Drug Industry to Announce Revised Code on Marketing

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from NY Times:

By GARDINER HARRIS
WASHINGTON — The pens, pads, mugs and other gifts that drug makers have long showered on doctors will be banned from pharmaceutical marketing campaigns under a voluntary guideline that the industry is expected to announce Thursday. The industry’s Code on Interactions with Health Care Professionals will ask the chief executives of large drug makers to certify in writing that “they have policies and procedures in place to foster compliance with the code.” The code was written by the Pharmaceutical Research and Manufacturers of America, the industry’s trade association. But the code provides no definite limits on the millions of dollars spent on speaking and consulting arrangements that drug makers have forged with tens of thousands of doctors. Nor does it ban the routine provision of office breakfasts and lunches, or the occasional invitation to educational dinners at fancy restaurants. “Informative, ethical and professional relationships between health care providers and America’s pharmaceutical research companies are instrumental to effective patient care,” said Richard T. Clark, chief executive of Merck and chairman of the trade association. Some industry critics praised the new rules.
“We’ve been pushing to see reforms like this for some time now,” said Senator Herb Kohl, a Democrat from Wisconsin. “Consumers will undoubtedly be the beneficiaries of these industry changes.” Mr. Kohl has co-sponsored a bill to require drug and medical device companies to publicly disclose payments to doctors of $500 or more. Other critics dismissed the new rules, which are entirely voluntary. “It strikes me as an attempt to persuade people against doing anything that’s serious,” said Sharon Treat, executive director of the National Legislative Association on Prescription Drug Prices. A growing number of states have passed or are considering legislation requiring drug makers to disclose payments to doctors. Minnesota has banned gifts to doctors valued at more than $50, including food; Massachusetts is considering a similar ban. Earlier this year, Christopher A. Viehbacher, now president for North American pharmaceuticals at GlaxoSmithKline, wrote to Gov. Deval Patrick of Massachusetts and Speaker Salvatore F. DiMasi of the state’s House, suggesting his company might not invest as much in Massachusetts if “political developments” worked to “devalue” its assets there.
Mr. Viehbacher said that the proposed gift ban would make Massachusetts “the most hostile state in the nation when it comes to biopharmaceutical sales.” But after years of opposing state efforts to require disclosures of payments to doctors, Pharmaceutical Research and Manufacturers of America recently announced support for the legislation to create the national registry of such payments, sponsored by Mr. Kohl and Senator Charles E. Grassley, a Republican from Iowa. On Wednesday, Attorney General William H. Sorrell of Vermont released that state’s annual report on pharmaceutical marketing efforts. As in past years, the state found that drug makers gave more money to psychiatrists than to doctors in any other specialty. Eleven psychiatrists in the state received an average of $56,944 each. Seven of the 10 most marketed drugs in Vermont treat psychiatric conditions. The report found that 84 drug companies spent more than $3 million in the 2007 fiscal year to market their products in the state, a 33 percent increase over reported expenditures the year before.
The new marketing code requires drug makers to set annual limits on the amounts they will pay doctors to deliver educational lectures to colleagues, although the code does not specify what the limit should be. Such a cap will require drug makers to track across divisions the amounts paid to doctors, which could make complying with a national registry far easier. The drug industry last updated its marketing code in 2002, when it banned “dine and dash” events in which drug makers provided free take-out dinners, Christmas trees and gas to doctors who agreed to listen to brief sales pitches. The earlier code also banned golf outings and free tickets to sporting events, bans which remain in effect. The new code takes effect in January. But neither the earlier rules nor those expected to be announced Thursday apply to biotechnology or medical device makers, many of which continue to give expensive gifts and resort vacations to high-profile physicians. Billy Tauzin, president of the drug industry trade association, said, “This updated code fortifies our companies’ commitment to ensure their medicines are marketed in a manner that benefits patients and enhances the practice of medicine.”
 
That is all well and good, but why don't they reduce the damn magazine and television ads. It would save a hell of a lot more money than getting rid of pens and post-its.
 
That is all well and good, but why don't they reduce the damn magazine and television ads. It would save a hell of a lot more money than getting rid of pens and post-its.

