Separate names with a comma.
Discussion in 'Medical Students - MD' started by dave262, Mar 15, 2004.
I think you have to sign up for a credit card to get the free Netter. Whenever I open my yahoo mail, there always is a pop-up link to some CC application that promises to give me $50 gift card after being approved. I guess The CC company pays the expenses of buying netters for AMSA.
No, it is not unethical, neither is eating free lunches provided by drug companies.
The AMSA thinks it is though
speaking of unethical
you could probably get away with getting the free Netters w/o joining AMSA.
after you fill out the CC app, they can hand you the Netters; not like you need to give them any real information.
You're right, you don't need to give them any real information if you want to commit bank fraud!
if you really care that much, then why don't you go to the convention and run for a position yourself?
the price of joining AMSA is roughly the price of a Netters. so just make believe you never joined and quit whining already.
i really can't feel sorry for you for dropping $60+ to join an organization when you didn't even take 5 minutes find out what it was all about. seriously, it would only have taken you 5 minutes. be more careful with your money in the future.
I only paid 10$ to join actually. How about if a drug company gave away free netters then? would the AMSA think that is okay?
I would love to go to the convention, but I have to study
why insist on tainting your original post with stupid political commentary. is that really productive to this conversation?
Free = Good.
AMSA boasts having the largest membership of any medical student organization, and they give Netters out to those who join. Clever AMSA.
It's only unethical when they claim that the same behavior by pharm companies with the intent of selling their product is wrong. Conceptually, these practices are the same...
...whether one runs for office in AMSA or not.
From Pfizer 2003 annual report:
Is the difference any clearer to you now?
...And this is only one of the many OBVIOUS differences between AMSA's Netter promotion and bribing docs with food or other gifts.
Well, you pointed out the difference in profit margin between AMSA and a big drug company; this information probably won't suprise anybody, nor is it even relevant.
If you believe one of the many 'OBVIOUS' differences between the Netter promotion and drug company promotions provides justification for how these two practices are fundamentally, ethically dissimilar, then yes I would like to hear it.
Keep in mind, I don't find either of these practices unethical. Neither of these practices constitute bribery (as you mentioned,) and the subjects are ultimately free to make their own decisions. Also keep in mind that the ultimate goal of these two practices (making a profit vs boosting membership) is not relevant to whether the practice itself is ethical.
Uh..Pfizer is a company..it sells things..it promotes them..that is what companies do to increase profits. Problem?
I want to be a drug company when I grow up.
AMSA is a student-governed, non-profit organization. Its GOAL is to represent the concerns of physicians-in-training. Dave262, you have voiced your displeasure with AMSA's policies, and suggested that they are not representative of most medical students. By offering incentives to increase membership, AMSA is more likely to better represent ALL medical students. How is this "unethical"? Isn't it actually what you want?
Kosmo, you are right that "subjects are ultimately free to make their own decisions" and I do not neccesarily think that accepting lunch from a drug rep should be frowned upon in all circumstances. However, it certainly does meet the definition of "bribe" (from AHED: 1. Something, such as money or a favor, offered or given to a person in a position of trust to influence that person's views or conduct).
This is a dubious assertion, and I would argue that it is wrong for both the reasoning and the assertion itself.
1. The goal of an action is indeed relevant to its rightness or wrongness (ethics). This general philosophical viewpoint, deontology, is a far more accepted approach to medical ethics than the utilitarian reasoning that your quote implies.
2. If you do want to ignore the goals and just argue that the results of drug company marketing make them right, then there are a lot of people paying hundreds of dollars a month for drugs that would probably like to argue with you.
This is an interesting topic and I would enjoy continuing the discussion on either of these points.
I think the only problem is when there extreme financial power allows them to dictate social policy.
I want a free netter's how do i sign up for the cc? Is there a link or something?
Well, money talks, so to speak; When looking at those profits, remember this: Every drug brought to market costs the company $800 million on average to develop!! Just because something is brought to market doesn't mean they are successful.
We live in a capitalistic society where successful people are rewarded with money and influence, while those that are not successful are rewarded with the opportunity to try again and try harder; In a non-capitalistic society, neither of these opportunities are afforded to people/businesses, so we should be thankful for what we have......
AMSA = socialist hypocrite
Can you say MATCH?
Good points y'all, thanks for the dialogue!
