Are you kidding me with this garbage?!?

[MoneyDoc]

This is ridiculous. In the last two days the NY times has published articles crucifying doctors who take money from drug companies for their services (either in the form of payments for lectures or rebates for prescribing drugs). Firstly, in the article from May 10, the doctors are paid for lecturing about the drugs. Are the drug companies supposed to just find experts who do research on their drugs who will lecture and market for them for free? How else are doctors going to learn about the drugs? I certainly don't think it is a huge deal for doctors to make a little bit of extra money on the side for working with drug companies if they choose too. What is the alternative? The second article, from May 9, describes how certain dialysis clinics and doctors are making millions from prescribing anemia drugs to their patients. The way that it works is that they are given a rebate based on how much of the drug is sold. The doctors are dosing the drug based on the best known information and they are not even making that much money. Instead they are being severely criticized for 'selling out' to the drug companies. I think that drug companies should be able to advertise and market to doctors. It's not like they are taking these doctors out to the Caribbean for a golfing weekend. I don't think that a few extra thousand from either working for a drug company or using a life saving drug is going to have a drastic effect on their prescribing habits. I just don't enjoy seeing doctors get absolutely grilled in newsprint. What are your thoughts on this?

http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1&hp

http://www.nytimes.com/2007/05/09/b...em&ex=1178942400&en=653e6f1b498823bf&ei=5087

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[Tired]

What confused me about the original article was that they referred to new ethical standards intended to prevent doctors from taking "comps" from drug companies. Did I miss the boat here? Because I had never heard of these ethical guidelines, at least beyond the "No Free Lunch" movement, or whatever the hell its called. Did the AMA come out with some kind of position statement on this and I missed it?

 

[Bertelman]

... It's not like they are taking these doctors out to the Caribbean for a golfing weekend. I don't think that a few extra thousand from either working for a drug company or using a life saving drug is going to have a drastic effect on their prescribing habits...

Uhh, you know that doctors do get free golfing trips, right?

...and that prescribing habits are affected by thses campaigns, right?

I mean, if the drug company didn't think throwing a bone or two to docs would result in increased scrips, they wouldn't do it. There is clearly a purpose to these incentives, and isn't necessarily in the best interest of the patient.

Of course, judging by your name, avatar and phrase, the patient may not be the first thing you think about.

Edit- OP, were you disappointed when your last money thread died? We all appreciate the occasional troll, but you shouldn't pigeonhole yourself this early in a young trolling career.

 

[megadon]

First mistake, reading the NY times with an open mind. Dude, you are a doctor making six figures, don't you have an obligation to society to give back and then be sued for your eight years of labor? What's up with your social conscious, why are you making a profit off these people? Just because it cost you six figures to go to medical school doesn't mean you should try and equalize it off these people's back.

Interject reality. Dude, you're reading the NY Times. They aren't in you corner, and won't be until you decide that your eight years of super higher education (med school + residency) relugates you to taking care of anyone who walks into your office, regardless of insurance. Mao-Se-Tung, a visionary, go pick up his red communist bible now while its cheap.

 

[naegleria brain]

doctors wouldnt learn about drugs nearly as quickly if not for the drug reps. they may influence us, but is it a NEGATIVE influence on our patients? i'm not entirely convinced, because if not for them, we would evolve slower.

its a physicians duty to research the drug once having it been presented before prescribing blindly to patients. this may be difficult with 10 new ones a day.

 

[NonTradMed]

If drug company compensations didn't work, they wouldn't do it. Obviously, some doctors are being influenced by drug companies. I'm not sure if this is legal now, but my roommate's parents were doctors and they used to get carribean cruises by drug companies in exchange for sitting in on drug company pitches (while on the cruise). So yes, drug companies do used to go all out for doctors. Being a doctor isn't a calling, but it's also not an entitlement to receive free gifts. If a biased toward prescribing new drugs shows a negative outcome for patients, I would say ban it. Otherwise, I don't care. Public health care policies should be based on what is good for public health.

 

[Tired]

Uhh, you know that doctors do get free golfing trips, right?

...and that prescribing habits are affected by thses campaigns, right?

I mean, if the drug company didn't think throwing a bone or two to docs would result in increased scrips, they wouldn't do it. There is clearly a purpose to these incentives, and isn't necessarily in the best interest of the patient.

Of course, judging by your name, avatar and phrase, the patient may not be the first thing you think about.

Edit- OP, were you disappointed when your last money thread died? We all appreciate the occasional troll, but you shouldn't pigeonhole yourself this early in a young trolling career.

I didn't quite get the heavy 'dis until I read the edit.

You're a resident, right? Is there any ethical prohibition (by professional societies, etc) against taking stuff from the drug companies?

