drug rep vs program paying for lunches, etc

[BabyPsychDoc]

The public's opinion basically doesn't matter.

The public is unqualified to judge how physicians should practice, what damage awards should be in the case of negligence, and certainly not in internal codes of behavior. To exemplify, this is why malpractice reform is underway in some states. The nonsensical and clear money-making scam called step II CS was borne out of public opinion. On the website when CS was borne, it was declared that [paraphrase] 'a public poll via the telephone was conducted which showed that 80% of respondents surveyed supported increased oversight and testing to ensure physician competence upon completing medical school." This is nonsense. Black/white polls of an uninformed population will always err on the side of "good." If I were to conduct a poll asking the average Joe, "Do you think it would be a good idea to extend physician training by 10 years in order to ensure greater competence and lowered incidence of medical mistakes?" The answer would be a resounding 80%ish yes. So why don't we do this? We've lost autonomy as a profession and nobody seems to mind.

Aye, but the public opinion does matter. It SHOULD NOT matter, but it does. I have long since became convinced that you are much less likely to get sued/have a complaint lodged against you if you are a personable idiot than if you were a competent but less personable jerk. And for politicians, votes are all that matters. So, public opinion is here to stay.

What is the licence revocation process like in the US? Is it regulated by the medics or the lay people? In the UK, it used to be done exclusively by medics - ie, members of the profession. But, it was not fair - or so the public decided. Those nasty doctors would only cover each other, right? So now, the GMC (similar to State Medical Board) proceedings are done by mixed panels (laymen and medics). I guess, laymen are there to judge how nice a person you are. Too bad, they have the power to suspend your licence or even erase you from the register completely - I guess, you just have to try really hard to be nice.

Billypilgrim, I am flattered (does it mean my writing style is as good? just kidding). I am afraid, though, that I could not even claim to be Ayn Rand's reincarnation as I was born a few years before her death.

---

Members don't see this ad.

 

[sunlioness]

5) The real issue, as I raised in these previous threads, is not freedom from regulation, but the appearance of an ethical conflict of interests. The patient who sees the neatly attired salesman entering the office with the fragrant pile of pizzas may rightly wonder if I am prescribing their medication based on their best interests or because I liked the lunch.

This is so true. Non-medical friends of mine have told me this directly. They really don't know what to trust when they're sitting in a waiting room with drug co literature and see the stack of pizzas go by. A friends just told me the other day that he wishes there was a way to know who was "on the take" (his words, not mine) and who wasn't as he definitely has more respect and would want to take his business to the latter.

Another thing I just discovered drug companies will do is pay a more senior physician in a practice to give a drug talk to more junior docs in the practice, which seems to me all kinds of confusing. I mean this is a person they know and are already predisposed to respect. Seems like a conflict of interest to me, but what do I know?

 

[Anasazi23]

Aye, but the public opinion does matter. It SHOULD NOT matter, but it does. I have long since became convinced that you are much less likely to get sued/have a complaint lodged against you if you are a personable idiot than if you were a competent but less personable jerk. And for politicians, votes are all that matters. So, public opinion is here to stay.

What is the licence revocation process like in the US? Is it regulated by the medics or the lay people? In the UK, it used to be done exclusively by medics - ie, members of the profession. But, it was not fair - or so the public decided. Those nasty doctors would only cover each other, right? So now, the GMC (similar to State Medical Board) proceedings are done by mixed panels (laymen and medics). I guess, laymen are there to judge how nice a person you are. Too bad, they have the power to suspend your licence or even erase you from the register completely - I guess, you just have to try really hard to be nice.

Billypilgrim, I am flattered (does it mean my writing style is as good? just kidding). I am afraid, though, that I could not even claim to be Ayn Rand's reincarnation as I was born a few years before her death.

I'm being only partly fecesious. Of course public opinion matters in some ways. Unfortunately, it's usually an irrelevant way or a way in which they cannot judge. Research is clear that rapport is the number one protective factor agaist malpractice lawsuits, but that's a different matter.

I'd bet that 1/2 the public wouldn't even know who drug reps are, or that they bring stacks of pizzas. They might change their tune when I tell them I've got no more samples - since I'm asked for them no less than 3x weekly. I asked my father his opinion on this drug rep thing, since he comes from the more "old school" life of when doctors actually were treated with respect. His response to the "stack of pizzas" scenario: "Well, doctors, I would imagine have a lot of that type of stuff. Every job has perks, I know I did when I was in the steamfitting business." I replied at this point that people see this as an ethical conflict, to which he replied, "that's ridiculous." No doubt someone will point out that my n=1 research is meaningless, which it is. The point, however, is that one person's opinion, when it comes to lawful restriction, is not everyone's opinion. And when it comes to restricting rights, one must weigh all sides equally. Physicians are hesitant to speak out against such regulation due to the mass hysterical crusader movement against industry within the field. No one wants to be seen as an "outsider," and we'll see no outcome studies 10 years after this has gone though looking at how public perception has changed for psychiatry for the better.

