Work to ban drug and device sales reps

[NoPDM]

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps. I'm curious what you think and what you are exposed to.

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[LADoc00]

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps. I'm curious what you think and what you are exposed to.

HUH??? Dude I know poor primary care docs that pratically rely on reps to eat a good lunch. Im serious. Take your self righteous Taliban-esque cause to Iran. Here we have something called "Liberty", look it up. Its the freedom to chow down on a free Subway sandwich while staring at a hot blonde drug rep and its the freedom our forefathers fought 2 world wars to ensure. Thanks for coming out.

Next.

 

[NoPDM]

HUH??? Dude I know poor primary care docs that pratically rely on reps to eat a good lunch.

I agree there are many who rely on the food and other gifts, but my whole point is that this stuff isn't really free.

Take your self righteous Taliban-esque cause to Iran.

Are you serious? Can you discuss something with maturity or do you have to degrade a discussion by making stupid jokes?


By the way, you may want to correct the grammar in your movie-quote signature. "...a hot older women..."

 

[irrka]

By the way, you may want to correct the grammar in your movie-quote signature. "...a hot older women..."

hey, it could be a hot rep who's a guy

 

[thos]

That's a nice presentation with a ton of info. I think the bottom line is that these are some of the most profitable companies in the US and they simply wouldn't spend the money to influence physicians decisions if it didn't work. I imagine most physicians can honestly deny a conscious influence, but it's working at some level so it's naive for anyone to think they're immune. The one bright spot mentioned in the Atlantic Monthly article is that the cause to reform this system has been taken up mostly by med students and young physicians.

 

[OUsooner]

Next time you pick a tree to bark up make sure it doesn't cost me my lunch, literally. thank you for your time and efforts (not really)

 

[LADoc00]

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.

SHEESH, why not be activist on issues that matter like the piss poor reimbursements from Medicare for primary care docs.

You are seriously out in left field.

And again, thanks for coming out. Bye.

The saddest part is some liberal activist admin type will listen to your crap spewing and sure enough some family med doc making less $ than the local Starbucks barista will have their free bagels and coffee taken away. Grats, grats on f'ing up medicine even more. Im sure you are super popular at UPitt.

 

[Mumpu]

Not all academic programs are willing (or able) to pay for lunch during noon conferences. Only dicks who promptly forgot what it was like to be a med student/resident when they graduated think this is not a big deal. When you've been up and running around nonstop since 6 am, a nice lunch that doesn't cost you $10 in the hospital crapeteria is a gift from heavens (also from GSK/Merck). The shpiel takes 1-2 minutes tops.

The studies may show the prescribing patterns are influenced. So effing what? I don't recall anyone showing that the outcomes were influenced. The majority of drugs within any given class at equivalent doses are the same.

As for device reps, they are absolutely necessary because they are the on-site tech support for that "laser" beam, that new fancy ortho tool, etc.

 

[angel80]

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps. Also, the samples they provide greatly help out those patients who have no prescription coverage.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.

 

[Methyldopa]

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.

Interesting that you react with such anger!

If you honestly think that docs are not influenced by those sales reps and free lunches, then why do you think Drug Companies give them, to feed poor residents/family docs/etc and give them helpful medical advice?

For ever $1 that Drug Companies invest in Drug Reps, they make back $10 and change. (Look it up in a recent article in the Atlantic Monthly).

Indeed there are more important issues in Medicine, and that getting free lunches (in my opinion) is not a big deal.

 

[thos]

I suppose this is a question as old as the discussion board itself, but why do so many threads devolve into childish name calling? I have no problem with disagreement between colleagues, but why not keep it civil? I tend to agree with the OP's opinion, but I'm eager to hear what others think. For instance, a good point is raised regarding whether outcomes are actually affected, but calling the OP is a "dick" just takes away from the argument. I'm sure in posting this I'm setting myself up for a barrage of insults, so let's get on with it.

 

[f_w]

I am in a gizmo and device heavy field. Without the companies constantly working on making a better mousetrap, we would still be in the stone ages of medicine. Yes, these are some of the most profitable businesses around these days, but since when has that become a bad thing ?

