpark with other countries.

US patients are basically subsidizing marketing/research costs for the whole freakin world. Other nations are getting a free ride off our backs. This is bull**** and needs to stop.100% agree here. :thumbup:

Personally I favor getting rid of the private pharma sector entirely and having the whole thing run by FDA and NIH. Yes, we'll have less "lifestyle" drugs but we will have legitimate research with no marketing influence which is priceless. Furthermore, we'll see more development on drugs that affect billions of people around the world rather than just fat/happy americans who want Viagra. Wrong conclusion. The government is biased in itself and there is nothing the govt could do that would be better than private industry. There is little to no incentive for any efficiency in the govt. There isnt a single area where the govt has or can outperform private business. Also if you are arguing that we shouldnt let other people ride on our backs then you mention we can help billions of non americans?

Big pharma is a sinking ship. Its absolutely foolish to attach the reputation of doctors and the medical profession to a bunch of scoundrels. I def wouldnt attach myself to them, but a sinking ship? Their profits suggest otherwise.

EF- *gasp* we actually agreed on something??? :eek:

Miracles do happen :)

Regarding 'studies', surveys are NOTORIOUSLY weak studies. They have HUGE INHERENT flaws. To make broad sweeping generalizations based on weak studies flaws any arguement. Are some people influenced by drug reps? absolutely. Are ALL people? no. .

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.
I dont agree. If someone buys me a beer (who I dont know) am i influenced(in a non etoh kind of way)? Im not stupid enough to think that pharma reps are doing it out of the goodness of their hearts but it doesnt mean i want to be their best friend or prescribe their med.

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet ***** perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip. .

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

:sleep:

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

:sleep:
You are kidding right? 1st how can you call me ignorant if you dont know me? Every job has some perk, if I build cars for GM me and my union buddies get discounts on the cars. When we attend meetings we get a free lunch. Electrical engineer without perks? Please... Unless he was self employed. You might not look at it like a perk but im sure he got some free things thrown his way. Maybe a bag at an E.E. conference or a book?

I have worked blue collar jobs, both of my parents did as well they both got better perks than Docs do. Back in the day my dad drove cabs that got him some benefits, not necessarily from the cab company but from other businesses he helped. I worked in a pizza shop, i got free food these my friend are perks. Everyone gets perks, some bigger some smaller, some more obvious than others dont be too ignorant to realize that.

Like the line in south park you got served...

BTW i want you to explain to me why a perk like a free lunch should be eliminated? Perhaps what they need to do is be more careful in CT scanning everyone or orders unnecessary tests.. this would save even more $$$

Blue collar workers - no perks.

You don't know what the hell you are talking about.

I worked a Burger King and you better believe that I got perks. I could stop by whenever I wanted and get free food.

I bartended in college. I got in for free and drank for free all night long. I only had to pay half cover for any concerts

I worked at a gas station. All of the vendors that came by gave me free stuff; posters, t-shirts, inflatable beer signs, cases of soda, and chips.

I worked construction/roofing for a while. All the sub-contractors let me use their equipment when I was building furniture for myself. The also let me use any "extra" materials they had.

You don't know what the hell you are talking about.

I worked a Burger King and you better believe that I got perks. I could stop by whenever I wanted and get free food.

I bartended in college. I got in for free and drank for free all night long. I only had to pay half cover for any concerts

I worked at a gas station. All of the vendors that came by gave me free stuff; posters, t-shirts, inflatable beer signs, cases of soda, and chips.

I worked construction/roofing for a while. All the sub-contractors let me use their equipment when I was building furniture for myself. The also let me use any "extra" materials they had.
Thank you for explaining the obvious again to some of our more clueless friends.

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.

Not if you don't pay attention to who the free gifts are from.

Ask me who paid for all the free drinks at the last phamaceutical reception I attended, and I'll probably tell you "Shiner Bock."

Lesson: academia, HMOs and big corporate medicine sucks. You have no control over much and are left to the whims of activist MD types who will make it their do gooding mission to take away your free lunch. Private prac is the only way to go, and private prac being a business, if drug reps want to come to my office and dance on a stripper pole while pouring cocktails, more power to em.

Lesson: academia, HMOs and big corporate medicine sucks. You have no control over much and are left to the whims of activist MD types who will make it their do gooding mission to take away your free lunch. Private prac is the only way to go, and private prac being a business, if drug reps want to come to my office and dance on a stripper pole while pouring cocktails, more power to em.

(Light bulb flickering a bit, then illuminating...) Stripper poles in the break room! Genius!! :thumbup: :thumbup:

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

:sleep:

And here we have a person who has clearly never had a job before.

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.


Actually, I'm not. I am not a sheep. I am probably more of a pain in the arse for drug reps because I have a strong research bent and thus question anything that comes out of thier mouth.

Medical surveys and sociological experiments are weak studies. period. Making broad sweeping judgements about every single mecdical person based on weak studies is NOT common sense nor based in decent research.