As I understand it, it is all because there are two major components of pharmaceutical marketing, the patient side, and the physician side. Public opinion generally has more of a problem with the latter. People don't like to hear about the pharm industry's attempt at influencing doctors through lunches, trips, and office supplies. So in order to alleviate public concern, the pharmaceutical PR department probably decided that it is not worth the money or public backlash to continue marketing to doctors. They make a good bit of money from advertising to patients who then go to their primary care provider to demand the latest and greatest, and in significant number of cases, they get what they want. Bottom line, selling the benefits of a particular drug to patients is far easier and, in turn more lucrative, then trying to convince doctors who actually studied pharmacology. That is why free pens and post-it notes might dissapear, but commercials suggesting a pill to treat erectile dysfunction will continue to be aired on TV and printed in magazines.
 
As I understand it, it is all because there are two major components of pharmaceutical marketing, the patient side, and the physician side. Public opinion generally has more of a problem with the latter. People don't like to hear about the pharm industry's attempt at influencing doctors through lunches, trips, and office supplies. So in order to alleviate public concern, the pharmaceutical PR department probably decided that it is not worth the money or public backlash to continue marketing to doctors. They make a good bit of money from advertising to patients who then go to their primary care provider to demand the latest and greatest, and in significant number of cases, they get what they want. Bottom line, selling the benefits of a particular drug to patients is far easier and, in turn more lucrative, then trying to convince doctors who actually studied pharmacology. That is why free pens and post-it notes might dissapear, but commercials suggesting a pill to treat erectile dysfunction will continue to be aired on TV and printed in magazines.

I am pretty curious actually. I know many drug reps, and from what I gather from them, physician marketing is far more effective than patient marketing in increasing scripts. At least they kept free meals though, they must realize that if they got rid of those the physician marketing opportunity door would slam shut on their fingers and fast!
 
I am pretty curious actually. I know many drug reps, and from what I gather from them, physician marketing is far more effective than patient marketing in increasing scripts. At least they kept free meals though, they must realize that if they got rid of those the physician marketing opportunity door would slam shut on their fingers and fast!

of course. that makes sense. A patient sees a commerical, he still has to A) have a PCP and have insurance, B) make an appointment, C) remmeber what drug he wanted to ask about, and D) have the doctorb write the script. That's a lot of steps. And frankly most patients don't demand medicines. A small (and loud) proportion does, but most don't. Most will just listen to what the doctor tells them.

A doctorb hears about a newer, expensive worthless drug like Nexium, will prescribe it ad nauseum to every patient that he sees.
 
There really is no harm in hearing what a drug rep has to say. Yes, they probably do cost money in terms of lost patient contact time in a very busy practice, but ethical violations, PLEASE! That's a load of moral crusading crap. If it wasn't for the drug reps, I wouldn't know half the drugs that I now see on formulary at different hospitals that I work at today. Doctors are smart enough to take what the reps have to say with a heavy grain of salt. We know it's biased. We didn't go to school for 20 something years to be duped. Though, yes exceptions do occur, it's not a majority. I really think it's harmless to receive gifts from them. For the most part, it's just free advertising, but with a practical end attached to it.

And yes, it's a hell of a lot better and cheaper to pitch these drugs directly to doctors, than to the masses of patients through TV and print. Because in the end, who are the patients going to eventually have to ask? It's the doctors.
And guess who in most of these cases is also going to say that the drug they're asking for is a bunch of crap and here's a cheaper more effective alternative? Bingo! It's the doctors.

DO NOT PISS US OFF! WE ARE THE GATEKEEPERS THAT KEEP YOU A$$HOLES IN BUSINESS! DO NOT FORGET THAT! LEAVE OUR FREE OFFICE SUPPLIES AND FOOD ALONE!😡
 
There really is no harm in hearing what a drug rep has to say. Yes, they probably do cost money in terms of lost patient contact time in a very busy practice, but ethical violations, PLEASE! That's a load of moral crusading crap. If it wasn't for the drug reps, I wouldn't know half the drugs that I now see on formulary at different hospitals that I work at today. Doctors are smart enough to take what the reps have to say with a heavy grain of salt. We know it's biased. We didn't go to school for 20 something years to be duped. Though, yes exceptions do occur, it's not a majority. I really think it's harmless to receive gifts from them. For the most part, it's just free advertising, but with a practical end attached to it.