The device reps are part of the mechanism. You have them around for tech-support, you use their gizmo, you listen to their talk, you eat their food. Then you look at the literature (no, not the 'hired gun' articles the rep gave you) and decide whether the mousetrap is indeed better or whether it is just another dead-end in the device market. For half of the stuff I use I don't even know the manufacturer, the gal doing the ordering does and thats enough.


(I do think that company sponsored lunches should be separate from their talk. If a resident/student doesn't want to hear the talk, they should be able to get the lunch without it. This was the policy where I did my residency, and I believe it makes sense.)

 

[EctopicFetus]

This is america..

1) making a profit even a huge one is not a crime

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet a$$ perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business.

Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.

 

[thos]

I am in a gizmo and device heavy field. Without the companies constantly working on making a better mousetrap, we would still be in the stone ages of medicine. Yes, these are some of the most profitable businesses around these days, but since when has that become a bad thing ?

The device reps are part of the mechanism. You have them around for tech-support, you use their gizmo, you listen to their talk, you eat their food. Then you look at the literature (no, not the 'hired gun' articles the rep gave you) and decide whether the mousetrap is indeed better or whether it is just another dead-end in the device market. For half of the stuff I use I don't even know the manufacturer, the gal doing the ordering does and thats enough.


(I do think that company sponsored lunches should be separate from their talk. If a resident/student doesn't want to hear the talk, they should be able to get the lunch without it. This was the policy where I did my residency, and I believe it makes sense.)

Do you think gizmos and meds need to have separate treatment? I can see your point about needing tech support, etc., but the same doesn't seem to apply to drugs. As you say, it's our obligation to do a little lit reading.

I'm not foolish enough to think that drug money will ever be off the scene, but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?

 

[thos]

This is america..

1) making a profit even a huge one is not a crime

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet a$$ perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business.

Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.

1) I don't have a problem with profit. By stating they're some of the most successful companies I meant to imply that they wouldn't be careless enough to spend their money on something that doesn't work.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making, and that takes me back to point #1. We'll just have to agree to disagree.

3) I'd guess most drug companies don't care whether their drug is better or not. In fact, if they knew theirs to be inferior they'd still push hard. It is business, but it's our job to give informed input. I'm not ready to be a pawn just yet.

 

[f_w]

Do you think gizmos and meds need to have separate treatment? I can see your point about needing tech support, etc.,

It is not only the tech support. This ain't rocket science, there is nothing the rep has to tell me that I couldn't find in the manual if I cared to read it.
But they will bring equipment around, give your hospital s##% on consignment and bust their ### to get something to you if a patient needs it. These are not the usual call-center drones that you have to deal with at major corporations, they have a vested interest in you being happy and that is why they support you the way they do.

but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?

Well, they must have an opportunity to peddle their product. If they don't think they get their moneys worth, the lunches will go away.
For the common scenario of the drug-rep lunch at residency programs, I think one potential solution could be to have 3-4 companies sponsor a weeks worth of food and in return they each have a 10 min slot to 'inform' about their product during a designated time slot.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making,

Under no circumstances whatsoever can we allow to participate in some sort of kickback scheme. If you get a fancy dinner in recognition of your prescriptions for antihypertensive X going up by 60%, you have turned yourself into a ***** (and a cheap one at that).

Btw. If I attend a fancy rep sponsored dinner but bring home some dessert for my wife, that dessert will go on my CC. It won't break the bank but at least nobody has to go to prison for it.

 

[f_w]

P.S.

I find it mildly amusing if a cardiology fellow is railing against money. Wait another year until you are in practice and listen how the tune you are whistling has changed .

 

[APGAR10/10]

A well-respected attending once told me, "If the drug rep is giving you information about a drug that you don't already know, then you aren't keeping up with your reading."

I tend to agree. I know it's a high standard, but we are responsible for knowing the drugs we use. And we really need to throw whatever literature the drug rep provides in the trash. Just my 2 cents.

 

[OSUdoc08]

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps. I'm curious what you think and what you are exposed to.

How else are we going to get free pens and food?

My student loans are already high enough!

 

[penguins]

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps. Also, the samples they provide greatly help out those patients who have no prescription coverage.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.

 

[flighterdoc]

I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps. I'm curious what you think and what you are exposed to.

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

 

[EctopicFetus]

1) I don't have a problem with profit. By stating they're some of the most successful companies I meant to imply that they wouldn't be careless enough to spend their money on something that doesn't work.