The vast majority of research and development of new drugs actually occurs at universities and research institutions, with NIH money! The drug companies then purchase licensing agreements to use and then patent the product.
If you want to talk about development costs, then it shold be highlighted that taxpayers pay for most of the R&D for new drugs, with drug companies reaping the benefits! You can talk all you want about a capitalist society, but the reality in this country is that corporations are one of the largest recipients of federal subsidy, which effectively squashes all competition.
For example, how is it consistent with free market principles to pass a prescription drug "benefit" but then forbid by law the buyers from trying to negotiate prices?
Now that I've thrown that bomb into this thread. . .
And while it may seem similar superficially, I think that ultimately there is no comparison between AMSA offering a free Netter's and drug reps offering free lunches.
In the first case, you have an very useful educational incentive to boost membership. In the second case, you have an incentive with the intent to change prescribing patterns. The end result is earning the drug company more money by passing along a higher bill to patients. The Netters is an unbiased source of anatomical information; I don't think the same can be said for a drug company rep as sources of drug information.
This kind of assertion needs a reference. First with respect to the proportion of drugs developed in this way; and second, for this assertion to be relevant it needs to be shown that the price paid for licensing is somehow inadequate. Having had experience in R&D with a major pharmaceutical company, I've seen first hand the effort that goes into research and development of novel drugs. "Vast majority"... bullchips.
I'm skeptical of this assertion as well. And even if this were true I'd like to see data that showed what percentage of R&D costs (which include the massive cost of FDA approval) paid by pharm companies is covered by subsidy. Generalizing here about corporations receiving a large portion of federal subsidy is somewhat inappropriate in that many (if not most) corporations operate without federal assistance. I.e., corporations like Amtrak which survives because the government keeps it running, receive massive subsidies; but it's not fair to include all corporations in your generalization merely because a few require massive government support to stay afloat.
You are correct, there is nothing about a prescription drug 'benefit', nor forbidding price negotion with buyers that is consistent with free market principles.
This has sort of been hit on already, but...
When AMSA gives out a free Netters for joining, they don't increase the cost for another group to pay for it.
However, drug companies charge the people who need the medicine more so that they can provide the free lunches for doctors.
And that is the main reason why it's a faulty comparison.
Not to be harsh, but this is the least convincing yet of the arguments posted so far. The cost of the Netters is borne by the customers of the credit card company sponsoring the AMSA promotion.
The only real difference between the two practices is the perceived beneficience with respect to AMSA's ultimate goals. And one is treading a slippery slope to suggest the ends always justify the means.
[PS: please remember that I do not find either of these practices to be unethical.]
Remember, the free Netter is analagous to the free lunch in this construct. Listening to the drug rep is ultimately the cost of the 'free' lunch, just like filling out the credit card app is the cost of the 'free' Netter.
Nobody goes into a drug rep sponsored event with the misconception that they will receive an unbiased representation of the product, one should take AMSA with the same grain of salt: as I said previously AMSA boasts the largest membership of any medical student organization, but they don't boast that it's largely due to their clever Netter promotion.
A lot of people say this same thing, but you guys are confusing money with innovation. NIH pays a bunch of phd's to sit in the lab and kill mice all day. That's where a lot of the new innovation takes place, but it's not that expensive. The drug companies then come in and fork over the real cash. They have to take these drugs with a tiny bit of promise, and give proof that they're safe in humans, effective, and better then the competition. It costs a huge amount of money, and most drugs fail.
That said, I agree that the country is getting ripped off by big pharm and that we should have some regulations on them. For example, do we really need to pay super high drug prices so every other drug company can come out with their own version of viagra and them pay millions to market it during the superbowl?
Somebody asked for references?
I would recommend anybody interested in this topic read the British Medical Journal's 31 May 2003 special issue on the relationship between physicians and drug companies, in particular the articles by Moynihan (The BMJ is free online).
From JAMA, a review by Wazana suggesting that physician-industry interactions affect prescribing and professional behavior.
Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?
And lastly, on the question of who pays for drug development, there is a very eye-opening report from the New Republic in 2002 that I HIGHLY recommend. The authors are both past editors-in chief of NEJM.
Relman A, Angell M. America's other drug problem. The New Republic 227 #25 D 16 2002, pages 27-41.
Enjoy! If anybody takes advantage of these references let me know what you think.