And yes, it's a hell of a lot better and cheaper to pitch these drugs directly to doctors, than to the masses of patients through TV and print. Because in the end, who are the patients going to eventually have to ask? It's the doctors.
And guess who in most of these cases is also going to say that the drug they're asking for is a bunch of crap and here's a cheaper more effective alternative? Bingo! It's the doctors.

DO NOT PISS US OFF! WE ARE THE GATEKEEPERS THAT KEEP YOU A$$HOLES IN BUSINESS! DO NOT FORGET THAT! LEAVE OUR FREE OFFICE SUPPLIES AND FOOD ALONE!😡

Right on!

I may be a Former AMSA chapter pres but it does not mean I agreed with the anti advertise drug crap!

I hate the commercials on TV sometimes they do not even make sense.

from the Celebrex backfired comercial "All NSAIDS Have the same Warnings" has been understood by average Joe to mean "All NSAIDS are the same"

"VIVA VIAGRA" To " I just had major abdominal surgery and half my intestines resected, My Doctor gave me TYlenol the real drug for pain".

LOL

Dressing spokes people in white coats to look like Doctors.

Only very few of the commercials have real Doctors in them.

We need some of the teaching material and models we get for free because of the mention of a drug on it, After awhile I do not notice the darn drug on the model.
 
WHats the next crazy crusade...... Samples?

Education is already being attacked, How Dare those Drug companies have dinners to teach about the new breakthroughs, attracting the (Evil) Doctors to the lectures, How come only the Doctors?

This money could be spent on the needy who cannot afford the expensive medicines.....................Yea right it just will not be spent at all.🙄
 
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Sorry Leemer and Oldpro. Though you may think there is no harm in receiving small gifts and free lunches from the pharmaceutical companies, the evidence contradicts you. Don't feel bad. Like you, most physicians believe that their interaction with drug reps has no influence on their prescribing habits. However, many studies have shown that receipt of gifts influences prescribing behavior (makes doctors more likely to prescribe the company's drug, makes docs less likely to prescribe generics, etc.).

Samples are even worse. Since the sample is always less than a full course of treatment, the patient will end up receiving a prescription for that drug, which will almost never be a generic or the least expensive option. Also, studies have shown that the majority of samples actually end up being used by the doctor and the staff working in the clinic, not patients.

Here are a couple of excellent review articles you should check out. There is a reason the drug companies spend billions buying you pens and giving you samples. They know it will increase their sales.

[FONT=verdana,arial,helvetica,sans-serif]Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?.
[FONT=verdana,arial,helvetica,sans-serif] Ashley Wazana
JAMA. 2000;283:373-380.
.

[FONT=verdana,arial,helvetica,sans-serif][SIZE=-1]Doctors and Drug Companies
[/SIZE].[FONT=verdana,arial,helvetica,sans-serif][SIZE=-1] Blumenthal, David[/SIZE].
[FONT=verdana,arial,helvetica,sans-serif][SIZE=-1]N Engl J Med 2004 351: 1885-1890.[/SIZE].
 
There really is no harm in hearing what a drug rep has to say. Yes, they probably do cost money in terms of lost patient contact time in a very busy practice, but ethical violations, PLEASE! That's a load of moral crusading crap. If it wasn't for the drug reps, I wouldn't know half the drugs that I now see on formulary at different hospitals that I work at today. Doctors are smart enough to take what the reps have to say with a heavy grain of salt. We know it's biased. We didn't go to school for 20 something years to be duped. Though, yes exceptions do occur, it's not a majority. I really think it's harmless to receive gifts from them. For the most part, it's just free advertising, but with a practical end attached to it.

And yes, it's a hell of a lot better and cheaper to pitch these drugs directly to doctors, than to the masses of patients through TV and print. Because in the end, who are the patients going to eventually have to ask? It's the doctors.
And guess who in most of these cases is also going to say that the drug they're asking for is a bunch of crap and here's a cheaper more effective alternative? Bingo! It's the doctors.

DO NOT PISS US OFF! WE ARE THE GATEKEEPERS THAT KEEP YOU A$$HOLES IN BUSINESS! DO NOT FORGET THAT! LEAVE OUR FREE OFFICE SUPPLIES AND FOOD ALONE!😡

So your saying that there is, in fact, a transaction. And a transactional mindset. But that it in no way whatsoever affects your prescribing patterns.

