Why have medical bodies and institutions gone to sleep on Big Pharma corruption?

[Nasrudin]

Where is the anger and repulsion against the tremendous erosion of ethics and conflict of interest introduced into medicine by the Pharm. industry?

Why is that if you express this point of view you get some kind of patronizing contempt that says...Awww isn't that quaint, this little anachronistic noob, doen't understand who pays the pills around here?


How did doctors get so spineless when it comes to how easily they get pimped and corrupted?

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[Miami_med]

Where is the anger and repulsion against the tremendous erosion of ethics and conflict of interest introduced into medicine by the Pharm. industry?

Why is that if you express this point of view you get some kind of patronizing contempt that says...Awww isn't that quaint, this little anachronistic noob, doen't understand who pays the pills around here?


How did doctors get so spineless when it comes to how easily they get pimped and corrupted?

Pharma may be the one institution left that actually tries to take care of physicians. That might be part of it. If we decide to grow spines, adequate reimbursement, freedom in practice, and liberation in general from the whole host of requirements imposed by outside forces should probably take precedence.

 

[jdh71]

Where is the anger and repulsion against the tremendous erosion of ethics and conflict of interest introduced into medicine by the Pharm. industry?

Why is that if you express this point of view you get some kind of patronizing contempt that says...Awww isn't that quaint, this little anachronistic noob, doen't understand who pays the pills around here?


How did doctors get so spineless when it comes to how easily they get pimped and corrupted?

You see . . . the western bioscientific model of medicine uses these things called "drugs" to treat illness and symptoms. These drugs are made by people called pharmaceutical companies. These companies are in business to make - NOT lose money. If these companies do not make money, they do not make pills, and your grandma goes the way of the dinosaur. So what shall we do soak? What's your plan to save doctor from using drugs mde by pharmaceutical companies?

You might as well rant against mechanics for being used by the evil tool companies - like Craftsman - into using their wrenches to work on cars.

Look kid, this is how we do things. The same way you cannot expect your mechanic not to use wrenches on your car, you cannot expect physicians not to use drugs from the pharmaceutical companies. Drugs are used and prescribed as they have shown to be effective in the literature.

 

[Nasrudin]

You see . . . the western bioscientific model of medicine uses these things called "drugs" to treat illness and symptoms. These drugs are made by people called pharmaceutical companies. These companies are in business to make - NOT lose money. If these companies do not make money, they do not make pills, and your grandma goes the way of the dinosaur. So what shall we do soak? What's your plan to save doctor from using drugs mde by pharmaceutical companies?

You might as well rant against mechanics for being used by the evil tool companies - like Craftsman - into using their wrenches to work on cars.

Look kid, this is how we do things. The same way you cannot expect your mechanic not to use wrenches on your car, you cannot expect physicians not to use drugs from the pharmaceutical companies. Drugs are used and prescribed as they have shown to be effective in the literature.

You do things however you want. I don't want the free lunch. Unless your 45 you're in no position to call me kid--especially since you both missed my point entirely.

Free Markets are great. Invent and profit at will. Conflict of interest when other people's lives are at stake, however, is tragic. Physicians' clinical judgement should be held to no less rigorous standards than a judge in our legal system which ideally and for the most part is free of commercial influences.

If you want to be snide and patronizing (read corrupt and defensive) at least come with something other than B.S.

 

[deleted87716]

The pharmaceutical industry's efforts to influence utilization with direct-to-consumer advertising and physician detailing is offset by the insurance industry's efforts to restrict formularies. The real battle is between them. Prescribers and patients are simply caught in the crossfire.

Personally, I use generics whenever possible.

 

[jdh71]

You do things however you want. I don't want the free lunch. Unless your 45 you're in no position to call me kid--especially since you both missed my point entirely.

Free Markets are great. Invent and profit at will. Conflict of interest when other people's lives are at stake, however, is tragic. Physicians' clinical judgement should be held to no less rigorous standards than a judge in our legal system which ideally and for the most part is free of commercial influences.

If you want to be snide and patronizing (read corrupt and defensive) at least come with something other than B.S.