And common sense? We aren't so great at that either... It was common sense that the reason postmenopausal women needed estrogen to avoid heart attacks until we realized oops, gives them heart attacks. Was common sense at one point that the world was flat.

Science is NOT based on common sense. Or it shouldn't be. It should be based on solid, well researched studies.

And here we have a person who has clearly never had a job before.
:thumbup:

All you pompous self-righteous people who think you are "too noble" to be influenced by marketing, please step up and receive your comeuppance.

Study after study has proven that you guys are LIARS.

One infamous study analyzed script data and surveys from over 50,000 doctors who were exposed to a pharma marketing pitch. The script data proved CONCLUSIVELY that their script habits were changed, and that the changed scripts resulted in NO IMPROVEMENT TO PATIENT CARE BUT MUCH HIGHER DRUG COSTS.

And then the kicker comes in. The VAST MAJORITY of the doctors surveyed said that they were "above influence" and that it was only "other doctors" whose script habits were changed. Thats right. The guys who changed their scripts the most were the SAME DOCS WHO SAID IT DIDNT AFFECT THEM!

Does that sound familiar to you guys, because that is EXACTLY the same argument you hold firm to.

Lets get real here guys. Nobody is saying that marketing causes doctors to make nefarious decisions that result in bad patient care. Nobody is claiming that doctors are letting patients stay sick because they arent scripting the right drugs. Its NOT A CONSCIOUS DECISION, ITS SUBCONSCIOUS. Doctors arent thinking to themselves "well I just got a free lunch so I need to get their back" its NOT A COGNITIVE DECISION, ITS A SUBCONSCIOUS DECISION.

Here's a typical scenario.

Doc attends a drug lunch for drug X which treats diabetes. Drug X is a brand new "me too" drug that costs twice as much as generic drug Y. Doc thinks nothing of it, not really paying attention to the drug rep, and then goes to his clinic. In clinic he sees a new patient with diabetes. When pondering the drug choices available, he defaults to drug X instead of drug Y. Again, this is NOT a conscious decision, its more along the lines of a subconscious decision based on increased familiarity with drug X. Drug X is not superior/inferior to drug Y, on health terms they are about equals. So the doctor doesnt think twice about scripting X instead of Y.

Guys, get off your high horse. The science has PROVEN that doctors are affected by pharma marketing, no matter how "high and mighty" you think you are. Again, its not a conscious decision, its SUBCONSCIOUS based on increased familiarity with the expensive "me too" drugs that most pharma companies push on docs.

Eh, this is all overkill. I don't go to drug dinners/retreats and never will because that's too much. But to go to grand rounds at my school with lunch paid for by some drug company? I go to grand rounds because I'm expected to -- I don't care who pays for the food.

US does not "sponsor" all of the world's drug research. The US drug costs are a reflection of the litigious society based on illiterate jurors (oh no, a fatass midwesterner with uncontrolled DM2 and CAD took one Vioxx and keeled over, let's give him 20 million, it was obviously the Vioxx that did him in). Canada and Europe are free markets that are less corrupted by lawyers, lawsuits, and a completely broken healthcare system. It's like the gas prices -- the pharm industry will charge what the market will bend over and take.

One more note: we are talking about AVERAGES here, not individuals. You dont base policy on INDIVIDUALS, you sculpt it based on AVERAGES.

Do you really think the big pharma companies are just throwing this money away if it doesnt change script habits?

These guys dont leave ANYTHING to chance. They spend billions of dollars on marketing campaigns, and they do a ****load of market research to make sure its having the desired impact.

Every "free" lunch you partake in, every drug pen you get, every golf trip you get sponsored for is passed on to the patient as higher drug prices.

The big pharma conglomerates arent stupid guys. They KNOW for a fact you guys are suckers just like everybody else for marketing. They dont spend billions of dollars just for the hell of it. The joke is on YOU

Eh, this is all overkill. I don't go to drug dinners/retreats and never will because that's too much. But to go to grand rounds at my school with lunch paid for by some drug company? I go to grand rounds because I'm expected to -- I don't care who pays for the food.

Of course you dont care. No doctor "cares." But the data PROVE that it changes script habits, which is independent of whether you "care" or not.

Of course you dont care. No doctor "cares." But the data PROVE that it changes script habits, which is independent of whether you "care" or not.
Im not even gonna go over your "points" here is the bottom line and IMO no one can challenge this. I got my MD it is my decision to prescribe whatever I want. I want choice if Pfizer or Merck or anyone else wants to spend money convincing me thats fine. In the end wouldnt it also just balance out? Of course I would be prescribing new (and more costly) drugs but isnt that my prerogative and I dont think anyone should be able to take that away from me.

On another note I have never and prob wont ever go to a dinner because I have a life and I would rather spend it with my family or friends and not some drug rep, even if they give away a $100 meal.

One more note: we are talking about AVERAGES here, not individuals. You dont base policy on INDIVIDUALS, you sculpt it based on AVERAGES. Good point..

Do you really