My opinion is that this is an artificial technique, which isn't all good or bad and deserves further discussion, that wil do relatively little for the overall advancement of the field as a whole.

I'm bowing out of the thread now. Good lively discussion.

 

[HCE]

OldPsychDoc and Anasazi:

Two great, well-reasoned posts...personally I think they deserve sticky treatment at the top of the Psych thread. I don't agree with everything you have said, but your contributions to this website are much appreciated by this humble poster.

 

[HCE]

Monitoring of my shopping habits by private companies could benefit both parties (eg, I get cut-price coupons for items I buy most often - that is fine by me!) - and they do not paternalise me (because they do not want to piss me off!). When the Big Brother thinks he knows best and he should know all about you "to protect you" - thank you very much, I had enough of this crap in the USSR.

I don't disagree with you necessarily about Big Brother, but I'm equally cautious of Big Brother professing to protect me, whether he is dressed in government or corporate clothing. I find the trade-off of cut-price coupons about as useful as free government cheese.

 

[whopper]

Looks like I missed a very good intellectual debate, due to the stress of moving from NJ to Kentucky within a few days.

n all this talk, I just can't believe that people actually don't seem to mind the fact that the government is actually about to regulate our morality.

Somewhat tangential....
A big hypocrisy I see is the gov wanting to intervene to stop the conflict of interest of drug reps giving us free meals.

While at the same time they're enjoying lots of free meals from several organizations including pharm companies.

Is it wrong for pharm companies to give us free stuff? I see pros & cons with it, several of which were addressed, but I just really get ticked off with that politicians are trying to "clean" us up when they're a whole lot dirtier than we are.

I'll back any move that improves our profession, but in this case we ought to be giving flack back to politicians as well in addition to pharm companies.

 

[HCE]

For those who have the time and interest in reading more on Big Pharma and its marketing issues, I highly recommend a new book, Our Daily Meds, by Melody Petersen.

http://www.amazon.com/Our-Daily-Med...bs_sr_1?ie=UTF8&s=books&qid=1214404026&sr=1-1

The fact that prescription pills taken as directed by physicians are estimated to kill one American every five minutes warrants some reflection on these issues.

 

[OldPsychDoc]

Looks like I missed a very good intellectual debate, due to the stress of moving from NJ to Kentucky within a few days.

Somewhat tangential....
A big hypocrisy I see is the gov wanting to intervene to stop the conflict of interest of drug reps giving us free meals.

While at the same time they're enjoying lots of free meals from several organizations including pharm companies.

Is it wrong for pharm companies to give us free stuff? I see pros & cons with it, several of which were addressed, but I just really get ticked off with that politicians are trying to "clean" us up when they're a whole lot dirtier than we are.

I'll back any move that improves our profession, but in this case we ought to be giving flack back to politicians as well in addition to pharm companies.

No one has brought up the idea of government intervention, although this seems to be assumed by many on this thread. The OP is asking in the context of a university self-imposing restrictions. I have mentioned restrictions as an organizational policy (which is I believe rooted in good ethical practice). I have also referred to the requirement to disclose payments and gifts over a certain value which are received from industry. Politicians must abide by similar limitations and disclosures--why do you think there is such a fuss about campaign finance laws and lobbyist connections?
I know that in my state, there are strict limits on the value of gifts a legislator can receive. A few years ago, I happened to be meeting with a legislator on a non-business-related matter and he refused to even let me pay for his coffee, as he was choosing to interpret the limits even more strictly than needed in order to avoid getting into any "gray zones". However, the fact that you bring this up at all (accusing politicians as a class of "enjoying lots of free meals from several organizations including pharm companies") is a pretty clear indication of the image that is conveyed when we attend a dinner paid for by someone else, isn't it?

 

[Faebinder]

The last time the government did a major intervension in medicine we ended up with EMTALA and MEDICARE.

IS this like the liberal to conservative argument? Premed = Idealistic Insane Liberal, MS I-II = liberal, MS III-IV = Unsure, Resident = Conservative Tendancies, Attending = Fully Blown Conservative, Attending Post 1st Lawsuit = Conservative With Paranoid Psychotic Episodes?

Does higher income enable you to take the high road eventually? The status quo is fine I believe and the issue is balanced.

 

[billypilgrim37]

Premed = Idealistic Insane Liberal, MS I-II = liberal, MS III-IV = Unsure, Resident = Conservative Tendancies, Attending = Fully Blown Conservative, Attending Post 1st Lawsuit = Conservative With Paranoid Psychotic Episodes?

I've been getting more and more conservative each year since my liberal peak around age 20. At this rate, I'll be conservative enough to be the democratic presidential candidate in 2048.

 

[1viking]

IS this like the liberal to conservative argument? Premed = Idealistic Insane Liberal, MS I-II = liberal, MS III-IV = Unsure, Resident = Conservative Tendancies, Attending = Fully Blown Conservative, Attending Post 1st Lawsuit = Conservative With Paranoid Psychotic Episodes?

This stereotype is all too true in so many instances. I don't fit, however, because I was trained as an economist and have worked on Wall Street prior to medical school. SO, I was a libertarian all throughout.