1. In 1998, only about 15 percent of the scientific articles cited in patent applications for clinical medicine came from industry research (54 percent came from academic centers, 13 percent from government).
2. The NIH selected the five top-selling drugs in 1995 and found that 16 of the 17 key scientific papers leading to the discovery and dev't of these drugs came from outside the industry. 85 percent of the relevant published research came from American taxpayer-supported laboratories or foreign academic labs.
Both of these tidbits are from the paper by Relman and Angell cited in my above post.
Well, federal govtment doesn't support any clinical trial research. It is the drug companies who have to cough up the cash to do this. Remember, majority of new drugs are eliminated in the clinical trial stages and it is really expensive. While a phD at Harvard just finds the new drug, he has to rely on Pfizer's money to do any clinical research.
Exactly, but for some reason most people just have a really hard time understanding that. If NIH had to also pay for the clinical trials, all the funding for the innovation would be cut down to a tiny fraction of what it currently is.
unfortunately the online site for your reference only goes back to 2003. (and incidently, TNR is about as unbiased of a source of information as drug reps. )
But I wonder if the article mentions the actual cost borne by industry for drug patents. Moreover, would you expect a for-profit pharm company to publish data (before patent) on a product in development?
Anyway, if you could provide some text (if that's allowed) or inform me of a way to access pre-2003 articles, I'd be happy to read the one you cited.
I unfortunately only have a print version of the article or I would post more excerpts from it. However, I didn't have any trouble getting it through my university's library-- I belive the resource I got it from was Academic ASAP. You should be able to do the same if you have access to an academic library.
I don't blame you for being skeptical of the source, which is why I mentioned the qualifications of the authors. For obvious reasons, evidence or opinion that is damning to drug companies is not published in major medical journals.
Most major innovations in the pharmaceutical world are made in the academic and government research worlds. However, I am not saying that drug companies do not spend a substantial amount of money on "research and development". In exchange for funding the trials that prove that a drug is safe, pharm companies recieve a government-granted monopoly and exclusive marketing rights.
Expenditures on marketing and administration combine for more than twice the R&D budget of large pharm companies. And when you add it all up, profits are consistently higher than those of any other American industry.
Thanks for beating me to the punch, Madcadaver
As far as the assertion that the gov't doesn't pay for any clinical trial research, that's not quite true, the National Cancer Institute for example funds a lot of clinical research, but I agree it's probably not the same league as what the drug companies fund (although I don't know the exact numbers).
One last tidbit though--how often do drug companies publish the results of clinical trials when their drug performs unfavorably?
Kosmo, I agree that most people realize they're not getting unbiased information when they go to a drug rep talk but the major issue for me is that people often don't realize how much just listening to the talk actually DOES affect prescribing practices. It doesn't matter whether somebody knows he or she is getting biased info if the end result is still that whatever drug that is being pitched gets prescribed more. The drug company still wins. See the articles referenced by Madcadaver for the stats. . .
Routinely. In fact, the recent findings that Lipitor improve health outcomes far more than expected came about because a drug company commissioned a study with the expectation that the results would improve its own competing drug's chances against Lipitor.
The problem with AMSA is the problem with the quoted statement--people tend to think the worst of business and act accordingly without a factual basis. This leads to rather unfortunate statements and positions that, if enacted, would leave us all a little more self-righteous and a little more heart attack, cancer, and virus-prone.
While I don't doubt that this anecdote is true, publication bias in the research world is a well known phenomenon and difficult to argue against. Paraphrasing an excellent point from an earlier post by Kosmo, why would drug companies publish data that could potentially hurt their profits?
Here is an excellent review with a free full text link:
Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326: 1167-70.
Free full text link: http://bmj.bmjjournals.com/cgi/ijlink?linkType=ABST&journalCode=bmj&resid=326/7400/1167
Arguing that some data is withheld is far different from saying drug companies won't publish studies disadvantageous to their drug-of-the-moment. As in this case, many researchers stipulate that the results be published in the contract.
Your rhetorical question is an excellent example of the problem--people ask these rhetorical questions as if the answer is self-evident and then proceed to go about their resolutions and summits without bothering to check the facts. AMSA's ratio of talk to support for that talk is unacceptably high, which is why a huge number of reasonable people avoid it altogether. This leaves a disproportionate number of students less interested in researching their positions than stating them, which is bad for the organization and the credibility of med students as a whole.