You want your free stuff. But according to you it is ostensibly of no value to the benevolent drug reps except to inform you.

I'm not saying that as a broke resident I wouldn't eat some free food. But I wouldn't claim that my animal instincts around a full belly are only informative in nature either.
 
Sorry Leemer and Oldpro. Though you may think there is no harm in receiving small gifts and free lunches from the pharmaceutical companies, the evidence contradicts you. Don't feel bad. Like you, most physicians believe that their interaction with drug reps has no influence on their prescribing habits. However, many studies have shown that receipt of gifts influences prescribing behavior (makes doctors more likely to prescribe the company's drug, makes docs less likely to prescribe generics, etc.).

I love this line of reasoning.

So you're saying that a new drug comes to market, and reps come to tell physicians about it. Physicians consider the pros & cons, and based on that will often prescribe the new drug, all the while using a new pen and eating lunch.

Okay okay, wait, lets break it down even simpler.

1) New drug comes to market, approved by the FDA
2) Physician learns about new drug
3) Physician prescribes new drug

Holy m***** f***ing hell! What are physicians thinking?! That's just disgusting. To think that physicians would give their patients a new drug instead of an old drug. Disgusting.

Clearly this needs to stop. In fact, I recommend doing away with all CME in addition to drug reps, lest physicians learn about new drugs and techniques. Further more, it is ridiculous that all these "new editions" of text books are published, and all these "research" articles. Clearly this new information is swaying physicians, influencing their prescribing habits.
 
I love this line of reasoning.

....and reps come to tell physicians about it. Physicians consider the pros & cons...
I'd say that's a pretty big assumption. Followed by an even loftier assumption involving the supposed impervious nature of a physician's education, as if that supercedes the inclinations of us as just another bipedal primate on the block. We are social animals after all. Suckers for a pair of tits, smiling face, warm full belly, etc. Not to mention the cases of expensive scotch, free golf trips and clubs, and the thousands in fees that some physicians make informing other physicians about the benefits of the latest pharmaceuticals.
 
I love this line of reasoning.

So you're saying that a new drug comes to market, and reps come to tell physicians about it. Physicians consider the pros & cons, and based on that will often prescribe the new drug, all the while using a new pen and eating lunch.

Okay okay, wait, lets break it down even simpler.

1) New drug comes to market, approved by the FDA
2) Physician learns about new drug
3) Physician prescribes new drug

Holy m***** f***ing hell! What are physicians thinking?! That's just disgusting. To think that physicians would give their patients a new drug instead of an old drug. Disgusting.

Clearly this needs to stop. In fact, I recommend doing away with all CME in addition to drug reps, lest physicians learn about new drugs and techniques. Further more, it is ridiculous that all these "new editions" of text books are published, and all these "research" articles. Clearly this new information is swaying physicians, influencing their prescribing habits.

New doesn't necessarily mean better. For example, new statins and statin blends are released by big pharma every year. Most are basically equivalent to all of the old statins, including the generics. Yet, these are some of the most heavily marketed drugs, since they are taken indefinitely. You got the process pretty much right. Drug rep comes and "teaches" the doctor about the great new statin, leaving behind pens, calendars, pads, and free lunch. The doctor starts prescribing the drug. The company makes money. The patient's care probably doesn't suffer, but maybe a generic could have been tried first.

If there is a new treatment that is impressive and creates a new standard of care, docs shouldn't need company reps to inform them about it. They should be reading about it in the New England Journal. If a new treatment is similar to old treatments, docs don't really need to be informed about it. They will know to try it after trying the most inexpensive, medically indicated treatments simply by looking at their prescriber's reference.

You do realize that drug reps are not educators or scientists. They are marketers. Their single goal is to influence a physician to prescribe their product more often, and they are very effective at achieving that goal. The research shows that receipt of a gift or a visit from a rep results in increased prescription of that drug. That is a problem. Prescribing habits should not be influenced by company marketing. They should be based on scientific evidence of efficacy and safety.
 
New doesn't necessarily mean better. For example, new statins and statin blends are released by big pharma every year. Most are basically equivalent to all of the old statins, including the generics. Yet, these are some of the most heavily marketed drugs, since they are taken indefinitely. You got the process pretty much right. Drug rep comes and "teaches" the doctor about the great new statin, leaving behind pens, calendars, pads, and free lunch. The doctor starts prescribing the drug. The company makes money. The patient's care probably doesn't suffer, but maybe a generic could have been tried first.