The latest failing of this stereotype, however, is with many of the Family Physicians that I know. They are mainly for universal coverage and medical homes, since they stand to profit more from it (note the ACP has come out in favor of universal coverage). The proposals that I see fly around all include an increase in salaries for medical home providers (FP and IM).

Back to industry support...I don't see this issue going away, since they fund large studies, such as the one that was released today in NEJM about Rivaroxaban vs. Lovenox. Those are beneficial to us, as clinicians and patients. There are some things that I think should change in regards to studies. First, I think that journals should voluntarily only publish studies that were preregistered with clinicaltrials.gov. Also, I think that every article written should have a section that discusses pretrial primary and secondary outcome measures (there are many studies that change their primary outcome measures after the data has been unblinded) and compare it with the actual measures. I think the article should publish who the initial investigators were and who they are now. A discussion should ensue about why they changed (hoping to eliminate ghostwriting). Also, I think it would be nice if we knew, not just who sponsored the study, but how much they paid for it.

I guess there is more. I'm not in to requiring this stuff from on high. I think that our profession is noble enough to enact guidelines like this on its own.

 

[Faebinder]

This stereotype is all too true in so many instances. I don't fit, however, because I was trained as an economist and have worked on Wall Street prior to medical school. SO, I was a libertarian all throughout.

The latest failing of this stereotype, however, is with many of the Family Physicians that I know. They are mainly for universal coverage and medical homes, since they stand to profit more from it (note the ACP has come out in favor of universal coverage). The proposals that I see fly around all include an increase in salaries for medical home providers (FP and IM).

Back to industry support...I don't see this issue going away, since they fund large studies, such as the one that was released today in NEJM about Rivaroxaban vs. Lovenox. Those are beneficial to us, as clinicians and patients. There are some things that I think should change in regards to studies. First, I think that journals should voluntarily only publish studies that were preregistered with clinicaltrials.gov. Also, I think that every article written should have a section that discusses pretrial primary and secondary outcome measures (there are many studies that change their primary outcome measures after the data has been unblinded) and compare it with the actual measures. I think the article should publish who the initial investigators were and who they are now. A discussion should ensue about why they changed (hoping to eliminate ghostwriting). Also, I think it would be nice if we knew, not just who sponsored the study, but how much they paid for it.

I guess there is more. I'm not in to requiring this stuff from on high. I think that our profession is noble enough to enact guidelines like this on its own.

Wishful thinking. It's funny how we all require... and we think... sometimes I wonder have anyone here really published articles? A lot? Whose funding all these ideas? Journals dont print themselves. How many journals are you subscribed to? I am not talking about 1viking specifically... We all need to understand that these journals we look for guidance are written and edited by people who arent getting much out of it.. otherwise the prestigous job would not be the chairman of the department of psychiatry at the XXXX institution... it would be the Head Editor of XXXX journal.

PS: Test of true mettle is after you are sued and settled as an attending and still maintain the liberal ideal. Libertarians are not liberals.

 

[1viking]

I'm not in to requiring this stuff from on high. I think that our profession is noble enough to enact guidelines like this on its own.

Did you forget this statement?

You bring up some great points...journals have to make money, too.

for the record, I haven't published anything. I read current issues of NEJM, JAMA, AFP, Green Journal, and Pediatrics. I'm am trying to get my apa subscription worked out. This is much more than the average med student...I guarantee that.

 

[BabyPsychDoc]

No one has brought up the idea of government intervention, although this seems to be assumed by many on this thread. The OP is asking in the context of a university self-imposing restrictions. I have mentioned restrictions as an organizational policy (which is I believe rooted in good ethical practice). I have also referred to the requirement to disclose payments and gifts over a certain value which are received from industry. Politicians must abide by similar limitations and disclosures--why do you think there is such a fuss about campaign finance laws and lobbyist connections?
I know that in my state, there are strict limits on the value of gifts a legislator can receive. A few years ago, I happened to be meeting with a legislator on a non-business-related matter and he refused to even let me pay for his coffee, as he was choosing to interpret the limits even more strictly than needed in order to avoid getting into any "gray zones". However, the fact that you bring this up at all (accusing politicians as a class of "enjoying lots of free meals from several organizations including pharm companies") is a pretty clear indication of the image that is conveyed when we attend a dinner paid for by someone else, isn't it?

I have never thought about it this way. My perspective is different because I have been practising in single-payer healthcare system, where my prescribing is monitored, and to a certain degree mandated by the government.

For instance, if I need a PPI, I have to prescribe Omeprazole. I could, of course, prescribe ANYTHING, but my prescription will simply bounce back to me, because my Primary Care Trust, or my NHS Trust do not allow any other routine PPIs.

Also, few UK attendings make 6 figures salaries, and the departments certainly do not have budget specifically for educational events. So, physicians are not shy about asking drug reps to come and sponsor, say, Grand Rounds, even though we do not want to deal with them. Then you just have to sit and listen to the mandatory 5-10 min presentation by the rep - because, truly, there is no such thing as free lunch.