2) Sure, most professions have perks. But in my opinion the concern is the fact that what's best for the patient needs to be paramount. I think the root of the disagreement is whether perks, big or small, influence a physician's decision making, and that takes me back to point #1. We'll just have to agree to disagree.

3) I'd guess most drug companies don't care whether their drug is better or not. In fact, if they knew theirs to be inferior they'd still push hard. It is business, but it's our job to give informed input. I'm not ready to be a pawn just yet.

1) Good
2) Its good to have your opinion. I am curious what yr you are in in your training. I have seen the studies but my experience is that residents make students go to the lectures and then come and eat when the non drug rep lecture starts. Lets say it does influence my prescribing? Is it effective? If it is then I am doing my job, if it isnt ill get sued.. Thats where the real influence is.
3) Its cool to be all full of hubris but if you think they dont care you are missing the point. Nothing makes a doc prescribe meds more than proof that they work. Believe what you will about this drug rep stuff but even at programs that have no drug rep sponsored stuff they have to use certain meds, the hospitals only stock so many things on formulary.. Do you think the hospital admins get wined and dined.. and of course offered "discount" prices. Lets be serious..

So if you arent gonna be a pawn I assume you will do Path or Rads where you dont really have to prescribe meds. Otherwise no matter what you prescribe you are nothing but a pawn.

Its like believing you have control.. its just a figment of your imagination. My 2 cents..

I guess we will have to agree to disagree..

 

[EctopicFetus]

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

We are trained to question everything, trust no one, and be independent.. I hope that some person with their wheelie and free meds doesnt totally change my life.. Of course in the ER I wont have to worry as much about this.

 

[remedios]

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

Yes, let's eat our free lunches and listen to the presentations and judge the information in a completely unbiased manner. Because no matter how much conclusive research there is to show that it's human nature to be consciously or subconsciously influenced by people handing out perks, WE are clearly above all that, we are clearly "morally centered" and are "uncorruptible by sales people". And clearly, those research results are skewed by those people sitting next to us, who have weak characters and easily tempted, like the original poster, or the French.

Paris delenda est, indeed. Let's not forget to salt the ground.

 

[Mumpu]

No one is calling the OP names, but the whole "No Free Lunch" movement makes its proclamations from a verrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrry high moral ground. The connection to reality is a wee thread. Hungry tired residents don't go to drug lunches because they need Viagra pens or because they are mindless sheep.

 

[elektrikbang]

No one is calling the OP names, but the whole "No Free Lunch" movement makes its proclamations from a verrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrry high moral ground. The connection to reality is a wee thread. Hungry tired residents don't go to drug lunches because they need Viagra pens or because they are mindless sheep.

The connection to reality also becomes tenuously thin when you deny that drug lunches and other perks don't have insidious effects on prescription patterns. What really need to happen is that, on a residency level, programs should be better at about feeding their residents, as a lot of programs are beginning to do already. On a medical education level, there needs to be mroe discussion about how doctors can be influenced by things such as free lunches, and make students aware that these influence can be subtle but effective. I applaud the OP in raising more awareness and debate on this.

As to the more important question of how much regulation there should be on marketing by companies, that is a more complicated issue.

 

[remedios]

Oops I posted on a friend's account by mistake. Please direct flames for electrikbang's post here.

 

[EctopicFetus]

So what if it changes your prescribing habits?

Q: is patient cured/treated properly?

A #1 = yes, then good you are doing your job

A# 2 = no. then we have a problem but as most of you know or maybe you dont they cant come and pitch a drug for any off label use. Anyways... take your moral high ground elsewhere cause I promise I dont care.. Feel free to keep discussing..

 

[OSUdoc08]

I've recieved plenty of free stuff from drug reps. Do you think I actually listened to them when they were telling them about their meds? No I was busy deciding which goodies I wanted to take.

I've been to a few luncheons sponsored by drug reps as well. I normally chat with the person next to me or just send text messages to friends.

Drug reps are harmless. Let them keep doing what they do, so I don't have to ever step a foot in Office Depot.

 

[EctopicFetus]

I cant 100% agree with OSUdoc but the general part of this is right.. FWIW I think the whole anti-drug rep contingency would be better off spending their energy pushing for *real* tort reform..

If I want to prescribe some drug leave me alone.. I worked my butt off through med school so i can prescribe whatever drug I want.