If there is a new treatment that is impressive and creates a new standard of care, docs shouldn't need company reps to inform them about it. They should be reading about it in the New England Journal. If a new treatment is similar to old treatments, docs don't really need to be informed about it. They will know to try it after trying the most inexpensive, medically indicated treatments simply by looking at their prescriber's reference.

You do realize that drug reps are not educators or scientists. They are marketers. Their single goal is to influence a physician to prescribe their product more often, and they are very effective at achieving that goal. The research shows that receipt of a gift or a visit from a rep results in increased prescription of that drug. That is a problem. Prescribing habits should not be influenced by company marketing. They should be based on scientific evidence of efficacy and safety.


You are wrong. There are many drugs i didn't know about if it wasnt for a drug rep dinner. I didnt prescribe many of them but even now I am surprised every now and then with a drug I didnt know about. Not all are a new class but for example I still remember when Tygacil came out and it was a new class of its own. If it wasnt for the reps I would have never considered it. There are a lot of little things I would certainly like to know about like the fact that they now have a drug in SR or XL... this matters to me and the patient. Yes the generic might be cheaper but the patient might be more compliant if I give them 1 pill a day instead of 3 pills a day. Taking 3 pills a day on time for the rest of your life is way harder than 1 pill. Did we discover a GREAT new finding? No... but I managed to make the patient take his meds on time. But yeah you dont care about that.

This is really a negative thing for residents. People who dont prescribe daily dont understand this.
 
I love this line of reasoning.

So you're saying that a new drug comes to market, and reps come to tell physicians about it. Physicians consider the pros & cons, and based on that will often prescribe the new drug, all the while using a new pen and eating lunch.

Okay okay, wait, lets break it down even simpler.

1) New drug comes to market, approved by the FDA
2) Physician learns about new drug
3) Physician prescribes new drug

Holy m***** f***ing hell! What are physicians thinking?! That's just disgusting. To think that physicians would give their patients a new drug instead of an old drug. Disgusting.

Clearly this needs to stop. In fact, I recommend doing away with all CME in addition to drug reps, lest physicians learn about new drugs and techniques. Further more, it is ridiculous that all these "new editions" of text books are published, and all these "research" articles. Clearly this new information is swaying physicians, influencing their prescribing habits.


But to say it better from my own experience--because the assault on a profession I am not a part of is not my goal--I think there are multiple tensions within your profession. One is the professionalism involved in becoming a physician means that nearly all physicians will conform to some basic principle of ethical service to their clients. The other is that there is excessive amounts of material available for the rationalization of making money or receiving benefits from being the gatekeepers to one of the largest industries the world has ever seen.

In my experience as a patient this has meant that there is a pretty wide range of ethics that are accepted as professionally sound. On the one hand there are those such as yourself who--if I understand it correctly--will be on the other side of world trying to keep men and women alive who are serving their country and who would probably do anything to help your patients and then there is quite another sort of physician, who chameleon-like, will adopt the principles of whatever organization they are apart of be to the extent that they serve the profit-motive of their company over any professional code of ethics.

Maybe it's too simplistic to want the good guys over here and the bad guys over there, but it the sense of the doctor-patient relationship, I for one believe it is that simple. And to that end what ever prejudices, financial or otherwise, the doctor brings to the encounter, the patient by whatever small degree is done a disservice by more convenient or more alluring constituents.

Having said that, if you put free food in my face I will eat it--no questions asked.
 
Look the drug reppery just needed to be toned down a little and perhaps taken a little underground.

I can remember playing a round of golf at a course that costs $250 on a drug rep's bill. I was the 16 y/o son of a doctor and I tagged along for the free breakfast, the round of golf and the dinner. That is obviously a gross misuse of money considering that said money is essentially a part of the cost to patients.

Now they have eliminated most of that outrageous stuff (golf, trips to acapulco, and so on) and frankly pens and paper are not really necessary for a doctor to do his job. Furthermore, they are essentially the beacon light screaming to the world whenever they enter a doctor's office that this sort of thing is going on. I just saw a cartoon in the New Yorker the other day (I can't find it for the life of me though) with a doctor standing by a patient looking like a Nascar driver with ads sewn all over his suit and plastered on his walls. Perhaps eliminating some of the "appearance of influence" is not such a bad thing.