 

[Faebinder]

That's what I am trying to say... when the income is high, one can afford to take the high road. It's hard to care about ethics when you are barely making ends meet.

Anyhow, a nice thing that might come up in the future is the infamous paperless systems. We might see in the future drug prices next to selected drug orders in electronic charts... and now you get to be ethical and select the less expensive drug.

Meanwhile, I dont see GME pounding at my door to go get epocrate or lexicomp to see those prices.

 

[OldPsychDoc]

That's what I am trying to say... when the income is high, one can afford to take the high road. It's hard to care about ethics when you are barely making ends meet.

Anyhow, a nice thing that might come up in the future is the infamous paperless systems. We might see in the future drug prices next to selected drug orders in electronic charts... and now you get to be ethical and select the less expensive drug.

Meanwhile, I dont see GME pounding at my door to go get epocrate or lexicomp to see those prices.

There is hope for you--I work in a system that is fully electronic. We do get cost information when ordering meds from the pop-up lists, and Epocrates is linked from the menu bar of our EMR application. Perhaps as more health care systems move in this direction, you will see more of this.

 

[BabyPsychDoc]

There is hope for you--I work in a system that is fully electronic. We do get cost information when ordering meds from the pop-up lists, and Epocrates is linked from the menu bar of our EMR application. Perhaps as more health care systems move in this direction, you will see more of this.

That's cool. Here, we have the cost information available in the BNF (equivalent of PDR, kind of) - but it is extra effort to look it up, whereas if it just pops up when you write up the drug, it makes it very convenient.

I can't believe we do not have anything remotely similar in a university affiliated tertiary referral centre in the UK:cry:, whilst you have this system up and running in a community hospital in the US! Jealous...

 

[whopper]

is a pretty clear indication of the image that is conveyed when we attend a dinner paid for by someone else, isn't it?

True.

 

[Shalom77]

For those who have the time and interest in reading more on Big Pharma and its marketing issues, I highly recommend a new book, Our Daily Meds, by Melody Petersen.

http://www.amazon.com/Our-Daily-Med...bs_sr_1?ie=UTF8&s=books&qid=1214404026&sr=1-1

I'm curious why you liked the book so much?

I was pretty turned off by the book although I admit I was turned off so early I didn't read most of it. Since so many people I know really struggle/debate/torture themselves before considering psychiatric medication - books who contain the thesis that people just take meds for a "quick fix" are somewhat off putting. I also see people get convinced to give up their "quick fix" or "stop being weak (ie by relying on a pill for their problems)" relapse and then have trouble regaining control of their symptoms since sometimes their medications are not as effective the second time around. I'm not saying that overmedication isn't a problem - just that I wasn't really feeling up for reading a book conveying that attitude while dealing with the opposite problem.

I think Marcia Angell's book is highly illustrative of drug company tactics without that flaw.

In fairness - pehaps it was just the section I read - since like I said I didn't read the rest.

As for the original question on the thread - while drug company lunches/dinners were banned at my hospital - some residents had an in with drug company reps and arranged dinners at local restaurants for our resident study group. On principle I usually avoid these - but I did go to one and heard a talk by the drug rep about how Bextra was so different from the other Cox-2 inhibitors - didn't have the same types of problems and wouldn't be pulled from the market. While I don't have the delusion that I'm immune to drug company influence - I do feel 100% certain that using the Bextra pen that I recently found while cleaning my apartment won't influence my prescribing practices.

I don't use drug company pens in front of any of my study participants though - I do agree perception is important.

 

[HCE]

I'm curious why you liked the book so much?

I was pretty turned off by the book although I admit I was turned off so early I didn't read most of it. Since so many people I know really struggle/debate/torture themselves before considering psychiatric medication - books who contain the thesis that people just take meds for a "quick fix" are somewhat off putting. I also see people get convinced to give up their "quick fix" or "stop being weak (ie by relying on a pill for their problems)" relapse and then have trouble regaining control of their symptoms since sometimes their medications are not as effective the second time around. I'm not saying that overmedication isn't a problem - just that I wasn't really feeling up for reading a book conveying that attitude while dealing with the opposite problem.

I think Marcia Angell's book is highly illustrative of drug company tactics without that flaw.

In fairness - pehaps it was just the section I read - since like I said I didn't read the rest.

As for the original question on the thread - while drug company lunches/dinners were banned at my hospital - some residents had an in with drug company reps and arranged dinners at local restaurants for our resident study group. On principle I usually avoid these - but I did go to one and heard a talk by the drug rep about how Bextra was so different from the other Cox-2 inhibitors - didn't have the same types of problems and wouldn't be pulled from the market. While I don't have the delusion that I'm immune to drug company influence - I do feel 100% certain that using the Bextra pen that I recently found while cleaning my apartment won't influence my prescribing practices.

I don't use drug company pens in front of any of my study participants though - I do agree perception is important.