BS? You mean opposed to your emotional laden diatribe? Where's your logic? Your certainly haven't laid any out here for me. What I heard is, "Whaaaaaaaaaaa!" The cry of a liberal no doubt . . .

Ok soak, you've got a problem with the system? A system which I pointed out you is very simple. All of these "evil pharma" companies make the drugs that western medicine utilizes. Now, since "evil pharma" is in buisness and need to MAKE money not lose money in order to pay it's employees salaries, cover contractual employee benefits, pay for research, pay for development, pay to have the drug put into mass production. Our drugs come from businesses not fairy dust. Do hardware stores give away lawnmowers for free? Ever been to clothing store that gave away all of it's items? So if "evil pharma" does not make money, there is no incentive to make drugs, and then people can die sooner, faster, and more painfully (YEAH!)

So smart guy . . . what's the solution? You tell me what is the solution.

 

[jdh71]

Personally, I use generics whenever possible.

I don't know a single Doc who doesn't.

 

[Llenroc]

I love these suggestible idiots who start ranting over something they saw Al Gore or Michael Moore say on TV, without any understanding of the issues whatsover.

 

[Miami_med]

Alright everyone, I'm not particularly fond of Nasrudin's position either, but let's try to keep it civil.

 

[Nasrudin]

BS? You mean opposed to your emotional laden diatribe? Where's your logic? Your certainly haven't laid any out here for me. What I heard is, "Whaaaaaaaaaaa!" The cry of a liberal no doubt . . .

Ok soak, you've got a problem with the system? A system which I pointed out you is very simple. All of these "evil pharma" companies make the drugs that western medicine utilizes. Now, since "evil pharma" is in buisness and need to MAKE money not lose money in order to pay it's employees salaries, cover contractual employee benefits, pay for research, pay for development, pay to have the drug put into mass production. Our drugs come from businesses not fairy dust. Do hardware stores give away lawnmowers for free? Ever been to clothing store that gave away all of it's items? So if "evil pharma" does not make money, there is no incentive to make drugs, and then people can die sooner, faster, and more painfully (YEAH!)

So smart guy . . . what's the solution? You tell me what is the solution.

If anyone is emotional its you. All I'm saying is No Free Lunch. Physicians should not accept gifts and lunches and trips from Pharmaceutical Reps imagining that their script writing habits are somehow above it. All the available evidence on how these gifts influence physicians indicate that their is associated increase in the amount of scripts relative to the amount of gratuities accepted.

The pharmaceutical companies will not go out of business if these practices were disallowed. They would continue to make enormous profits which could be directed into R & D or other things.

And to the other person who used some sort of vague "liberal" character assassination--I haven't even seen the Moore film--as if that would be grounds for your rude and dismissive behavior.

Even if I disagree with Miami Med's position that corruption is somehow inherent to free market dynamics at least he and I can be civil.

 

[Sol Rosenberg]

Free Markets are great. Invent and profit at will. Conflict of interest when other people's lives are at stake, however, is tragic. Physicians' clinical judgement should be held to no less rigorous standards than a judge in our legal system which ideally and for the most part is free of commercial influences.

Of course, this is just your opinion. Here's mine: The difference between judges and doctors is that judges are government officials, and government should, in theory, be free of commercial/external influence (note that I used the qualifier, "in theory.") I think the "liberal" comments stem from your equating of physicians to government officials, implying that physicians too should be government officials.

BOTH pharma and medical practices are for-profit businesses run by private citizens (or corporations.) Their goals are to generate profit by treating patients' ailments. I'm not really sure about which corruption, etc you are referring, but I gather from other posts that you are talking about the "wooing" of physicians by pharma companies (through various methods) to prescribe their drugs over others. A physician's job is to look out for his/her patients' physical health and not his/her patient's financial health. Personally, I see nothing wrong with this practice so long as the doctor is not committing malpractice (i.e. prescribing a totally inappropriate drug.) This is the ultimate check on the physican's judgement -- with malpractice claims so easy to initiate and with malpractice insurance companies effectively becoming a fourth-party (along with the doctor, patient, and health insurance company) in dictating courses of treatment in some specialties, I don't think that physicians will be getting rich on the "kickbacks" from pharma companies. If the patient asks for a generic, the physician obviously shouldn't lie about the availability of one, but prescribing the brand-name drugs by default isn't ethically wrong, in my opinion.