I can certainly agree with tired though. Drug rep presentations are necessary and not a bad thing in any way. Moving forward, if you look in the business world, there is food at every single meeting, and this should be no different with drug rep presentations. Nobody is crying about the price of apple computers being a hair higher because the employees order pizza when they have a meeting.

So the drug companies themselves have taken some good steps to do away with the gross abuse of funds, and I don't think that getting rid of free pens and packets of tissues is the worst thing in the world. I don't see them dropping lunches or presentations to docs anytime soon. The problem, though, is if doctor's, who actually know what they are getting into, can be bought by cheap trinkets and crap, how un-ethical is it to sell this stuff to ignorant patients?
 
Look the drug reppery just needed to be toned down a little and perhaps taken a little underground.

I can remember playing a round of golf at a course that costs $250 on a drug rep's bill. I was the 16 y/o son of a doctor and I tagged along for the free breakfast, the round of golf and the dinner. That is obviously a gross misuse of money considering that said money is essentially a part of the cost to patients.

Now they have eliminated most of that outrageous stuff (golf, trips to acapulco, and so on) and frankly pens and paper are not really necessary for a doctor to do his job. Furthermore, they are essentially the beacon light screaming to the world whenever they enter a doctor's office that this sort of thing is going on. I just saw a cartoon in the New Yorker the other day (I can't find it for the life of me though) with a doctor standing by a patient looking like a Nascar driver with ads sewn all over his suit and plastered on his walls. Perhaps eliminating some of the "appearance of influence" is not such a bad thing.

I can certainly agree with tired though. Drug rep presentations are necessary and not a bad thing in any way. Moving forward, if you look in the business world, there is food at every single meeting, and this should be no different with drug rep presentations. Nobody is crying about the price of apple computers being a hair higher because the employees order pizza when they have a meeting.

So the drug companies themselves have taken some good steps to do away with the gross abuse of funds, and I don't think that getting rid of free pens and packets of tissues is the worst thing in the world. I don't see them dropping lunches or presentations to docs anytime soon. The problem, though, is if doctor's, who actually know what they are getting into, can be bought by cheap trinkets and crap, how un-ethical is it to sell this stuff to ignorant patients?

The interesting triangulation at work here is that there is certainly business going on, right? But between who.

So that disclosure is the issue. You wanna do business with big pharma, go for it. But I think the public who by proxy sanctions the meaning of your medical license should have easy access to that information.

The real uneasiness being poked around at in the shadows is that physicians, for the most part, just don't have the balls or ovaries to keep it real on this issue and that's why they react aggressively and defensively.

These self-regulatory moves are slick attempts to not disturb the masses who, newsflash, already have a common sense mistrust of doctors. I don't fault doctors for this state of affairs entirely but they are certainly not doing anything to help themselves either.

Doctors work extremely hard and are catching hell on many fronts but so are their patients. Try being a broke wingnut who just got f'd up in an industrial accident and facing off against a company-pocketed doc who controls your destiny. Then you can convince me about the inconsequence of outside the doc-patient business interests.
 
So your saying that there is, in fact, a transaction. And a transactional mindset. But that it in no way whatsoever affects your prescribing patterns.

You want your free stuff. But according to you it is ostensibly of no value to the benevolent drug reps except to inform you.

I'm not saying that as a broke resident I wouldn't eat some free food. But I wouldn't claim that my animal instincts around a full belly are only informative in nature either.

This is the game of sales. It is no different than any other industry. To entice new customers and increase your volume, you gotta have an angle, or a gimmick. The only difference is that as physicians, we are supposedly educated. (Last I checked). With this, we have not only the ability to research and educate ourselves outside of drug rep presentations, we also in essence have a duty to do so in order to advocate on behalf of our patients if this drug is worth adding. Of course you have to prescribe the new drugs on occasion to patients. Besides, if they can't afford it, it's not like they're gonna continue with it and we'll end up switching them back to the same old affordable $hit they were on before. Then we'll just go back to the drug reps and say "my patients think your drug is an overblown expensive piece of crap."

Remember...medicine is a PRACTICE, ergo, not PERFECT!

