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Do Drug Co's influence DOs as much as MDs?

Discussion in 'Medical Students - DO' started by coreyw, Apr 21, 2004.

  1. coreyw

    coreyw Senior Member
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    Check out this article. What do folks think: Are DOs as influenced by drug company advertising as Australian medical doctors appear to be?


    Australian Broadcasting Corporation (ABC Online)
    Sunday, April 18, 2004

    Doctors influenced by drug companies, study finds

    Most doctors genuinely believe they are immune to the influence of drug companies when choosing which medications to prescribe.

    But new studies show overwhelming evidence that prescribing habits can be changed by aggressive marketing.

    Associate Professor Wendy Rogers, from the Department of Health Ethics at Flinders University, says doctors are affected subconsciously.

    "It's not like a bribe where they get a free meal and say I must prescribe brand X, but the branding and the product placement works," she said.

    A study in today's issue of the Medical Journal of Australia says 95 per cent of doctors have regular visits from drug company representatives and the more frequent the visits, the greater the chance of over-prescribing.

    It also found that those medicos attending conferences sponsored by pharmaceutical companies were more likely to prescribe those companies' drugs.

    Dr Kerry Breen from the National Health and Medical Research council ethics committee writes: "My criticism is of the naivete of doctors and their unwillingness to accept overwhelming evidence that the techniques used by the industry to increase prescribing of their products actually work."

    Associate Professor Rogers says when doctors are influenced by pharmaceutical companies, they prescribe more expensive drugs and ones that are not quite as good.

    A second study raises concerns about the relationship between the drug industry and medical students.

    Its authors were alarmed to find that were no restrictions on what students can accept from pharmaceutical manufacturers.

    Matthew Hutchinson, president of the Australian Medical Students Association, would like to see a code of conduct for Australia's medical students.

    "So that we can begin now and set up ethical relations with the industry so that we can treat our patients to the best of our ability," he said.

    The pharmaceutical industry itself has moved to limit the perks given out to doctors, tightening their own code of conduct to ban expensive gifts and hospitality.

    A spokesman for Medicines Australia says there are no plans to limit the frequency of drug representative visits.
     
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  3. Maxip

    Maxip Member
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    No, everybody knows that DO's are better educated and more knowledgable than MD's.
     
  4. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    This doesn't sound too terribly convincing to me. It seems reasonable to assume that in aggregate, doctors will prescribe those medications they have the most familiar with. If a pharm company markets its drug heavily, doctors will be hearing and learning more about that drug.

    I'm also a little skeptical of the way the study seems to assume cause and effect, if indeed it's been summarized correctly in the article. Might it be possible that a significant number of doctors choose at least some of the drug conferences they attend based on their interest in the drug being presented, or good experience with the company's drugs in the past? Isn't it possible that the companies with the money to heavily market a given drug have that money because they've been successful with a string of quality drugs in the past?

    I'm sure there's some influence going on, but it seems like quite the stretch to claim "overwhelming evidence," at least based on the logic and evidence in the article. From this lowly vantage point, it looks like a conclusion in search of a study.
     
  5. coreyw

    coreyw Senior Member
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    FYI The link for the Medical Journal of Australia is http://www.mja.com.au/

    There are a couple of articles specifically about medical students and the pharmaceuticals industry too.
     
  6. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Corey,

    Thanks for the link! Interesting topic. I'm going to past the evidence summary the article presents:

    Some of the available evidence about doctors? prescribing habits

    Most doctors deny that gifts from the industry influence their prescribing.14

    The number of gifts received correlates with the belief that seeing representatives does not influence prescribing.14

    80%?95% of doctors see industry representatives regularly.4

    More frequent contact is linked to unnecessary prescribing and to increased use of new drugs. 14,15

    Attendance at sponsored conferences is associated with increased prescribing of the sponsor?s product. This increase can be seen for the next 6 months.14

    It is estimated that industry spends about $21 000 per year per practising doctor on drug promotion.16

    My thoughts:

    I'm not exactly sure how doctors' denial that gifts influence prescriptions, or that this belief correlates with the number of gifts they receive, is evidence for alteration of prescribing habits. I can think of at least one very reasonable explanation to the contrary--doctors who attend lots of conferences will receive lots of gifts. They will also, on the whole, probably be less interested in hearing what the pharm companies have to say or market. Diminishing returns--if you go to one sponsored conference a year, you'll remember the drug. If you go to twenty, you probably won't.

    As for frequency of contact, amount spent, etc, none of that is really telling us anything about influence on doctors. It's telling us that drug companies spend lots of money to get the word out about their products. Some people find this distasteful, but it's definitely not news.