Before you respond with the whole, "But it's a doctor's job to save people's lives, not turn a profit, etc, etc" there are lots of other professionals whose job is essentially to save people's lives in some form, but people proposing the same sorts of ridiculous ethical standards for those professions would be laughed at unmercifully. One example: Defense Attorneys.

Therefore, I'm not so sure that there is a huge outrage about this "corruption" so I doubt cleaning it up is high on the medical bodies' to-do lists.

 

[elwademd]

"if you can't take their money, drink their liquor, screw their women, and then come in here the next day and vote against them, you don't belong here." - attributed to jesse unruh, when speaking to the california state legislature many decades ago.

clearly, physicians prescribe drugs for their patients. most of the time, patients benefit from these drugs. as jota_jota said, as well as others, as long as the physician is prescribing an appropriate drug, there shouldn't be a problem.

if a physician can't accept a pen, get a free clock, eat a sandwich, go to a nice restaraunt paid for by a pharmaceutical company, and not have the self restraint to prescribe drugs appropriately, that physician shouldn't be in practice.

there are also "ways" to use pharm reps to a physicians advantage- such as knowing the latest updates (personally, i heard the news of avandia's link to m.i.'s from a glaxosmithkline rep in clinic), journal articles, patient assistance programs (i was able to get a patient much needed chemo through a rep).

Physicians should not accept gifts and lunches and trips from Pharmaceutical Reps

the days of free trips paid for by pharma, in california at least, are illegal.

 

[Nasrudin]

Of course, this is just your opinion. Here's mine: The difference between judges and doctors is that judges are government officials, and government should, in theory, be free of commercial/external influence (note that I used the qualifier, "in theory.") I think the "liberal" comments stem from your equating of physicians to government officials, implying that physicians too should be government officials.

BOTH pharma and medical practices are for-profit businesses run by private citizens (or corporations.) Their goals are to generate profit by treating patients' ailments. I'm not really sure about which corruption, etc you are referring, but I gather from other posts that you are talking about the "wooing" of physicians by pharma companies (through various methods) to prescribe their drugs over others. A physician's job is to look out for his/her patients' physical health and not his/her patient's financial health. Personally, I see nothing wrong with this practice so long as the doctor is not committing malpractice (i.e. prescribing a totally inappropriate drug.) This is the ultimate check on the physican's judgement -- with malpractice claims so easy to initiate and with malpractice insurance companies effectively becoming a fourth-party (along with the doctor, patient, and health insurance company) in dictating courses of treatment in some specialties, I don't think that physicians will be getting rich on the "kickbacks" from pharma companies. If the patient asks for a generic, the physician obviously shouldn't lie about the availability of one, but prescribing the brand-name drugs by default isn't ethically wrong, in my opinion.

Before you respond with the whole, "But it's a doctor's job to save people's lives, not turn a profit, etc, etc" there are lots of other professionals whose job is essentially to save people's lives in some form, but people proposing the same sorts of ridiculous ethical standards for those professions would be laughed at unmercifully. One example: Defense Attorneys.

Therefore, I'm not so sure that there is a huge outrage about this "corruption" so I doubt cleaning it up is high on the medical bodies' to-do lists.

Yes I suppose it does come does to how you view the patient/doctor relationship--whether this is a simple business relationship or something else. If it is as simple as business then you are indeed correct that physicians operate within the guidelines of doing business and in which case receiving a case of scotch and round of golf and a massage at a resort could be considered product education on behalf of clients.

I maintain, against this stream, that the Hippocratic Oath is not obsolete and that these types of activities erode the public trust. Is it so arcane to think of the doctor/patient in terms of patient advocacy? Because I think it is impossible to advocate for patients when drug companies are influencing decisions. I don't think they're evil. I just think they're like any other business in that they are beholden to their shareholders to maximize profits, hence, Vioxx-type scenarios.