Very thoughtful response; thanks. I really don't think the "quick fix" point is at all a major point in the book. I do recall some passing mention that Americans tend to be consumer-driven and look for quick fixes as a general proposition. One of the more moving stories she related involved a single mother of two children who were prescribed multiple medications at very early ages, the eventual intervention by a pediatrician to insist the children receive counsellng surrounding their father's death (which amazingly never occurred), and the weaning of the multiple medications. In that case it seemed it was in fact the Insurance company's policy of paying for medication and not paying for time spent talking to the child that was the issue. In other words, the insurance system was pushing a quick fix, the mother was looking for the right fix, and an inspiring pediatrician insisted that the right thing happen.

I agree with you (as the author seems to) that medication has its place, sometimes with miraculous results, and has given otherwise suffering people great relief. I think the book is more concerned with "life-style" medications marketed to the public constantly on television, etc. rather then the long-term medication regimens prescribed by psychiatrists for their carefully followed patients.

I think in the end what I liked about the book was its "hammer over the head" approach. Corporations are organized for profit, but at some point some of them cross a line. My own opinion is that Big Pharma crossed that line a long time ago, and anyone willing to do the research and write a book on the subject is fine by me. If you read about the founders of some of the large drug companies (e.g. George Merk), you can't help but come to the conclusion that they would be rolling in their graves if they saw how the well-being of patients has become secondary to the marketing and the sales of drugs. Thanks again for the response.

 

[HCE]

Sorry, didn't mean to get off-topic.

the way I see it, it starts with pens and free lunches, and before you know it, you are in private practice and your light switches are Viagra ads:


View attachment Viagra switch.bmp

 

[billypilgrim37]

sorry, Didn't Mean To Get Off-topic.

The Way I See It, It Starts With Pens And Free Lunches, And Before You Know It, You Are In Private Practice And Your Light Switches Are Viagra Ads:

Win!!!

 

[OldPsychDoc]

Win!!!

I think you meant "Schwing!!!"

 

[freaker]

In all this talk, I just can't believe that people actually don't seem to mind the fact that the government is actually about to regulate our morality. You can "cover" it in science...but this is what's happening.

I'm in complete agreement. I see no reason whatsoever for the government to barge in and force itself upon free enterprise. Any person who doesn't wish to buy into what is being sold or said is free to look elsewhere. But here comes the nanny state to save the day--or rather, to shackle the exchange of ideas and corporate interests.

When I see people avoiding these events out of self-righteousness, it makes me all the more motivated to attend. I am not of the opinion that corporation = evil. Nor am I of the opinion that every research journal is unbiased, either.

Frankly, we have allowed government to restrict far too many of our freedoms, and it's a very disturbing trend. The whole argument about handguns above just sent my eyes rolling. No society is quite so vulnerable as an unarmed one. And as for gun ownership and crime, we can see Switzerland manages just fine, though I have a feeling that has as much to do with having a relatively homogenous population as anything.

I'll bristle at pretty much any intrusion of freedom that I come across, anyway, particularly one imposed by a government body.

 

[HCE]

I'm in complete agreement. I see no reason whatsoever for the government to barge in and force itself upon free enterprise. Any person who doesn't wish to buy into what is being sold or said is free to look elsewhere. But here comes the nanny state to save the day--or rather, to shackle the exchange of ideas and corporate interests.

When I see people avoiding these events out of self-righteousness, it makes me all the more motivated to attend. I am not of the opinion that corporation = evil. Nor am I of the opinion that every research journal is unbiased, either.

Frankly, we have allowed government to restrict far too many of our freedoms, and it's a very disturbing trend. The whole argument about handguns above just sent my eyes rolling. No society is quite so vulnerable as an unarmed one. And as for gun ownership and crime, we can see Switzerland manages just fine, though I have a feeling that has as much to do with having a relatively homogenous population as anything.

I'll bristle at pretty much any intrusion of freedom that I come across, anyway, particularly one imposed by a government body.

The only comparison I see between biased, whitewashed research and handguns is the menace each contributes to society.

 

[sunlioness]

I also don't see what those darn "self-righteous" people avoiding drug lunches by choice has to do with government interference.

 

[HCE]

I also don't see what those darn "self-righteous" people avoiding drug lunches by choice has to do with government interference.

Freaker was just being self-righteous.

 

[Anasazi23]

Increasing number of physicians feel pressured by health insurers to prescribe generic medications.
New York's Star-Gazette (6/27, Finger) reported that a growing number of physicians "believe that health insurance companies are taking medical decisions out of their hands by dictating the medications a doctor can prescribe to patients." Some "physicians say they are often strong-armed by insurers who demand they prescribe generics by forcing patients to pay higher co-payments for brand-name prescriptions, even when no generics are available -- or by refusing to pay at all." Francisco Corbalan, M.D., who practices internal medicine in Elmira, N.Y. said, "I do get lots of requests from insurance (companies) directly to me to change the medication, sometimes bypassing the patient." Health insurance providers "counter that they are following legitimate medical protocol developed by panels that include physicians." Insurance providers also contend "that without the pursuit of cost-effective treatment, prescription insurance coverage would be too expensive for employers to offer."

Where's the outrate? Where's the shouting? Where's the ethics police? Where's the government legislation?