 

[f_w]

So what if it changes your prescribing habits?

Q: is patient cured/treated properly?

A #1 = yes, then good you are doing your job

A# 2 = no. then we have a problem but as most of you know or maybe you dont they cant come and pitch a drug for any off label use. Anyways... take your moral high ground elsewhere cause I promise I dont care.. Feel free to keep discussing..

You forgot:

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).

 

[Gfunk6]

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).

or . . . A# 4=yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed Nexium instead of Prilosec. Astra-Zeneca's Prilosec patent ran out and it went generic. So by isolating the S-enantiomer from Prilosec . . . voila . . . you have Nexium. Which, of course, is just barely enough of a chemical change to approve a new patent.

However, by looking at the ads now for the "Purple Pill" you'd think Prilosec was the devil incarnate, at least if you believe what A-Z is selling.

 

[A-non-y-mous]

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.

Thus, i vote that they stay.

 

[f_w]

This of course assumes that $$ is not an unlimited resource.

I just got a look at healthcare from the 'billpayers' end of the stick, makes you think twice about ordering that 'heme-onc panel' when a CBC and a K would have done.

 

[f_w]

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.

This is a flaw in the healthcare system that should be addressed by the people running and regulating the racket (--> your friend, the goverment).

If it was about giving away drugs for free, a program run by the pharmaceutical industry to provide a limited formulary of generics for financial need patients at nominal cost would be a far better way to spend their money.

They give us the samples bc they want us to prescribe the stuff to paying customers. This is certainly no charity and it doesn't justify the 'drug-rep' as a marketing strategy. They are in the business of making money, and that is good. But we have to keep them at arms length.

 

[EctopicFetus]

You forgot:

A# 3= yes but you blew out 3.5 times the amount of healthcare $$ because you prescribed a patent protected variant on an old theme (after the manufacturer of the patent protected drug got FDA to rescind the approval of its perfectly sufficient predecessor so generic manufacturers won't be able to copy it and sell it at cut-rate).

Thats why someone as smart as I am always checks generics ok.. Nice try.. now try again..

As far as getting the FDA to rescind stuff... well they are just protecting their business. you might not like it but almost all of medicine is a monopoly including physicians. imagine if getting into med school was like law school? Too many lawyers so some of them have to work crappy jobs making little to no money shooting commercials for slip and fall cases and suing docs and others for no reason. You could have any idiot who "wanted to help someone" become a doc.. Ill pass.. im happy with the monopoly.. IMO if the govt wants to mess with pharma thats cool with me. I def wont stand up for them but its not my plight...

Also most residents have to pass what drugs are prescribed by their attending.. most attendings dont even go to the same meals as the residents.. there is a little bit of a disconnect there.

 

[EctopicFetus]

This is a flaw in the healthcare system that should be addressed by the people running and regulating the racket (--> your friend, the goverment).

If it was about giving away drugs for free, a program run by the pharmaceutical industry to provide a limited formulary of generics for financial need patients at nominal cost would be a far better way to spend their money.

They give us the samples bc they want us to prescribe the stuff to paying customers. This is certainly no charity and it doesn't justify the 'drug-rep' as a marketing strategy. They are in the business of making money, and that is good. But we have to keep them at arms length.

I dont mind keeping them at arms length... its the sandwich or pasta I want a little closer.. I would rather bend my elbow there..

 

[NoPDM]

The point is NO ONE but self righteous activists like yourself care about the "free lunch" issue. Most docs take the free lunch and listen to "wonk wonk wonk" of the sales reps without being influenced one bit so your whole point is moot.

The fact that people don't care is part of the reason we need to discuss this. We all should practice evidence-based medicine and there is plenty of evidence that rep involvement has a negative impact on care.

SHEESH, why not be activist on issues that matter like the piss poor reimbursements from Medicare for primary care docs.

There are many issues in medicine which can be improved. I am interested in this one. Perhaps your interest in Medicare will lead you to do something to reform Medicare.

Not all academic programs are willing (or able) to pay for lunch during noon conferences. Only dicks who promptly forgot what it was like to be a med student/resident when they graduated think this is not a big deal. When you've been up and running around nonstop since 6 am, a nice lunch that doesn't cost you $10 in the hospital crapeteria is a gift from heavens (also from GSK/Merck).