But your point is taken. And I don't presume things are so simple. Still I wonder why a physician's business model could not include being free from conflicts of interest. It seems that such a position would actually be good for business if consumer awareness were not restricted to drug advertising. I bet there will be more Vioxx situations in the future--the FDA/Pharma relationship being what it is. Perhaps public and consumer awareness will shift. As for myself, presuming sucess in med school applications, I won't be caught in bed with a Pharm Rep's interests when that happens. In the meantime, I suppose, I'll just have to eat my locusts and honey, and risk sounding like some Old Testament freak.

 

[Nasrudin]

"if you can't take their money, drink their liquor, screw their women, and then come in here the next day and vote against them, you don't belong here." - attributed to jesse unruh, when speaking to the california state legislature many decades ago.

clearly, physicians prescribe drugs for their patients. most of the time, patients benefit from these drugs. as jota_jota said, as well as others, as long as the physician is prescribing an appropriate drug, there shouldn't be a problem.

if a physician can't accept a pen, get a free clock, eat a sandwich, go to a nice restaraunt paid for by a pharmaceutical company, and not have the self restraint to prescribe drugs appropriately, that physician shouldn't be in practice.

there are also "ways" to use pharm reps to a physicians advantage- such as knowing the latest updates (personally, i heard the news of avandia's link to m.i.'s from a glaxosmithkline rep in clinic), journal articles, patient assistance programs (i was able to get a patient much needed chemo through a rep).



the days of free trips paid for by pharma, in california at least, are illegal.

I have heard this argument. It is used quite a bit. I do not buy it though. Perhaps I am not as sophisticated as the rest of you, but when someone offers me a meal I feel some indebtedness to their hospitality. Are we to imagine that we are so above being swayed with a nice hot meal in our stomachs. That does not only contradict my understanding of human nature but also all of the available research on this topic--research probably not provided by your drug rep, I would imagine.

 

[Miami_med]

Nasrudin,

#1: I don't really believe that corruption is inherint in free market economics more than in any other sort of economics. Corruption is one thing that is constant and omnipresent from anarchy to communism. In the market however, the interplay between multiple groups in the form of competition limits the ability for any one group to become powerful enough to completely rule the economy with corruption.

#2: One of the major perks that physicians receive from drug companies is drug samples, which actually benefit patients. If I am not mistaken, this is actually the majority of physician perks. The sort of exchange that goes on between physicians and pharm companies is really no different than the sort of business relationship that goes on anywhere else.

#3: The Hippocratic Oath specifically bans surgery, so we'd have to admit that it is atleast a bit outdated. It also doesn't forbid pharm relationships, and prescribing drugs that are suggested by pharm reps doesn't inherintly create harm, which would be a violation of the oath.

Now, I have no problem with a physician refusing these perks and using it as a selling point to patients. The impact is questionable, but it is a perfectly reasonable thing to do if you think patients would prefer a doctor completely free of such influence. That'll be up to you when your time comes.

 

[jdh71]

Alright everyone, I'm not particularly fond of Nasrudin's position either, but let's try to keep it civil.

My bad - been swimming with the sharks in the Lounge and forgot to meter my response

 

[jdh71]

If anyone is emotional its you. All I'm saying is No Free Lunch. Physicians should not accept gifts and lunches and trips from Pharmaceutical Reps imagining that their script writing habits are somehow above it. All the available evidence on how these gifts influence physicians indicate that their is associated increase in the amount of scripts relative to the amount of gratuities accepted.

I remarked that the argument is one from emotion, not that you were "emotional" - besides outside of the sociopath we are all have and experience emotion.

The pharmaceutical companies say A LOT, but unless they can back up their shizzle with evidence based studies it's meaningless. Physicians are not going to merely use a new and exspensive medcation simply because it's new and expensive - that's batshizzle crazy. And the truth is some of the newer and more exspensive drugs are BETTER than their predecessors in terms of efficacy of primary action and side effect profile.