Idealism is nice to hear every once in a while. It's cute, but in the end I don't know...people just wind up sounding like total douchebags afterwards. Therefore I prefer not trying to live in an absolutely perfect world. Takes too much time. Just my 2 bits.
 
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This is the game of sales. It is no different than any other industry. To entice new customers and increase your volume, you gotta have an angle, or a gimmick. The only difference is that as physicians, we are supposedly educated. (Last I checked). With this, we have not only the ability to research and educate ourselves outside of drug rep presentations, we also in essence have a duty to do so in order to advocate on behalf of our patients if this drug is worth adding. Of course you have to prescribe the new drugs on occasion to patients. Besides, if they can't afford it, it's not like they're gonna continue with it and we'll end up switching them back to the same old affordable $hit they were on before. Then we'll just go back to the drug reps and say "my patients think your drug is an overblown expensive piece of crap."

Remember...medicine is a PRACTICE, ergo, not PERFECT!

Idealism is nice to hear every once in a while. It's cute, but in the end I don't know...people just wind up sounding like total douchebags afterwards. Therefore I prefer not trying to live in an absolutely perfect world. Takes too much time. Just my 2 bits.

So you basically admit that drug pitches do influence what drugs you prescribe. You just don't see it as a problem, because: a) you will do research outside of their biased presentations to see if the drug is good, and b) patients will just be able to switch back to less expensive drugs after they run out of money or realize the new drug isn't worth it.

If A is true, why are drug rep sales pitches and toys necessary? If you are actually doing the research yourself, why would you want some salesman to come in and pitch drugs to you? Like you said, you have an obligation to treat your patients based on unbiased, scientific information. Drug reps are not a source of this.

I'm sure B is true, it just seems like a pretty crappy way to handle a patient's medications. Unless there is a breakthrough drug, there is probably little reason to switch a stable patient to a newer model. If there is a breakthrough drug, you should be well aware of it by reading journals and staying on top of your craft. As you said before, it is your obligation to your patient to do that research. Also, I should point out that drug reps are not only pushing new, different treatments. They are also pushing any drug that is still under patent, treatments that have existed for years, which you should already know about.

At the risk of sounding like a douchebag, I think you are the one living in an idealized world. While the research shows that even small gifts influence which drugs doctors prescribe, you choose to ignore that in favor of free pens and free lunch info sessions. Just because you are a doctor doesn't mean you are immune to marketing.
 
In my experience as a patient this has meant that there is a pretty wide range of ethics that are accepted as professionally sound. On the one hand there are those such as yourself who--if I understand it correctly--will be on the other side of world trying to keep men and women alive who are serving their country and who would probably do anything to help your patients and then there is quite another sort of physician, who chameleon-like, will adopt the principles of whatever organization they are apart of be to the extent that they serve the profit-motive of their company over any professional code of ethics.

But how many really serve the profit motive of a company? The major objection to pharmaceutical "gifts" is that it changes the prescription patterns of physicians who receive them. As I understand it, these are primarily private practice physicians in outpatient settings.

All the while we ignore the giant inpatient systems with their "formularies" supposedly based on cost, but who knows since it is administrators and senior physicians who make these decisions behind closed doors? And, as I have pointed out previously, who is to say that "gifts" actually influence these precription patterns, and not the research that the reps present? I think it is professionally insulting (not you specifically, but in general terms) to say that a free lunch made a doctor prescribe a new drug, rather than the research articles the rep brought along with them.

There is a big push to get doctors to prescribe generics. And while there are certainly benefits to this in some circumstances, in many others there are clear advantages in safety and efficacy of new on-patent drugs over traditional generic alternatives. Why are we so comfortable over-ruling the clinical judgement of front-line physicians?
 
So you basically admit that drug pitches do influence what drugs you prescribe. You just don't see it as a problem, because: a) you will do research outside of their biased presentations to see if the drug is good, and b) patients will just be able to switch back to less expensive drugs after they run out of money or realize the new drug isn't worth it.

If A is true, why are drug rep sales pitches and toys necessary? If you are actually doing the research yourself, why would you want some salesman to come in and pitch drugs to you? Like you said, you have an obligation to treat your patients based on unbiased, scientific information. Drug reps are not a source of this.