As I mentioned in my first post, I am a fellow. That means I still get paid the minimal wages of a resident. So, no point in talking like I’m a rich doctor. Also, no point in looking for sympathy saying you’ve been up since 6 am. No matter how hard you work, there will ALWAYS be someone working harder.

The studies may show the prescribing patterns are influenced. So effing what? I don't recall anyone showing that the outcomes were influenced.

Actually, you are mistaken here. If you define outcomes based on prescribing habits and expenditures of a hospital, the interactions with reps clearly show an impact. If you define outcomes based on patient expenditures, again the reps show an impact on patient costs. If you define outcomes based on morbidity and mortality, I am not aware of data relating to reps, but there is data referring to industry behavior and negative impact on patients (e.g. hiding data regarding antidepressants and suicide, as well as COX-2’s and MI’s).

As for device reps, they are absolutely necessary because they are the on-site tech support for that "laser" beam, that new fancy ortho tool, etc.

I agree there needs to be a company rep on-site for tech support, but they don’t need to provide free lunches or other free items. Their scope should be limited to working on their devices -- not their promotion.

I have no problem with pharm reps feeding/giving presentations to physicians. As a student, I've learned a lot from the drug-sponsored lectures and the reps' presentations. Although you have to take what they say with a grain of salt, many physicians would not know about new products and practice guidelines without the pharm reps.

We need to be responsible and educate ourselves without depending on drug reps. Is there anyone who really believes a rep is going to provide unbiased information? Of course not, because it doesn’t make corporate sense – their job is to make money. Consequently, we need to educate ourselves, such as with Medical Letter, which provides information nonbiased information from pharmacists. The guidelines are also available from our respective societies and, again, we need to take responsibility to keep up on the guidelines. Being an MD means learning all of your life – not just in school.

Also, the samples they provide greatly help out those patients who have no prescription coverage.

There is extensive data that samples are problematic. I address this in depth in my talk, so I’ll only mention a couple points. The samples are typically the “latest ‘n greatest” drugs, which means they are more expensive and likely not covered by insurance. For example, Crestor samples are all over clinic shelves, but it’s quite expensive and not covered by UPMC insurance. There are real alternatives, which I outline in my talk, such as providing poor patients with vouchers or generic-only samples.

I am, however, greatly opposed to direct marketing by the pharmaceutical companies to the general public. The U.S. is one of the few countries in the world that allows that practice.

I agree completely. The use of direct-to-consumer marketing is quite harmful to the doctor-patient relationship. There can be other methods of educating our patients and we need to do better. However, again, learning about a disease from an unbiased source such as a drug company is NOT wise.

Indeed there are more important issues in Medicine, and that getting free lunches (in my opinion) is not a big deal.

I wouldn’t quite agree other issues are more important. Is our going to Canada to get medicine a reasonable solution? Of course not. The drug system in place in our country needs to be reformed, but the lobbying influence of the drug companies is too massive to allow this to happen without a huge fight. The problem with any gifts, be they lunches, pens, or payments for attendings to speak, they change our prescribing patterns inappropriately.

This is america..
1) making a profit even a huge one is not a crime

Agreed.

2) Every other profession has perks (getting crap for free) why should we be different. Gone are the sweet a$$ perks but a free lunch isnt too shabby. IMO people who want to stop this stuff need to get a grip.

The problem is that we are different in that we need to care for our patients and be their advocates. We aren’t like every other profession, because we have to think first about others before ourselves. Our patients trust us and have faith in our decisions. So, that’s why we should be different.

3) some of the drugs they are advocating are better and they know that if they dont spend their money advertising the other guy will. There is a name for this.. its called business. Its time for people to grow up and learn that while we all get soft and mushy sometimes.. in the end this is a business and most of us are nothing more than well paid pawns.

Should they be able to advertise? Absolutely. The problem is that I think their market should be limited to only professional media (e.g. NEJM, JAMA, etc.). No need to advertise to the lay person.

I'm not foolish enough to think that drug money will ever be off the scene, but an "education pool," "lunch pool," etc. seem like a reasonable solutions. But what does the company get in return? Do they get to push their products sometime other than lunch?

This is the whole issue. We know they wouldn’t just throw massive amounts of generic money into pools without getting real credit, but perhaps they may be willing to spend a fraction, so long as it was known they were contributing. The point is that we need to separate the person who gives the money and the person who receives it.