I get the movement to ban this kind of "advertising", but in all honesty, if I were offered a free trip to a conference in Aruba, I'd take it. And I don't think twice about taking food from the reps when they show up.

 

[Critical Mass]

Methinks Bert and Tired are both graduating (or newly minted) MD's.

Is it also unethical for doctors to participate in drug trials subsidized by the companies who make new drugs? Seems like without patients, you couldn't run the trials.

 

[Tired]

Methinks Bert and Tired are both graduating (or newly minted) MD's.

Ah, my mistake.

Is it also unethical for doctors to participate in drug trials subsidized by the companies who make new drugs? Seems like without patients, you couldn't run the trials.

I think it's unethical to prescribe drugs, since that also contributes to pharm companies' profits. Evil drug companies! I shall treat with nothing except herbs grown in my backyard!

 

[FenderHM]

wazzup with an atypical for an eating disorder? with their weightgain side effects I think they would only amplify an eating disorder...

you've gotta change this girl's self-image, not try to utilize a normally unwanted side affect from a drug made by the company paying u on the side to lecture for them. if anything give SSRI

this is practically mal-practice material.
1) he was her doctor=duty
2) prescribed off-label use of WRONG drug made by company that pays him=breach
3) patient now has dystonia and is made fun of= harm

 

[kchan99]

As a poor graduate student sans stipend, I have done a lot to minimize drug company influences while maximizing MY "profitability." I read journals while attending lunches. Otherwise, I eat leftovers when the lunch is almost over. I also pick up promotional items for use in my lab. I obliterate the drug name; it may even be replaced with my name. I don't use drug company pens, but I do keep a drug company pen or two in my bag for other people to use so I won't miss the pens if they are not returned.

I will be starting med school in the fall. I don't feel bad about eating drug company food if I try not to pay attention to product names and companies. But I don't like the idea of rebates for physicians.

As a patient, I have never felt bad about my health care providers eating drug company food. I did not like the behavior of drug company reps who entered patient care areas to talk to physicians without checking in at the front desk. I really don't like that when I have to wait a long time.

 

[Law2Doc]

This is ridiculous. In the last two days the NY times has published articles crucifying doctors who take money from drug companies for their services (either in the form of payments for lectures or rebates for prescribing drugs). Firstly, in the article from May 10, the doctors are paid for lecturing about the drugs. Are the drug companies supposed to just find experts who do research on their drugs who will lecture and market for them for free? How else are doctors going to learn about the drugs? I certainly don't think it is a huge deal for doctors to make a little bit of extra money on the side for working with drug companies if they choose too. What is the alternative? The second article, from May 9, describes how certain dialysis clinics and doctors are making millions from prescribing anemia drugs to their patients. The way that it works is that they are given a rebate based on how much of the drug is sold. The doctors are dosing the drug based on the best known information and they are not even making that much money. Instead they are being severely criticized for 'selling out' to the drug companies. I think that drug companies should be able to advertise and market to doctors. It's not like they are taking these doctors out to the Caribbean for a golfing weekend. I don't think that a few extra thousand from either working for a drug company or using a life saving drug is going to have a drastic effect on their prescribing habits. I just don't enjoy seeing doctors get absolutely grilled in newsprint. What are your thoughts on this?

http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1&hp

http://www.nytimes.com/2007/05/09/b...em&ex=1178942400&en=653e6f1b498823bf&ei=5087

Maybe it's just me but while I have no problem with doctors lecturing other doctors, getting taken out to lunch by pharmaceutical companies, having pharmaceutical companies sponsor luncheons and meetings, and giving various token freebies of modest value, there's something more sinister about getting rebates for amount of drugs prescribed. The lunches and token gifts are mere marketing -- seen in every industry, where sellers take out potential customers to lunch, maybe give them something with the company name emblazoned across it. Unlikely these efforts sway a physician away from sound medical practice. This last form, however (the rebate for quantity) has an absurdly greater risk of abuse because it directly affects patient care -- the physician puts himself in a position where he has to decide whether the drug is the best or most cost effective or the most benign side effect profile for the patient versus just the one that puts the most in his pocket. Effectively this is a commission being paid to the doctor for sales, which is troubling, and subject to serious abuse, both consciously and subconsciously. Other industries (eg law) prohibit this kind of blatent conflict of interest, so I think the Times is onto something here.

 

[Dr. Dukes]

Is there any ethical prohibition (by professional societies, etc) against taking stuff from the drug companies?

Back in September Stanford prohibited drug companies from taking ANYTHING (even pens or paper or food) from drug companies if they get it on hospital grounds.

Press release here: http://med.stanford.edu/news_releases/2006/september/coi.html

 

[AmoryBlaine]

Many other professions are awash in slush money and free lunch. My friends who are attorneys are actually told that they should "never have to buy their own lunch." Granted this is at a top firm but no one seems to be crying over how much money companies spend on the lawyers that represent them.