Physicians rarely use "me too" drugs - that is newer and more expensive drugs that bring nothing new to the table merely treat the same symptom or disease the same as the cheaper older drug.

And if a pharmaceutical company is stupid enough to buy thai or mexican food everyday, I'm going to take them up on it (my wife doesn't seem to understand I'm not making good money yet)

The pharmaceutical companies will not go out of business if these practices were disallowed. They would continue to make enormous profits which could be directed into R & D or other things.

While this is true, if pharmaceutical companies do not promote these new drugs, many times we do not know about them or enough about them to use them regularly. Unless given a good reason to change most physicians will continue to use the drugs they learned during residency. And, as mentioned above, often the newer drugs are the better drugs, therby throwing a confound into any study that attempts to show drug companies "buying" doctors. If the drug is better we will use it. It's not rocket science - it's medicine.

Even if I disagree with Miami Med's position that corruption is somehow inherent to free market dynamics at least he and I can be civil.

Point noted.

 

[jdh71]

Perhaps I am not as sophisticated as the rest of you, but when someone offers me a meal I feel some indebtedness to their hospitality.

Please don't project your codependency

 

[Nasrudin]

Please don't project your codependency

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* Adair RF, Holmgren LR. Do drug samples influence resident prescribing behavior? A randomized trial. Am J Med. 2005 Aug;118(8):881-4
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How you like them apples chief?

 

[jdh71]

How you like them apples chief?

I don't know. What was your point?

 

[dilated]

Because every group BUT pharma is going after physicians - lawyers, politicians, patients, even the media (I'm still waiting for "Do Journalists Get Paid Too Much?" to be written). Why pick a fight with the only group that's not after you?

 

[Nasrudin]

I don't know. What was your point?

You are so focused on me and my various characteristics....I thought I'd present some of your physician colleagues' papers who share my concern and have gone to the trouble of researching and publishing.


Either way you answered my original question as did the others here with the nature of your posts. This is what I wondering about. I don't fault residents and medical students who are strapped and could use the extra meals. Nor do I disagree with the general poor state of affairs for physicians and especially residents. But a kick-back is a kick-back whether you called it something else is up each of us.

Take care every one. I think this discussion has run its course for my purposes.

 

[jdh71]

You are so focused on me and my various characteristics....

Well you did say: "when someone offers me a meal I feel some indebtedness to their hospitality"

Called it like I saw it . . .

(codependency is endemic in our society, so don't feel so bad)

 

[Nasrudin]

Well you did say: "when someone offers me a meal I feel some indebtedness to their hospitality"

Called it like I saw it . . .

(codependency is endemic in our society, so don't feel so bad)

You aren't the genius behind the phrase "cut and run" are you by chance. Your talent for the pleonastic is uncanny.

 

[docB]

As an EP I'm pretty much outside this debate. We don't get much interest from the reps as we don't do long term prescribing. The last batch of pens I got was from a local mortuary and I like to think that's not influencing me to kill people so...

I am curious thought. The argument of those who oppose pharma perks is that it causes the docs to overprescribe the perk drugs out of self interest. How do docs who earn money from certain procedures fit into this? Are opthos who recommend Lasik and surgeons who recommend gastric bypass to be criticized because they might be perceived to be practicing with self interest?

 

[jdh71]

You aren't the genius behind the phrase "cut and run" are you by chance. Your talent for the pleonastic is uncanny.

I used "unecessary" words? I seem to have used very few words. Whatever . . . I thought you were done here?

 

[Miami_med]

Come on guys, please try to avoid the personal insults. This applies to both sides.

 

[Nasrudin]

Come on guys, please try to avoid the personal insults. This applies to both sides.

Indeed. I would like to retract the the ignorant tone of my original question. Mr. JDH and I have discussed it privately and I have realized that hostility towards my future colleagues is not what I was seeking to invoke.

Apparently things are not as simple as I would like to believe. I will approach this issue with more civility and perhaps a better understanding later in my career.

I remain a suspicious spectator until then.