    Re. #5, attendance correlating with prescription. Again, I don't find this all that damning. I see no reason why doctors shouldn't rely at least partially on information at conferences for prescribing habits. While it would be the lazy or corrupt doctor that relied exclusively on these, there are all sorts of very legitimate reasons why attendance at a drug company's conference could correlate with increased prescriptions for that company's drugs.

    The only one that troubled me at all was #4--unnecessary prescribing. I followed both the links cited as evidence. One wasn't a study itself, but just a synthesis of other studies, with the conclusion that more study is needed. Using this study to support point #4 seems a bit of a stretch at best.

    The other study cited for that point is more convincing, but also full of important nuances--the doctors most likely to overprescribe and have frequent contact with drug reps are the doctors who work in remote or underserved areas and are isolated from their colleagues. It makes sense that these doctors would be more inclined to lean towards the drug companies' take on the medicines, as these companies are really some of their only professional support. I don't see much a problem with this.

    As for the whole notion of students and drug companies--personally, I find the idea of swearing off pharm benefits sort of silly. By the time students are in a position to prescribe the drugs they're supposedly being influenced to favor, they'll be generic anyhow. The most that could stick would be pharm company name recognition, and I have a hard time believing that by taking an Eli Lilly pen I'm going to be more inclined to prescribe Lilly drugs years hence when residency's through.

    Anyhow. It's certainly an issue on which reasonable people can disagree, but for my money, it's a tempest in a teapot.
     
  7. DireWolf

    DireWolf The Pride of Cucamonga
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    I'm not really sure what you are getting at here with the MD vs. DO thing.

    There's a similar study cited on cnn.com about how physicians in the U.S. are more likely to prescribe newer, more expensive drugs rather than the cheaper, recommended ones.

    This is obviously due to the relentless adverstising by pharmaceutical companies and frequent visits from drug reps. Whether it's right or wrong is debatable. If the physician is helping the patient achieve better health, then I don't see any problems. However, this is not always the case.

    As far as DO vs MD, I've seen it first-hand with both types of physicians. It doesn't make much sense to compare the two professions on this topic. Like many issues in medicine, choices are solely dependent on the individual physicians, not the degree behind their names.
     
  8. H0mersimps0n

    H0mersimps0n HMO CRUSHER
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    Well after doing my MS-I LECOM preceptorship and getting to go back into the "special room" of the physician I was working with I have to say MD and DO alike are VERY influenced by drug reps. He is VERY RURAL too, so aparently location doesn't matter all that much either.

    Prescribe it and they will come (and with food too!)...

    On another note:
    Just before I moved away to medical school my previous physician got a palm pilot and when he went to up my monopril he consulted it to see what the cheapest option would be.

    Is there a program for the palms to help you figure out which drugs are the cheapest? He ended up decided that switching to lisinopril would be cheaper for me. He's an MD but to this day he is my secret idol, I have met rarely a DO's that has impressed me with their knowledge like he always did. Currently I have a DO as my PCP and he has more personality and I can talk to him but my perception of his skills and knowledge just don't match up. Maybe there's something to say for instilling confidence in patients with that old fashioned hard-nosed MD coldness afterall... hmmm....
     
  9. gioia

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    Wouldn't it be logical to conclude that the physicians most influenced by drug companies at all, are the primary care docs? I think (but am not sure) the statistic is that 80% of all meds are perscribed by primary care docs. So physicians in that arena would be most susceptible to the marketing I would think, (regardless of their title).
     
  10. flighterdoc

    flighterdoc Rocket Scientist
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    Geez, folks. If getting a free pen or a reflex hammer or a plate of bagels is going to affect your medical judgement, then you probably shouldn't be physicians.

    Now, if you want to get upset about the drug companies, how about the way they stack the "peer-reviewed and independent" journals?

    As for me, I hope to never buy another pen again. It sure as hell isn't going to affect what I prescribe, though,
     
  11. DireWolf

    DireWolf The Pride of Cucamonga
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    While I respect your morals and hope to remain free of the influence of drug reps myself, you are TOTALLY misguided in your assessment of the perks handed down by the pharmaceutical companies.

    Just to list a few of the perks my primary care doc back home has received from drug reps:
    - Dinners at fancy restaraunts
    - Free golf outings at expensive public/private golf courses
    - Free weekend "business" trips
    - Lots of small items/equipment that add up during the course of a year

    And let's not forget the big one - who sponsors these medical conferences and CME seminars at ski resorts and golf resorts? You guessed it.

    We're not talking pens and bagels here. Maybe this is all you see as a med student, but in private practice the stakes are much higher.
     
  12. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Even if the stakes are much higher, is there a functional difference between being influenced by a pen and a free dinner? Personally, if I were to be influenced by such things, I'd be more influenced by a pen than a dinner, since the pen is neat and branded and I play with it for hours in between patients because it lights up or makes a little cartoon dance. The dinner, though, loses its branding upon digestion.