Oh, that's right. This is much less sexy and doctors deserve it because they got rich in the 80's.

 

[sunlioness]

Never mind.

 

[HCE]

Increasing number of physicians feel pressured by health insurers to prescribe generic medications.
New York's Star-Gazette (6/27, Finger) reported that a growing number of physicians "believe that health insurance companies are taking medical decisions out of their hands by dictating the medications a doctor can prescribe to patients." Some "physicians say they are often strong-armed by insurers who demand they prescribe generics by forcing patients to pay higher co-payments for brand-name prescriptions, even when no generics are available -- or by refusing to pay at all." Francisco Corbalan, M.D., who practices internal medicine in Elmira, N.Y. said, "I do get lots of requests from insurance (companies) directly to me to change the medication, sometimes bypassing the patient." Health insurance providers "counter that they are following legitimate medical protocol developed by panels that include physicians." Insurance providers also contend "that without the pursuit of cost-effective treatment, prescription insurance coverage would be too expensive for employers to offer."

Where's the outrate? Where's the shouting? Where's the ethics police? Where's the government legislation?

Oh, that's right. This is much less sexy and doctors deserve it because they got rich in the 80's.

Hey, I think its sexy and I'm outraged. When are doctors going to have a call to arms to wrestle back the control of medical treatment from Insurance and Pharmeceutical companies. And when are physicians going to stop selling out to insurance and pharmaceutical companies by becoming paid "consultants." By and large physicians are an honorable group of people. For those less then honorable, its time to call them out.

Get outraged!!

 

[TheWowEffect]

I think 'Sazi makes some very valid arguements about insurance companies. This is true especially for some of these Medicaid HMOs. They want you to prescribe Benadryl, instead of Zolpidem. This one HMO will not even allow Restoril. This is just one of the many examples. And you discover these funny loopholes in the process. If you tell them that pt's psychiatric condition will be exacerbated by Insomnia, they will happily approve it for 6 months.

 

[OldPsychDoc]

Increasing number of physicians feel pressured by health insurers to prescribe generic medications.
New York's Star-Gazette (6/27, Finger) reported that a growing number of physicians "believe that health insurance companies are taking medical decisions out of their hands by dictating the medications a doctor can prescribe to patients." Some "physicians say they are often strong-armed by insurers who demand they prescribe generics by forcing patients to pay higher co-payments for brand-name prescriptions, even when no generics are available -- or by refusing to pay at all." Francisco Corbalan, M.D., who practices internal medicine in Elmira, N.Y. said, "I do get lots of requests from insurance (companies) directly to me to change the medication, sometimes bypassing the patient." Health insurance providers "counter that they are following legitimate medical protocol developed by panels that include physicians." Insurance providers also contend "that without the pursuit of cost-effective treatment, prescription insurance coverage would be too expensive for employers to offer."

Where's the outrate? Where's the shouting? Where's the ethics police? Where's the government legislation?

Oh, that's right. This is much less sexy and doctors deserve it because they got rich in the 80's.

Sazi--why so down on free-enterprise all of the sudden? Why should government force these insurance providers to pay for something that hurts their bottom line? How is it "strong-arming" doctors to expect patients to pay more for a branded (presumably higher quality, right?) medication? I mean if the patient wants to pay $80 a month to have Lexapro instead of $4 month for citalopram, they have that option, right?

Let the free-market rule, man.

 

[Anasazi23]

Sazi--why so down on free-enterprise all of the sudden? Why should government force these insurance providers to pay for something that hurts their bottom line? How is it "strong-arming" doctors to expect patients to pay more for a branded (presumably higher quality, right?) medication? I mean if the patient wants to pay $80 a month to have Lexapro instead of $4 month for citalopram, they have that option, right?

Let the free-market rule, man.

Your point is well-taken. It's a fine line.

My point with my provocative remark was to show that the government tends to inbue its wisdom at times that are classically, less urgent or important than other times when it's more necessary. Government "intrusion" is sometimes necessary - monopolies and price fixing come to mind. These dubious occurrances may appear free-market driven, but as we know, can be harmful to the free market as well - and particularly to the consumer.

The above example of insurance companies making decisions for doctors is a different matter entirely. This is the continued backlash against doctors, who, because of our inability to represent ourselves properly, allowed insurance companies to dictate our practices. Yes, patients are free to pay for brand meds, and I have lots of patients that do pay through the nose as an assumed healthcare cost, since that's what keeps them functioning, as I'm sure you do too.

 

[freaker]

I also don't see what those darn "self-righteous" people avoiding drug lunches by choice has to do with government interference.

I never actually made that connection. You did.

The government interference refers to other posts calling for restricting contacts with drug-reps and limited marketing. Hence separate paragraphs.

Now, if you wish to boycott these meetings out of your own personal ethics, be my guest. The individual, however, who attemps to bring the government in to legislate such matters, I have major issues with.

 

[freaker]

The only comparison I see between biased, whitewashed research and handguns is the menace each contributes to society.

