Free Netters from AMSA for joining = free lunches from drug reps for listening?

[Kosmo]

Originally posted by Red58
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.

This has been a good thread, but it's gotten a bit snippy and sarcastic. I'd like to suggest that you summarize this piece and make an argument based on that. The whole 'read this book that I dug and then come back when you're educated' crap is tiresome.

Correct me if I'm wrong but it seems like you're suggesting that Fortune 500 companies--sans the unwholesome pharm companies--don't participate in any corporate schmoozing... that is, they don't suck up to their customers. It does get a little twisted with the drug industry, granted, since they are required by law to sell their product through a middleman; but pharm companies are not unique here. Although I gather that this point is irrelevant because it is our patients that matter. Our patients. Indeed.
So, what exactly is your argument? Is the practice of pharm company schmoozing to doctors actually raising the price of drugs? It's always popular to come up with a pie-chart that shows the relative cost of marketing against other aspects of drug development. But most presentations I've seen stop there, as though this piece of rhetoric stands alone as damning evidence that marketing is evil. I think this is a little short-sighted. Marketing is as important to the survival of a company as R and D. To suggest that such marketing is unnecessary, and that it unfairly puts the price of drugs out of reach for whichever group demands more evidence than mere relative cost.

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[LukeWhite]

Moreover, there are a good many things that doctors can do to ease problems with drug prices in a real and immediate way. There's still a remarkably large subset of folks who buy name-brand rather than generic drugs because they haven't been properly educated by their doctors, who perhaps understandably are too busy to spend much time explaining the difference. Even more of a problem is the doctors who DO allow themselves to be unduly influenced by drug pitches, or prescribe expensive drugs simply because it's the easiest thing to do or because their patients demand something they've seen advertised.

Are pharm companies partially to blame for this? Of course, but one can hardly expect a business to act otherwise. A free lunch is hardly a visit from the mob, though, and doctors are free to prescribe whatever they like and educate their patients accordingly.

My principal problem with AMSA/AMA is that, as I've said, it's less interested in accomplishing things like this than in trying to dictate its interests in broad sweeping generalizations that fit nicely beneath their letterhead. There are a few planks in the practice of medicine that need to be removed before AMSA's entitled to chase after the specks with the persistence it does.

 

[periodic]

Snarky position papers are a dime a dozen and produced by all sides of the issue, not just the AMA and AMSA. Ever checked out PhRMA's website?....if you want different estimates for how much money it takes to develop a drug and how much pharma spends on marketing relative to R&D, check there.

Is the practice of pharm company schmoozing to doctors actually raising the price of drugs? Marketing is as important to the survival of a company as R and D. To suggest that such marketing is unnecessary, and that it unfairly puts the price of drugs out of reach for whichever group demands more evidence than mere relative cost.

Most aren't arguing that all marketing is bad. The extremity of some pharma marketing, though, is bad. Look at FDA citations for improper marketing...TV ads that have misleading language about side-effects, pharma reps marketing drugs for off-label (unapproved) uses. It can and does happen. Yes, marketing is necessary and important, even for patient education (the rationale behind approving direct-to-consumer advertising a few years ago). When half your costs are marketing (estimates vary, some are lower, some are higher), are you selling a product with real value or perceived value that you created for it through marketing? And won't that perceived value allow you to charge higher prices?

Look at what AstraZeneca did when Prilosec lost its patent protection...enter $500M/year campaign to switch people to a newly-patented drug, Nexium, with marginal, if any, advantages, yet a similarly high price. Check out the graph of Prilosec and Nexium sales over time in this WSJ article:

http://www.chelationtherapyonline.com/technical/p36.htm

 

[LukeWhite]

Why are we against pharm companies marketing drugs for off-label uses? The right of physicians to practice nearly any medication for nearly anything they like, approved or not, is a huge benefit of our medical system and one of the reasons we're able to get so much mileage out of the drugs we have.

Pharm companies obviously have a stake in this, as finding a new use for an old drug not only increases sales, but allows the company to apply for a fresh patent. But doctors aren't dumb, for the most part, and can only benefit from having more research to base treatments on. Again, nobody's forcing doctors to prescribe an off-label use, and all but the most unethical or lazy will only prescribe off-label if they have excellent reasons for doing so.

I'm rather disturbed by this organizational thrust to somehow protect doctors from themselves. From single-payer healthcare to over-regulated drug markets to FDA domineering, the bureaucracies representing physicians seem more interested in perpetuating bureaucracy than genuine physician interests.