I find it mildly amusing if a cardiology fellow is railing against money. Wait another year until you are in practice and listen how the tune you are whistling has changed .

I hope I don’t.

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

Thanks flighterdoc. I was waiting for someone to say what you did, as this is one of my favorite responses. There’s an amazing amount of arrogance among bright people. There is a tremendous amount of data saying that regardless of how you judge my moral character, the reps do affect how we practice.

So what if it changes your prescribing habits?

The problem is that if it does change prescribing habits, then you are not making unbiased, informed decisions in your patient’s best interest. We need to be advocates for our patients and ensure we aren’t pawns of the drug companies.

Drug reps are harmless. Let them keep doing what they do, so I don't have to ever step a foot in Office Depot.

That’s what they want you to think. That’s why what they are doing will work and be in place for a long time. We keep taking their stuff and keep saying it doesn’t affect us.

I did a family practice preceptorship last summer. Honestly,without the drug reps, a lot of poor people would be unable to get alot of their meds. These guys give the docs tons of free smaples that they pass along to their patients they know need them but cant afford them.

I know there are plenty of people out there who need help. My talk outlines at least three different options people can get expensive meds. Also, we need to come up with other options about how to get medicines to the poor.

 

[NoPDM]

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch

 

[OSUdoc08]

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch

Yeah right, like anyone is going to turn down a free lunch. Give me a break. The food doesn't contain special drugs that convince you to prescribe their meds. Just tune out what they are saying, and think about which nurse you're going to take home that night.

 

[f_w]

Thats why someone as smart as I am always checks generics ok.. Nice try.. now try again..

Well, you didn't offer that option in your little Q/A.

Also most residents have to pass what drugs are prescribed by their attending.. most attendings dont even go to the same meals as the residents..

They don't care so much about the 3 prescriptions you write in your residents clinic (where most patients are on the medicaid HMOs formulary anyway and end up with a gneric substitution). They try to form your young malleable mind so your prescribing pattern once you are out in practice is skewed towards their product.

It is ok if you want to be the uncritical stooge of the industry, just don't try to tell me that this without consequences and therefore not a problem. I am not saying that I am not influenced by their tactics, I am just trying to remind myself that they are sales reps and here to make a sale.

 

[EctopicFetus]

The fact that people don't care is part of the reason we need to discuss this. We all should practice evidence-based medicine and there is plenty of evidence that rep involvement has a negative impact on care.

Have a cite for this? the only studies show that there is an increase in prescriptions and not anything else..

There are many issues in medicine which can be improved. I am interested in this one. Perhaps your interest in Medicare will lead you to do something to reform Medicare.

Uhh thats good..

As I mentioned in my first post, I am a fellow. That means I still get paid the minimal wages of a resident. So, no point in talking like I’m a rich doctor. Also, no point in looking for sympathy saying you’ve been up since 6 am. No matter how hard you work, there will ALWAYS be someone working harder.

oh my god... r u serious?

Actually, you are mistaken here. If you define outcomes based on prescribing habits and expenditures of a hospital, the interactions with reps clearly show an impact. If you define outcomes based on patient expenditures, again the reps show an impact on patient costs. If you define outcomes based on morbidity and mortality, I am not aware of data relating to reps, but there is data referring to industry behavior and negative impact on patients (e.g. hiding data regarding antidepressants and suicide, as well as COX-2’s and MI’s).

Uhh right the patient outcome.. morbidity and mortality. no change.. nuff said...FWIW the studies I have seen on the prescribing changes are sketchy at best...

I agree there needs to be a company rep on-site for tech support, but they don’t need to provide free lunches or other free items. Their scope should be limited to working on their devices -- not their promotion.

Why shouldnt they have the right to promote their business like any other business?

We need to be responsible and educate ourselves without depending on drug reps. Is there anyone who really believes a rep is going to provide unbiased information? Of course not, because it doesn’t make corporate sense – their job is to make money. Consequently, we need to educate ourselves, such as with Medical Letter, which provides information nonbiased information from pharmacists. The guidelines are also available from our respective societies and, again, we need to take responsibility to keep up on the guidelines. Being an MD means learning all of your life – not just in school.