Give a freaking doctor a couple of free pens and wrath of God comes down upon all of us? I don't think so.

My favorite are the med students who have been sold on this nonsense. They haughtily turn their noses up at the penlights and the lunches as if such things are going to sully the soul.

 

[Bertelman]

wazzup with an atypical for an eating disorder? with their weightgain side effects I think they would only amplify an eating disorder...

you've gotta change this girl's self-image, not try to utilize a normally unwanted side affect from a drug made by the company paying u on the side to lecture for them. if anything give SSRI

this is practically mal-practice material.
1) he was her doctor=duty
2) prescribed off-label use of WRONG drug made by company that pays him=breach
3) patient now has dystonia and is made fun of= harm

You might want to take this sentiment on over to the Psych forum, friend.

 

[tacojohn]

The way I see it, I've completed four years of college, took the MCAT, and completed four years of medical school, not to mention a residency - therefore, I should be allowed to do pretty much whatever I want to no matter what anybody else says and nobody better dare suggest otherwise.

 

[Bertelman]

I didn't quite get the heavy 'dis until I read the edit.

You're a resident, right? Is there any ethical prohibition (by professional societies, etc) against taking stuff from the drug companies?

I get the movement to ban this kind of "advertising", but in all honesty, if I were offered a free trip to a conference in Aruba, I'd take it. And I don't think twice about taking food from the reps when they show up.

I've eaten many a free lunch, and I will continue to do so. I understand the benefit of having a few moments to sit down with a rep and chat. I hate free pens mostly because I prefer my own. You could argue for the benefit of a free trip sponsored by a drug company which has an educational componnet, however, they push the limits of the IRS on these programs. Four days in Hawaii usually nets you a total of 5-6 hours conference time, and several more hours on a golf course. The way I look at it, that company would have probably shelled out 100k to send our group to the destination. That's a quick 100k filtered down to my patient who complains about not being able to afford prescriptions, while their counterpart in another country gets the same dose for a fraction of the U.S. costs.

Those arguments don't approach the conflict present when actually receiving a kickback from a drug company for prescriptions. I don't understand how someone can even begin to defend this practice (not that you are). We purport to base our decisions on objective data, which we should, but that is thrown out the window the minute a rep tells me I can make an extra $50 off each Epo scrip I write. Now my wallet has convinced me that Epo is necessary on all my patients. Read what Law said for a more eloquent argument.

And I understand the argument that this happens in every other industry, but then let me ask- do you want to be perceived like every other industry? People hate lawyers. Business people get fired for unethical violations. As physicians we carry a sometimes blessed role in the eyes of our patients. I think that had no small part in the decision of many of us to pursue the profession. Do you want to throw that away because drug companies have convinced you that this practice is acceptable?

 

[Flopotomist]

One other consideration is what patients' perspectives on this are. If patients BELIEVE that we are all "owned" by the drug company, and have the drug companies interests as a priority, then our opinions will not be valued as much by patients. I am sure others have had the conversation with patients who don't want to take medication X because "the doctor only wrote a prescription for it because he is beholden to the corporations." Then of course the patient goes and takes some wacky magnetic bracelet and eye of newt from the local herbalist instead.

If we can regain the trust and confidence of patients by using our own pens, declining free food, not accepting kick-backs from drugs - then I think it is a small price to pay that would in the end benefit patient care when those magnet therapy users again trust us and return to their lasix.

 

[thewebthsp]

money for prescribing drugs -- yeah this sounds very ethically flimsy --
money for referrals for example is explicitly illegal (excepting cases where your referring to your own practice because it has something unique in the city you're in)

Trips to carribbean -- also very problematic.

But paying for physicians to help market/educate and for research is very very helpful -- why the nyt doesnt discuss the large pool of $ for research from private industry is puzzling. Penn has also banned lunches and pens since 2006. I think it's a private organization's (like Penn) prerogative in banning such things is their own but it shouldn't be the heavy handed actions of government that ban such things -- they're marketing not bribery. On the other hand, paying for doctors to prescribe stuff is probably too big of a conflict of interest to allow.

 

[Miami_med]

Can we all agree that undisclosed kickbacks and having someone pay for you to attend a sales meeting are two very different things? The ethical issue with kickbacks is really more an issue for a patient if they are undisclosed. A patient thinks that he is getting the best drug from the doctor ( or atleast the drug that makes the most sense). I don't see problem with someone taking me out and trying to convince me of something. That's business. They give the pitch, and I decide if I want to accept. A vacation is fine, if that's your thing. Condo companies do crap like that all the time. If these things aren't connected to a doctor having to prescribe the drug, I don't see how someone could have a problem. Does Bertelman think that this $100k would go to patients if it wasn't used on doctors? He might have to take that up with the company shareholders.