 

[periodic]

Because often the "marketing" for off-label uses is based on non-rigorous evidence. These are not peer-reviewed studies published in journals that are busted out for doctors sometimes, they are self-funded studies, sometimes with dubious methodology and conditions. Pharma research can be good, though, but physicians don't have the time (or sometimes the training) to assess a study's methodology or compare available evidence for the plethora of medications available.

I am not against the right of physicians to choose their medications at all, however they absolutely need better information from trustworthy sources. Many larger practices have taken on the task of educating themselves, having "journal club" type events to educate each other about what the current state of evidence shows for treatment guidelines, drug therapies, etc.

 

[jabrin99]

FREE NETTERS FOR MEMBERSHIP=FREE LUNCHES FOR LISTENING

these are not the same...I consider the former more of a bribe if anything....there is a contract placed in a free netter with AMSA..vs....a free lunch just for your time....and trust me...a doctor's prescription preference is not changed by free dinners at the nearest Five star restaurant.....I grew up in a medical household..and have accompanied my parents to many of these type of occassions....these pharm rep sponsored events can be quite blatant(or honest..if you're not a cynic)...or be disguised as a "audio conference" ..etc.....I share the opinion with my parents(and really the opinion of most doctors in practice)...that contrary to what I've been reading on these thread...doctors use Pharm reps if anything..it is a free dinner, free lunch, free samples...period. Once you begin practicing..you will develop a preference for the drugs that you feel comfortable prescribing(often determined through personal experience of efficacy, availability,cost,and safety)......and it will take at the least a congressional mandate to change your habits!!....it is as simple as this...then compound this assertion with the limited free time doctors have...leads to the mindset..that .."hell ya, you better treat me to a free lunch, dinner, set of golf clubs." ...just to listen how Brand A is soooooooooo much better than Brand B ...despite the fact it is more expensive....and BRand B works quite well...then the following day....you just continue to prescribe brand B...and tell the office how crappy and expensive that five star restaurant was that you ate at....

BTW...pharm reps are hotties...ami right or am i right?!.lol

 

[LukeWhite]

Periodic,

I'll be the first to agree that off-label marketing isn't rigorous by a long shot, and drug reps can be at times inexcusably pushy in trying to expand their drug's range. The Oxycontin reps were a perfect example of this before they were slapped down.

But physicians know this, and unless they want to be fooled, they can differentiate between rigorous, peer-approved studies and poorly-backed up sales pitches. Information is information, though, and unless the drug reps lie (which, if it happened in anything but an isolated fashion, would be quickly caught), docs shouldn't have too much trouble sorting wheat from the chaff.

The question, then, is do we trust ourselves to make reasoned decisions based on our evaluation of the evidence? I certainly think so; there's no reason to believe that restricting physician rights, which is essentially what all these disputed AMSA/AMA positions amount to, will improve medical care.

But the point of a bureaucracy is to govern, and it's inevitable that these organizations will continue to gnaw away at autonomy rather than working hard for things that WOULD improve autonomy (e.g. tort reform). I'm frankly surprised that AMSA has so many willing defenders here among those whose rights it seeks to infringe.

 

[madcadaver]

I agree with Kosmo that the this thread is getting sour... it was good while it lasted.

Good news-- found a resource for the Angell and Relman paper I was talking about earlier in the thread. "America's Other Drug Problem", published in The New Republic in Decmber 2002. Drs. Relman and Angell have both served as editor-in-chief of The New England Journal of Medicine. This piece won the George Polk Award for 2002, one of journalism's most coveted awards. This is highly recommended reading for everyone, regardless of which side of the debate you are arguing.

Direct .pdf link:
http://www.drugawareness.org/pdf/tnrdrugpiece.pdf

Also, I can't believe I have been active on a thread discussing how physicians evaluate drugs without plugging The Medical Letter. This is an awesome source of peer-reviewed, unbiased drug information. I will just copy and paste a description from the website (www.medletter.com)-- I think medical students and residents can subscribe for around $20 a year.

The Medical Letter on Drugs and Therapeutics is an independent, peer-reviewed, nonprofit publication that offers unbiased critical evaluations of drugs, with special emphasis on new drugs, to physicians and other members of the health professions. It evaluates virtually all new drugs and reviews older drugs when important new information becomes available on their usefulness or adverse effects. Published every other week in a four-page newsletter format, it carries no advertising and is supported entirely by subscription fees. A typical issue appraises two or three new drugs in terms of their effectiveness, toxicity, cost and possible alternatives. Occasionally, The Medical Letter publishes an article on a new non-drug treatment or a new diagnostic aid.