Clearly they are biased.. whether or not I listen is a different story..

There is extensive data that samples are problematic. I address this in depth in my talk, so I’ll only mention a couple points. The samples are typically the “latest ‘n greatest” drugs, which means they are more expensive and likely not covered by insurance. For example, Crestor samples are all over clinic shelves, but it’s quite expensive and not covered by UPMC insurance. There are real alternatives, which I outline in my talk, such as providing poor patients with vouchers or generic-only samples.

Different strokes different folks...

I agree completely. The use of direct-to-consumer marketing is quite harmful to the doctor-patient relationship. There can be other methods of educating our patients and we need to do better. However, again, learning about a disease from an unbiased source such as a drug company is NOT wise.

I dont think many of us learn about the disease as we pretend to listen to their talk about what their drug does.

I wouldn’t quite agree other issues are more important. Is our going to Canada to get medicine a reasonable solution? Of course not. The drug system in place in our country needs to be reformed, but the lobbying influence of the drug companies is too massive to allow this to happen without a huge fight. The problem with any gifts, be they lunches, pens, or payments for attendings to speak, they change our prescribing patterns inappropriately.

How about the lobby of plaintiffs attorneys? Or any other lobby. They hope to influence people, I just dont see the problem. The problem is not with the drug rep or their lunches but rather with the MDs who dont keep up with research.. Maybe your focus needs to shift.

The problem is that we are different in that we need to care for our patients and be their advocates. We aren’t like every other profession, because we have to think first about others before ourselves. Our patients trust us and have faith in our decisions. So, that’s why we should be different.

This is not much different than business. You get clients by showing them how you will help them. Then of course you profit by it..Sounds a lot like medicine to me.

Should they be able to advertise? Absolutely. The problem is that I think their market should be limited to only professional media (e.g. NEJM, JAMA, etc.). No need to advertise to the lay person.

I actually agree with you here. Lay people think they know more than they do.. thats a problem.

This is the whole issue. We know they wouldn’t just throw massive amounts of generic money into pools without getting real credit, but perhaps they may be willing to spend a fraction, so long as it was known they were contributing. The point is that we need to separate the person who gives the money and the person who receives it.

That wouldnt provide a good ROI.

Thanks flighterdoc. I was waiting for someone to say what you did, as this is one of my favorite responses. There’s an amazing amount of arrogance among bright people. There is a tremendous amount of data saying that regardless of how you judge my moral character, the reps do affect how we practice.

I just dont believe it.. sorry.. The way I have seen medicine practiced shows there is a disconnect.

The problem is that if it does change prescribing habits, then you are not making unbiased, informed decisions in your patient’s best interest. We need to be advocates for our patients and ensure we aren’t pawns of the drug companies.

As opposed to pawns of everyone else? We are nothing more or less than pawns. You can believe otherwise and thats cool but your PD and any attending you work with has his own "agenda" for you. You are their pawn, then you will gain the knowledge and thought processes they feed into you and then you make someone else your pawn.

That’s what they want you to think. That’s why what they are doing will work and be in place for a long time. We keep taking their stuff and keep saying it doesn’t affect us.

I am saying I dont care I just want a free lunch, a free pen, a free book, a free reflex hammer, a free thing to hold my ID, and a free Sanford or Pharmocopeia.

I know there are plenty of people out there who need help. My talk outlines at least three different options people can get expensive meds. Also, we need to come up with other options about how to get medicines to the poor.

Good luck..

 

[bigfrank]

What a shame that you're so unsure of your moral center that the mere presence of salespeople can corrupt you.

Stupid thread.

Hey, I really like your signature, fighterdoc.

 

[EctopicFetus]

Well, you didn't offer that option in your little Q/A.

I didnt think I had to offer a step by step process. You are in Rads.. so..

They don't care so much about the 3 prescriptions you write in your residents clinic (where most patients are on the medicaid HMOs formulary anyway and end up with a gneric substitution). They try to form your young malleable mind so your prescribing pattern once you are out in practice is skewed towards their product.

Right.. cause Ill remember the talk they gave me as a student or the talk they gave me as an intern.. My mind is totally screwed, I guess they are wasting their money with me... and you of course since I dont think Rads guys give out prescriptions..