I suppose you're in favor of banning alcohol? Far more dangerous and menacing than any handgun. And of absolutely incapable of saving a human life, very much unlike a handgun. (Well, I'm saying this never having tried to bribe a potential assailant with a bottle of Maker's Mark... )

Lots of fun, both of them. Just depends on how they're used.

 

[sunlioness]

I never actually made that connection. You did.

You said, and I quote:

When I see people avoiding these events out of self-righteousness, it makes me all the more motivated to attend.

Seems like you did make that connection to me.

But have it your way.

 

[billypilgrim37]

I suppose you're in favor of banning alcohol?

Non sequitur much?

Is there some sort of libertarian Godwin's law variant about banning alcohol?

 

[Anasazi23]

As I've intimated, the dangerousness of the overarching banning of any and all company-sponsored education is addressed in part here. It's just an opinion piece, but it's germane to the discussion here.

Get ready to say goodbye to Medscape, webmd, and most other profit-driven sites.

http://www.medscape.com/viewarticle/575699

 

[freaker]

Seems like you did make that connection to me.
But have it your way.

You asked what voluntarily choosing not to attend luncheons had to do with government interference. I never made that connection. I mentioned them in the same post. I didn't link them together.

I guess you could make that link in that it does motivate me to attend such luncheons and the like in part because I hear the rumbling as well as anyone else, and I fundamentally take a difference stance.

I do owe you an apology, though. I should have left out the "self-righteous" part. I was in part fired up over this over an attending who made a big deal about all of this and how he was going to be speaking to a Congressman about banning such interactions. I feel pretty strongly when it comes to limiting government interference in business. I think we've got a power structure that has way out-stepped its Constitutional authority.

So again, my apologies. I wasn't referring to you directly, but there's no place for pointless language like that, anyway.

 

[sunlioness]

Thanks, freaker. I appreciate it. And self-righteousness annoys me too. I kind of think that if you are doing something out of a strongly held belief, why make a big deal over it? It is what it is.

 

[whopper]

I'm in complete agreement. I see no reason whatsoever for the government to barge in and force itself upon free enterprise

I'm going to play devil's advocate & say some good things about pharm advertising & residencies. Note that some of these benefits only apply to residents, not attendings (and again, I'm playing devil's advocate--so don't think I'm a pharm company supporter)

1-new residents most often do not know the differences between meds within a class in practice. By attending pharm dinners, they are given a presentation for each med which can build a basic framework on the benefits the specific med can provide. Often times the educational aspects presented at the the dinners exceed that of professors in a psyche program.
2-residents are heavily in debt, overworked & often times benefit from the free items pharm companies can provide them. A free book, pens, dinners can be a big morale booster to the overworked resident
3-pharm companies can allow a program to get in some big name (& high price) speakers to grand rounds. My own program was only willing to pay $500 tops (including nothing else such as travel expenses) for a speaker from their own pocket. That severely limited who I could bring in as a grand rounds speaker (one of my responsibilities when I was chief).

We were able to get Phil Resnick, M.D. to give a lecture, only because a pharm company helped to sponsor his trip. Dr. Resnick's lecture was definitely worth the assistance provided by the pharm co. He's one of the top guys in the field & a fantastic lecturer. The price of his plane ticket alone would've been over $500 and there was no way I could've gotten him from the program's own funds.

4-some institutions have created counter-pharm company policies that create harm. E.g. the NJ state hospital system forbids any of its attendings from being paid to give lectures. Although its meant to prevent its doctors from being paid by pharm companies, this in turn has prevented them from getting paid for any speaking engagement, even if not from a pharm company. As a result, I couldn't get any of them to speak at a grand rounds at my residency program.

5-some freebies offered by pharm companies can point out to things the program should be offering but isn't. Edible food vs the slop at the cafeteria? Top notch speakers vs the attending who "winged it" & gave a flat & boring lecture, a free DSM-IV? If a resident seems to be influenced by pharm company advertising, shouldn't that also call into question the attending's teaching & direction of a resident (or lack thereof...), which should include healthy disclaimers of the problems with pharm advertising & the justification of why any specific med is used on a patient?


Overall, I am most for the practice of psychiatry to be done in the interests of the patient. Pharm companies certainly should be monitored & their commercial insertion questioned. I can certainly point out the problems created by pharm advertising but I think that's been covered well in the thread.

 

[whopper]

I mean if the patient wants to pay $80 a month to have Lexapro instead of $4 month for citalopram, they have that option, right?

A problem though is several patients are not given the option. I've seen several attendings pick an SSRI for the patient & the patient has little or no say. Its not like the patient is given a list of every single SSRI & educated on its pros & cons to make an informed decision. Often times they are "reccomended" which one, which is a de-facto appointed med. Its also not like every doctor is asking if the patient can afford the med either. Until my 3rd year, I'd estimate less than 10% of the patients I saw in a bad financial situation actually got asked about their finances & their ability to afford a med being put into the clinical consideration of which choice of med to be given. The situation changed my PGY-III year because the social workers & myself became vocal about being bugged about a clearly preventable situation where the same patients were noncompliant over & over again because they couldn't afford & med & would just be continued on the same med. We started mentioning the new $4/month generics which was new at that time. The attendings kept to their practices, but I was able to get the newer residents to change the trend.