I'm sure B is true, it just seems like a pretty crappy way to handle a patient's medications. Unless there is a breakthrough drug, there is probably little reason to switch a stable patient to a newer model. If there is a breakthrough drug, you should be well aware of it by reading journals and staying on top of your craft. As you said before, it is your obligation to your patient to do that research. Also, I should point out that drug reps are not only pushing new, different treatments. They are also pushing any drug that is still under patent, treatments that have existed for years, which you should already know about.

At the risk of sounding like a douchebag, I think you are the one living in an idealized world. While the research shows that even small gifts influence which drugs doctors prescribe, you choose to ignore that in favor of free pens and free lunch info sessions. Just because you are a doctor doesn't mean you are immune to marketing.

How else do you think I'm going to be informed about the latest and sometimes greatest drugs out there? I sure as hell am not going to be flipping through the entire PDR each year. And, a drug rep presentation is certainly not the only modality available to me. Besides, I kinda like having a little fun with them too. I like seeing them squirm a bit when I ask them up front, what makes their drug so much more superior than others in the same class? Sometimes, the landmark studies just aren't out there yet pitching their drug against others. I'll give them that much. Until then, I'll go with what I know.

On the same token, you feel that a drug rep hock leads solely to a change in prescribing patterns. I'd rather take a more pragmatic approach. You'll never know how a drug works until you try it on someone. You know the ole adage, "Never be the first to try a new drug or the last to use an old one." Well #1 had to come from someone somewhere. Journals are nice, wordy though, not as many colors, :meanie: but if someone can summarize that info for me and succinctly I'm a happy guy. Uptodate sometimes just doesn't cut it.

As far as these things I "should know about," well then you "should know" that textbooks only go so far until you see it in the real world. At that point, you "should know" that sometimes textbooks don't do justice for the realistic clinical presentation.

Yes, I know I'm not immune to marketing. I'm a human doing God-like work, working unGodly hours. I like being appreciated for my work and my title. It's stuff that should come with the territory. I worked hard to get this far in my life and career. Honestly, in the totem pole of free crap, Drug rep provided office supplies and do-hickeys are probably at the lowest end of marketing. I've never seen or been on any drug rep sponsored trip (and don't plan on it with the current trend) Lunches and dinners are nice. Lets me sample classy restaurants I normally wouldn't go to for free. Who would pass that up? However I am far from being a tool. I still have this annoying habit that people hate. It's called critical thinking
 
But how many really serve the profit motive of a company? The major objection to pharmaceutical "gifts" is that it changes the prescription patterns of physicians who receive them. As I understand it, these are primarily private practice physicians in outpatient settings.

There is the objection that spending on physicians drives up the cost of the drug to the consumer.
 
There is the objection that spending on physicians drives up the cost of the drug to the consumer.

It's pretty well documented that the major factor in on-patent drug prices is the R&D. I doubt my $5 hamburger, free pen, or even golf junket to Aruba does much to drive up prices.
 
It's pretty well documented that the major factor in on-patent drug prices is the R&D. I doubt my $5 hamburger, free pen, or even golf junket to Aruba does much to drive up prices.


Actually the pharmaceutical industry spends roughly twice as much on marketing than it does on R&D. Those burgers and pens add up.
 
Actually the pharmaceutical industry spends roughly twice as much on marketing than it does on R&D. Those burgers and pens add up.

Marketing to physicians? Be interested to see those marketing numbers broken down.
 
Marketing to physicians? Be interested to see those marketing numbers broken down.


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Source: Gagnon MA, Lexchin J (2008) The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States. PLoS Med 5(1): e1 doi:10.1371/journal.pmed.0050001


Direct-to-consumer advertising is estimated as only about 7% of marketing expenditures, with the remainder of the marketing budget directed toward physicians and, to a lesser extent, pharmacists.
Excluding direct-to-consumer advertising, CAM considers that around 80% of the remaining promotion is directed towards physicians, with 20% of this figure going to pharmacists. (IMS does not provide any comparable values.) With about 700,000 practicing physicians in the US in 2004 [20], we estimate that with a total expenditure of US$57.5 billion, the industry spent around US$61,000 in promotion per physician. As a percentage of US domestic sales of US$235.4 billion [21], promotion consumes 24.4% of the sales dollar versus 13.4% for R&D.
 
Thanks for the info, fascinating.


I'm so gonna get paid . . . :meanie:
 
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