 

[Bertelman]

Does Bertelman think that this $100k would go to patients if it wasn't used on doctors? He might have to take that up with the company shareholders.

I can't say where it would go. But I know exactly where it is coming from, and it doesn't sit too easy with me.

 

[dynx]

One other consideration is what patients' perspectives on this are. If patients BELIEVE that we are all "owned" by the drug company, and have the drug companies interests as a priority, then our opinions will not be valued as much by patients. I am sure others have had the conversation with patients who don't want to take medication X because "the doctor only wrote a prescription for it because he is beholden to the corporations." Then of course the patient goes and takes some wacky magnetic bracelet and eye of newt from the local herbalist instead.

This sounds familiar...wait a minute, I got it! Natural selection! I've met these patients, they are better off dead.

 

[dynx]

Maybe it's just me but while I have no problem with doctors lecturing other doctors, getting taken out to lunch by pharmaceutical companies, having pharmaceutical companies sponsor luncheons and meetings, and giving various token freebies of modest value, there's something more sinister about getting rebates for amount of drugs prescribed. The lunches and token gifts are mere marketing -- seen in every industry, where sellers take out potential customers to lunch, maybe give them something with the company name emblazoned across it. Unlikely these efforts sway a physician away from sound medical practice. This last form, however (the rebate for quantity) has an absurdly greater risk of abuse because it directly affects patient care -- the physician puts himself in a position where he has to decide whether the drug is the best or most cost effective or the most benign side effect profile for the patient versus just the one that puts the most in his pocket. Effectively this is a commission being paid to the doctor for sales, which is troubling, and subject to serious abuse, both consciously and subconsciously. Other industries (eg law) prohibit this kind of blatent conflict of interest, so I think the Times is onto something here.

This is pretty much my stance on the issue payment per quanitity is unethical because it adds an incentive to sell the drug that had nothing to do with what is good for the patient. If you want to buy my time and try to convince me that your product IS what is good for the patient then by all means spend away.

 

[Law2Doc]

Many other professions are awash in slush money and free lunch. My friends who are attorneys are actually told that they should "never have to buy their own lunch." Granted this is at a top firm but no one seems to be crying over how much money companies spend on the lawyers that represent them.

Give a freaking doctor a couple of free pens and wrath of God comes down upon all of us? I don't think so.

While I personally don't have a problem with pharmaceutical companies sponsoring physician lunch meetings, your above analogy actually isn't a good one. I've partaken in more than my share of working lunches on someone elses dime. But the ethics in your example are different. The free lunch is fine when it comes from the customer -- i.e. the client or the patient. There's no conflict there, just perhaps an exhorbitant bill. The loyalties still run from the professional to the customer, without deviation. But in this thread we are actually talking about someone else other than the customer buying you lunch so that you will hopefully sell their product to your customer. Hence your loyalties may be divided. So it's a totally different animal. It is the conflict (or perception of conflict) that is the problem, not the lunch.

 

[megadon]

I would like to point out one thing, this is America, which is a capitalist society. Drug companies make drugs to make money. Yeah, maybe there is a bit of altruism, but that goes into orphan drugs, which have their own congressional protections for some recompensation for development. Otherwise, we wouldn't have five major competing brands of proton pump inhibitors to treat reflux. There is money to be made, so they go after it. Is that unethical, no, based on the fact that our economy is based on capitalism and competition.

Is it wrong to attend lunches and take pens, I say no. However, you should be aware that the positives are going to be over emphasized, and the negatives glossed over. A little research (cause we have so much time) before hand about what the negatives are can be quite useful. Ie, uhhmm, could you go back to that side effect and go over it a little more, cause your phase II/III made it sound a little bit more than that.

Cruises, now we are getting into the bribe side of things and very questionable. I would think you would be hanging out with a lot of Bob Kelso's. I don't like Bob Kelso.

Drug companies have to market their drugs. They have to reclaim the money they spent on research and approval. Plus they have to cover the losses of all the failed drugs. That is unless our goverment wants to take that one over too, anyone want that? Hmm, anyone? They are already so efficiently spending the rest of our money. Are they making way above what the need to cover all that, I think so, but that is partly medicare's fault for covering all those drugs. So, maybe the question you also should be asking is should all these branded drugs be covered by medicare?

 

[tncekm]

This is ridiculous. In the last two days the NY times has published articles crucifying doctors who take money from drug companies for their services (either in the form of payments for lectures or rebates for prescribing drugs). .....

What were you expecting? If the journalists at NYT had their way medical care would be free and anybody who associates a good income with practicing medicine would be thrown in a room with hungry and horny baboons (hornier than they are hungry so they'll screw you first).