Every single patient I've seen who had no insurance or other financial aid to pay meds wanted citalopram over lexapro whenever I actually sat down with them, explained the price & the differences between the meds. Its not like lexapro is leaps & bounds better than citalopram either & we know that.

Any patient who wanted lexapro over citalopram, I always honored their decision.

 

[MBK2003]

Here it's not just the W-mart and Chez Target that have the $4/month Rx lists, but one of the local grocery store chains has done $4/month or $10/3mo for the same lists. Since I'm doing child psychiatry and our 3 big SSRIs for use in kids are Fluoxetine, Sertraline, and Citalopram, I end up directing all my patients & parents to using these 3 pharmacies. The families with private insurance appreciate being able to get a month supply for $4, much less then the mandatory $15-20 copay for generics that the chain drug stores charge them. I have a few families that have taken the $4 Rx list to the parents' PCP and the kids' pediatrician to see if they can get switched to meds on the list. I really, really like having a chance to educate families about being better health care consumers.

 

[whopper]

but one of the local grocery store chains has done $4/month or $10/3mo for the same lists.

Shop Rite in NJ is one of those offering the the $4/month, $10/3 month deal.

Is this important? Yes. Walmarts & Targets are usually located on highways which require transportation. For some, especially those without cars, that busride can be over an hour of their time which can be a big pain in the butt. If there's a Shop-Rite right down the street that they can walk to instead of spending 2 hrs on a bus to get to a location only 7 miles away, its worth it for them.

Kroegers (where I live now in KY & OH) also has the $4 & $10 generic program.

I haven't seen Sertraline available as one of the $4 generics.

The families with private insurance appreciate being able to get a month supply for $4, much less then the mandatory $15-20 copay for generics that the chain drug stores charge them.

I don't really see any big reason to start most with insurance on a nongeneric SSRI. Its not like Lexapro is far & away superior to Citalopram. Now if the person had any chronic liver disease, a history of significant liver damage or was on several meds that could interact with an SSRI, then I'd consider Lexapro over Citalopram, but otherwise I don't really see much reason to give Lexapro over Citalopram.

 

[Anasazi23]

There's a lot of bad things about airing "dirty" laundry in your profession. Every anti-psychiatry organization is using this as fodder for their zealot masses:

Notice to Members of the New York County District Branch, American Psychiatric Association, Inc.


Please note the following message which we received today from the APA

Members of the American Psychiatric Association:

It has come to our attention that some members have received an e-mail from Psychsearch.net with the subject line "APA Faces Scrutiny Over Drug Industry Ties." The e-mail starts out "Dear Doctor, Three question survey" and includes the text of Saturday's New York Times article about the APA and the issue of pharmaceutical funding of medicine.

The e-mail is from Ken Kramer <[email protected]>. Psychsearch.net is an anti-psychiatry Web site. We advise all members to disregard the survey and not respond, as it is NOT an official member communication.

If you have any questions please contact [email protected].

Office of Communications & Public Affairs
American Psychiatric Association

 

[BabyPsychDoc]

there's A Lot Of Bad Things About Airing "dirty" Laundry In Your Profession. Every Anti-psychiatry Organization Is Using This As Fodder For Their Zealot Masses:

Nice.

 

[whopper]

There's a lot of bad things about airing "dirty" laundry in your profession. Every anti-psychiatry organization is using this as fodder for their zealot masses:

I agree. If there's a problem and you're in the administration, you solve the problem yourself. If the problem is something that is beyond you, you take it up and ask that management to solve the problem.

You only blow it out to the 3rd parties if its something that will not be fixed by those within the group, despite it being addressed several times.

This IMHO is even more reason for the APA among other psychiatric groups to practice honestly & to make sure the profession acts within ethical & legal guidelines.

 

[HCE]

I suppose you're in favor of banning alcohol? Far more dangerous and menacing than any handgun. And of absolutely incapable of saving a human life, very much unlike a handgun. (Well, I'm saying this never having tried to bribe a potential assailant with a bottle of Maker's Mark... )

Lots of fun, both of them. Just depends on how they're used.

Freaker:

Didn't mean to ignore your post, I just missed it somehow.
No, I don't think i'm in favor of banning alcohol (never really thought about it, and don't drink it myself), but I could live with banning or limiting advertisement for alcohol. Alcohol does have a purpose other then killing (albeit a dubious purpose at best), whereas the sole purpose of a gun is to kill. But certainly, a bottle of Boone's Farm smashed over the head of an assailant will do the trick....

 

[whopper]

A gun has more purposes than simply killing.

 

[Faebinder]

Well, I am glad I got my Kaplan book from the drug company before they stop this in the beginning of next year. I am hording as many pens as possible damn it as I refuse to buy a single pen to sign my name on the billionth form. I think I have enough now to last me for two years till i get that darn license. And yes, that damn stamp my chief is holding is looking mighty fine now!