    So if a physician's influenced by one and not the other, it's just a difference of price, not substance, and it's just a matter of how expensive a bribe is required. I agree with FD, though--I have trouble believing many physicians allow themselves to be bribed, and thus far the evidence I've seen doesn't strike me as that compelling. This is an issue where the burden of proof rests on those making the accusation, and I'm absolutely ready to change my mind and agree with them once I see the overwhelming evidence the OP's article claims, but doesn't provide or reference.
     
  13. flighterdoc

    flighterdoc Rocket Scientist
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    Your attempt at discerning some moral difference reminds me of the old joke - a guy goes up to a girl in a bar and says "would you sleep with me for 10-million dollars?", she says "yes". He then says "would you sleep with me for 10 dollars" and she says "what sort of girl do you think I am?" He replies, "we've already determined that, now we're just negotiating".

    Again, if you're going to be corrupted, then you're going to be corrupted.

    If you want to make relative value judgements, I'd still say that the pharm companies and journals in bed with each other is far more dangerous. We're supposed to be about EBM? What are we supposed to do when the evidence is cooked?
     
  14. flighterdoc

    flighterdoc Rocket Scientist
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    I agree. In a prior career, I was responsible for buying "technology" for one of the largest law firms in the world. I was the guy that made the final determination about what we bought, and this was in the day when we went from zero technology to technology on 3,000+ attorneys desks in less than a year.

    Just about every computer and software company in the world was attempting to wine and dine me. I can honestly say that while I took some of their toys, I told them that the gifts wouldn't affect my decision one bit, either giving it to me, or not. Some believed me, some didn't, I took their offerings and still made the best decision for the firm, and could objectively justify my decisions based on qualitative and quantitative analysis. And, when a few bitched that they gave me x,y,or z and didn't get the contract, I returned their toys and told them that they need not ever bid on another contract with me.

    BTW, my superiors were completely cognizant of these activities. They trusted me to be honest.

    The toys don't matter, dinners don't matter, trips don't matter. If the conferences matter then don't go to them.

    The OP sounds like a playbook from AMSA - where socialized health care is wonderful, and drug companies are evil incarnate.
     
  15. cooldreams

    cooldreams American Mensa Member :)
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    hehehe.. i like you... :thumbup:
     
  16. gioia

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    INSPIRING! I love it!


    I agree to the aforementioned opinions about Physicians not being easily swayed, especially when I consider the loads of free sample meds they have in bins and forget to give away... :) Hopefully they don't forget where their flashy little pen is...
     
  17. DireWolf

    DireWolf The Pride of Cucamonga
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    You are all making valid points but misreading my point. The OP wanted to know if DOs are less likely to prescribe more expensive meds than MDs. The answer is no.

    My point is that it doesn't matter if you're a DO or a MD. Both types of physicians use more expensive drugs, mostly as the result of pharmaceutical lobbying.

    Also, I wanted to clarify flighterdoc's point that drug reps are only giving out bagles and pens. When in fact, the perks are much more significant.

    Now the question is "are MOST docs affected by this lobbying and prone to prescribe more expensive drugs as a result?"

    I don't think it's a majority per se, but there certainly are a ton of docs that do this. Money talks, and doctors are certainly not above that. They're all out to help people but also to make money.

    Let's not be so naive.
     
  18. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Dire,

    Simply saying "Let's not be so naive" isn't an argument--while I'm willing to be persuaded that perks induce doctors to prescribe unnecessarily or unwisely, I'd like to see evidence beyond the claim that to think otherwise is naive. Cynicism's not support.
     
  19. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    I sure don't. The one I have can be disassembled if one's clever and used to blind people with its super-bright LED light. AMSA's decided this is unethical, though, so I don't have as much fun with it as I could.
     
  20. DireWolf

    DireWolf The Pride of Cucamonga
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    Evidence:
    Penn

    I don't have time to find more, since I have a path exam tomorrow. Maybe when I get more time I can dig some stuff up, including the original study.

    I'll assume you know the difference between evidence and proof. This article is not meant to be used as a definitive answer, just evidence to support my opinion.
     
  21. flighterdoc

    flighterdoc Rocket Scientist
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    It may support your conclusion, but it is neither evidence, nor proof - it is conjecture:

    The researchers did not examine why, exactly, doctors go with the costlier drugs, but they speculated that aggressive drug-company advertising may be one reason.​
     
  22. DireWolf

    DireWolf The Pride of Cucamonga
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    Good point.

    It is EVIDENCE to support my claim that many physicians prescribe costlier drugs to patients, when cheaper alternatives are available.

    It is CONJECTURE in regards to my claim that the reason for this behavior is due to aggressive lobbying by pharmaceutical companies/reps.