It is ok if you want to be the uncritical stooge of the industry, just don't try to tell me that this without consequences and therefore not a problem. I am not saying that I am not influenced by their tactics, I am just trying to remind myself that they are sales reps and here to make a sale.

Yes the name calling has started.. I am very critical of the industry I just think this is the most ******ed way of going about it and I am glad 99% of people think this is stupid. I know who they are and why they want to talk to me. I simply tune them out. Its really not that hard since I usually eat, then work on my notes or chat it up with friends. Maybe you are the stooge who hasnt learned how to tune out BS.

 

[EctopicFetus]

Stupid thread.

Hey, I really like your signature, fighterdoc.

Dumb thread... thats why I cant wait for my next free meal!

We had Pompeii last time.. that was sweet.. I dont even remember which drug was there.. I do remember it was Elan Pharma and they gave me a free pharmacopeia..

 

[f_w]

Right.. cause Ill remember the talk they gave me as a student or the talk they gave me as an intern.. My mind is totally screwed, I guess they are wasting their money with me...

Apparently the brainwash is working quite well.

and you of course since I dont think Rads guys give out prescriptions..

I guess you'll die ignorant then.

 

[EctopicFetus]

Apparently the brainwash is working quite well.

I guess you'll die ignorant then.

Yeah they installed a little microchip in my head. f_w you are the sheep my friend, think a little for yourself its good for you.

I guess I will but I wont be any worse for it.

 

[southerndoc]

No one has mentioned it yet. Be sure to check out the following site: No Free Lunch

Why is there not a push to limit drug rep dinners and free gifts to hospital pharmacy and therapeutic committees?

The drug reps can wine and dine those physicians and pharmacists on the committee, and while they may give substantial discounts to the hospital for using their products, it causes a vast majority of patients to be discharged home on the same medicine. Therefore, drug companies make a lot of money off this.

Wooing the P&T committee of a hospital affects prescribing practices way more than wooing a private physician in the community.

 

[EctopicFetus]

Why is there not a push to limit drug rep dinners and free gifts to hospital pharmacy and therapeutic committees?

The drug reps can wine and dine those physicians and pharmacists on the committee, and while they may give substantial discounts to the hospital for using their products, it causes a vast majority of patients to be discharged home on the same medicine. Therefore, drug companies make a lot of money off this.

Wooing the P&T committee of a hospital affects prescribing practices way more than wooing a private physician in the community.

QFT....

 

[spalatin]

OP, you are correct. No free lunch.

Your presentation is in powerpoint, which is a non-generic language. Are you trying to force me to buy MicroSoft PowerPoint and further enrichen the most wealthy corporation in America? Why didn't you make the presentation available in a generic standard language like HTML? Are you trying to influence me to give up Linux and buy products I know are inferior and cost more?

Everyone and everything is biased. One need read and properly analyse a few published studies to see this. Knowing that biases exist help understand and correct for them. A drug rep lunch/gift/seminar will be biased, we know that and compensate. What about the talk at the national meeting where the investigators have a vested interest (not financial, but ego) and no apparent personal gain. There's bias there too. Years of work going into research yield poor results or we massage the data to make it say what we expected in the first place. It's just more transparent when they come to grand rounds give out coffee and bacon and eggs. They are buying a few minutes of your time with their lunches and cheap pens. Personally, I'd prefer cash at whatever the going hourly rate is. If your time is worth so little or so much that you don't want a drug rep to be in your hospital/office, fine. But we pay for the lunch with the few minutes we spend humoring the reps.

Next, the drug rep dinners do give valuable information, particularly if you have experience with a drug that doesn't work as described or worse, people have a hard time tolerating it. You can be the one to ask the embarrassing question and listen to the detail men scramble to cover the issue and at the same time educate the crowd on the problems that are glossed over.

Next, I read somewhere that in the United States, a free press is highly cherished, or maybe even guaranteed and if a drug company wants to pay for a minute of superbowl time to advertise an expensive alternative, who am I to stop them? If they want to buy me lunch to do the same, so what? I have to explain to 30 patients why the commercial doesn't apply to them with the same Brief/Focused office visit in the 7.2345 minutes allowed by the HMO for patient direct contact time.

Finally, how come rich Canadians are coming to the states for treatment that their own health care system won't can't provide at the price they've decided to pay for it?

Dear drug reps: I think we should have more tai food at our next meeting, err maybe some sushi.