Of course, not all AMSA members are in this boat. Regardless, though, that's the tack the organization's taken, and it's to the detriment of all the good things it could be doing.
I have provided evidence, in the form of systematic reviews published in well-known medical journals, that publication bias exists (see below and my previous posts). To say that I have not "bothered to check the facts" is silly and intellectually dishonest. If you want to ignore the evidence I've provided, that's your choice, but I would expect you to put up a better argument than that.
Are neutral or negative results published? Yes, of course they are. The upcoming statin report in NEJM that you mentioned is one example of that. There are certainly many others. A bias is not a rule, it is a tendency. The TENDENCY is for pro-industry findings to be published, and for negative findings to not be published.
Bhandari M, et al. Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials.
CMAJ 2004 170: 477-480.
Kjaergard LL, Als-Nielsen B. Association between competing interests and authors' conclusions: epidemiological study of randomised clinical trials published in the BMJ. BMJ 2002;325(7358):249-53.
Djulbegovic B, et al. The uncertainty principle and industry-sponsored research. Lancet 2000; 356(9230):635-8.
Lexchin J, et al. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003; 326(7400):1167-70.
The charge made was not that there was a "tendency," though I'm glad to see that some nuance has been added to the position. The charge made was that drug companies simply *didn't* publish disadvantageous findings, which is patently false. No one will argue that bias doesn't exist; however, several recent posts have taken that and suggested that drug companies simply never publish data not advantageous to them. It's just not true, but is exactly the sort of short-sighted thinking that leads to short-sighted AMSA positions.
Actually, the $800 million figure is grossly inflated. The study that the figure came from was done at Tufts with money form Merck and was so biased that the manuscript did not hold up basic EBM. In addition, drug compaines spend 2.5 times more money on advertising than on R&D.
Research into virus-killing gels that can prevent HIV infections in women will receive a large boost on Monday when Johnson & Johnson announces it has donated the rights on a potentially exciting new product to a non-profit group that specialises in the area.
And your point is?
Rather a bit hostile, eh? If I could pick any cliche for AMSA, it would be that it has a large chip on its skinny med student shoulder. Thinking the worst of people and corporations in general without a sense of balance only serves to turn bitter med students into bitter doctors.
I did not make the assertion that drug companies never publish negative findings. I don't think anybody else in this thread did. A "bias" is a tendency, by definition.
I went away for the weekend and expected to come back to some interesting points to debate! Alas, nothing new and interesting, just another single anecdote apparently intended to prove some invisible point.
Feel free to bash AMSA all you want. I'm not a member and personally don't agree with many of their stances, most notably Tort Reform. I do however agree with their stance on drug compaines. I am a member of the AMA-MSS and very involved at the national level and I know that similar issues are being looked at very closely by the governing council. As for being bitter, yes I may be bitter, but it's only because I get sick of treating eldery patients who can't afford their medicine and end up taking half a dose to make it last longer.
And that sort of attitude ends up being completely unproductive. Others have made reasoned arguments that I won't repeat, but suffice it to say that without avaricious drug companies your elderly patients would have no worries about affording their drugs, because they wouldn't exist.
AMSA's position on the drug companies reminds me of the poor Texans who sniped at the neighbor who never found an honest job and just spent hours digging holes, and then complained after he struck oil that he was charging too much for gas. It takes a lot of energy to actually, you know, *do* stuff, but writing up snarky position papers is, much to the benefit of AMSA and the AMA, free.
Pharm-marketing payola rules...
I love knowing that my grandmother's med $ is helping to subsidize my organ-shaped-notepad, stethoscope tag, down-spiraling-blue-goo-drop-paperweight, post-it note, day calendar, and pen collections.
She can't afford to actually consume her meds, so she just licks one over and over and sells the rest.
I bet that goes over real well with your patients. It is readily apparent that you have not educated yourself about the industry nor the issue at hand. Do me a favor, because I don't "have the energy to actually, you know, *do* stuff" like educate you about globalization, the need for compaines to be transparent, and the state of free market trade and capital in the 21st century; read the Lexus and the Olive Tree. Then compare that manner of business, the manner by which just about every Fortune 500 company runs itself, with the pharmaceutical industry. After that, hopefully you'll realize what exactly your "avaricious drug companies" do and how counterproductive their buisness practices are toward our patients and health care system.