    Actually proving "why" would be almost impossible in this case, because most physicians would not admit to allowing drug reps/companies to influence their practice of medicine.
     
  23. KittenKnows

    KittenKnows Member
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    Time to admit my past...I was a drug rep before starting medical school. So I can't pass up this thread without adding my 2 cents to what really goes on behind the scenes.
    The bagels, pens, lunches, goodies... this isn't to get the doc to write more scripts. This is for access, being allowed by "the gatekeeper" aka receptionists and nurses, to go back to the drug cabinet, wait 30+ minutes just to get 20 seconds to "remind the doctor why drug x is a better choice over other drugs in the class". Why the extravagance? The receptionists now expect it. If you don't bring in the goodies, you don't get access. Simple as that. Some offices expect lunch. No lunch, no access. If you ask any of the drug reps, they really hate bringing in the junk everyday. They feel like caterers bringing in food all the time, but if they go see their number one doc and don't get in, guess who is out of a job soon?

    And I say number one, because the physicians are rated. Yup, you get a rating by a drug company. Drug companies spend a fortune on finding out what the docs are writing. They make up a list of physicians and it is up to the drug rep to make sure the top 25-50 physicians on this list are seen the most. This is where the dinner lectures, CME programs, more expensive items take place. Drug companies also think that the more you see a physician the more likely he/she will remember the drug in the future. That is why you might see 5 Pfizer reps calling on the same doc with the same drug, and usually with the same message for that drug. The drug companies seem to think that repetition is the key, but personally I don't agree with this tactic. I received a lot more respect going in and talking science with a physician, journal articles about recent drugs, what is in the pipeline, and maybe reminding them of certain adverse effects or MOA in a drug I was representing.

    Finally, the general conscensus I received from physicians (MD's and DO's alike), is that they are going to write only what is covered by insurance. No one has the time or wants the hassle of filling out a preauthorization form for a drug that has several others in its class that might be covered. I don't blame them a bit. So you can wine and dine the physicians, they still are only going to write what is covered by most plans, otherwise the script gets kicked back. So they might be writing more expensive drugs, but maybe that is because that is the drug covered by most plans and there isn't a generic- which is the case for more of the newer expensive drugs like the statins, ACE's, CNS drugs and others.
    Just want to shed a bit of light on the topic- "from the other side of the fence"! :D
     
  24. LukeWhite

    LukeWhite USC Pulm/CCM 2014
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    Kitten, great post! Thanks!
     
  25. coreyw

    coreyw Senior Member
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    So there's nothing at all in DO training and 'socialisation' that would make you lot more/less inclined to be influenced by drug company promotions and the like?

    BTW: Great to see some really good discussion on this one. And KittenKnows - some really insightful stuff.
     
  26. flighterdoc

    flighterdoc Rocket Scientist
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    EEk, a drug rep! Get the rope! (j/k)

    Thanks for the perspective. Especially the insurance issues.
     
  27. KittenKnows

    KittenKnows Member
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    :p Yeah, you know I get a lot of flack from my friends about being an ex-drug rep. But you would be surprised at the number of physicians I came across that used to be reps as well!
    And you know something, that experience was very educational for me. Not only did I learn the insides out of the pharmaceutical industry, but I learned so much about insurance issues- not only for drugs, but for lab tests and other hassles that require prior authorization from insurance companies. There is a lot of crap that a physician has to put up with behind the scenes. Some physicians hire people to fight the insurance companies for authorization because it is SO time consuming. The patient needs an MRI but is missing one of the "required" symptoms needed to get it paid. Your ass is on the line if the patient can't get this test, so you spend all your time filling out paperwork to get the authorization approved. Not fun. And you think they want to do this with a drug that is in the same class with 10 other drugs that are already approved? Don't think so.


    Additionally, as a rep I was required to do the educational dinner talks, which by the way is tightly regulated by the FDA. You hire a well-respected physician to talk about a disease state (one that obviously relates to the drug you sell). For example: Poly-drug therapy in difficult to control hypertension. This is a generic topic that is educational and does not come out and scream the drug you are representing (this is required by the FDA). These talks were very educational for me because I got to sit around a table with several physicians and listen to them discuss the disease state of a certain illness and how to manage these patients. Wow! Find me another pre-med student that gets to do this on a regular basis. This was a heck of a lot more educational than picking up a Harrison's on a Saturday afternoon! And because these talks were usually round table discussions, they were very open to discussing management amongst themselves and what works or what doesn't work.

    Then finally, I was given many opportunities to shadow a physician, which a lot of pre-meds can do as well, but since the physicians get paid by the drug company to do this, they are more inclined to make sure you walk away having learned something about the disease state. Again very rewarding.

    Would I do it again? You betcha! I was the one who won in the end, even if it meant going in with my pens and bagels everyday! :eek:
     

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