Work to ban drug and device sales reps

[tibor75]

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. .

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

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[EctopicFetus]

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

You are kidding right? 1st how can you call me ignorant if you dont know me? Every job has some perk, if I build cars for GM me and my union buddies get discounts on the cars. When we attend meetings we get a free lunch. Electrical engineer without perks? Please... Unless he was self employed. You might not look at it like a perk but im sure he got some free things thrown his way. Maybe a bag at an E.E. conference or a book?

I have worked blue collar jobs, both of my parents did as well they both got better perks than Docs do. Back in the day my dad drove cabs that got him some benefits, not necessarily from the cab company but from other businesses he helped. I worked in a pizza shop, i got free food these my friend are perks. Everyone gets perks, some bigger some smaller, some more obvious than others dont be too ignorant to realize that.

 

[EctopicFetus]

Like the line in south park you got served...

BTW i want you to explain to me why a perk like a free lunch should be eliminated? Perhaps what they need to do is be more careful in CT scanning everyone or orders unnecessary tests.. this would save even more $$$

 

[Perrin]

Blue collar workers - no perks.

You don't know what the hell you are talking about.

I worked a Burger King and you better believe that I got perks. I could stop by whenever I wanted and get free food.

I bartended in college. I got in for free and drank for free all night long. I only had to pay half cover for any concerts

I worked at a gas station. All of the vendors that came by gave me free stuff; posters, t-shirts, inflatable beer signs, cases of soda, and chips.

I worked construction/roofing for a while. All the sub-contractors let me use their equipment when I was building furniture for myself. The also let me use any "extra" materials they had.

 

[EctopicFetus]

You don't know what the hell you are talking about.

I worked a Burger King and you better believe that I got perks. I could stop by whenever I wanted and get free food.

I bartended in college. I got in for free and drank for free all night long. I only had to pay half cover for any concerts

I worked at a gas station. All of the vendors that came by gave me free stuff; posters, t-shirts, inflatable beer signs, cases of soda, and chips.

I worked construction/roofing for a while. All the sub-contractors let me use their equipment when I was building furniture for myself. The also let me use any "extra" materials they had.

Thank you for explaining the obvious again to some of our more clueless friends.

 

[OSUdoc08]

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.

Not if you don't pay attention to who the free gifts are from.

Ask me who paid for all the free drinks at the last phamaceutical reception I attended, and I'll probably tell you "Shiner Bock."

 

[LADoc00]

Lesson: academia, HMOs and big corporate medicine sucks. You have no control over much and are left to the whims of activist MD types who will make it their do gooding mission to take away your free lunch. Private prac is the only way to go, and private prac being a business, if drug reps want to come to my office and dance on a stripper pole while pouring cocktails, more power to em.

 

[G'ville Nole]

Lesson: academia, HMOs and big corporate medicine sucks. You have no control over much and are left to the whims of activist MD types who will make it their do gooding mission to take away your free lunch. Private prac is the only way to go, and private prac being a business, if drug reps want to come to my office and dance on a stripper pole while pouring cocktails, more power to em.

(Light bulb flickering a bit, then illuminating...) Stripper poles in the break room! Genius!!

 

[dynx]

I love ignorant comments like this.
It's the kind of stuff you hear 5 year olds say: "well, Johnny's mom lets him stay up till 9, why can't I?"

Just because "every other profession" has perks, why should we? that makes no sense.
And even more so, you are completely wrong. Not every profession has free perks. My Dad was an electrical engineer - no perks. Blue collar workers - no perks. The list goes on and on. Maybe you meant to say, "All rich people work in jobs that have perks, so why can't we?"

And here we have a person who has clearly never had a job before.

 

[roja]

If you take free gifts, you ARE influenced. It's as simple as that. It is borne out in medical surveys and in sociological experiments. And it's common sense.

Actually, I'm not. I am not a sheep. I am probably more of a pain in the arse for drug reps because I have a strong research bent and thus question anything that comes out of thier mouth.

Medical surveys and sociological experiments are weak studies. period. Making broad sweeping judgements about every single mecdical person based on weak studies is NOT common sense nor based in decent research.

And common sense? We aren't so great at that either... It was common sense that the reason postmenopausal women needed estrogen to avoid heart attacks until we realized oops, gives them heart attacks. Was common sense at one point that the world was flat.

Science is NOT based on common sense. Or it shouldn't be. It should be based on solid, well researched studies.

 

[EctopicFetus]

And here we have a person who has clearly never had a job before.

 

[MacGyver]

All you pompous self-righteous people who think you are "too noble" to be influenced by marketing, please step up and receive your comeuppance.

Study after study has proven that you guys are LIARS.

One infamous study analyzed script data and surveys from over 50,000 doctors who were exposed to a pharma marketing pitch. The script data proved CONCLUSIVELY that their script habits were changed, and that the changed scripts resulted in NO IMPROVEMENT TO PATIENT CARE BUT MUCH HIGHER DRUG COSTS.

And then the kicker comes in. The VAST MAJORITY of the doctors surveyed said that they were "above influence" and that it was only "other doctors" whose script habits were changed. Thats right. The guys who changed their scripts the most were the SAME DOCS WHO SAID IT DIDNT AFFECT THEM!

Does that sound familiar to you guys, because that is EXACTLY the same argument you hold firm to.

Lets get real here guys. Nobody is saying that marketing causes doctors to make nefarious decisions that result in bad patient care. Nobody is claiming that doctors are letting patients stay sick because they arent scripting the right drugs. Its NOT A CONSCIOUS DECISION, ITS SUBCONSCIOUS. Doctors arent thinking to themselves "well I just got a free lunch so I need to get their back" its NOT A COGNITIVE DECISION, ITS A SUBCONSCIOUS DECISION.

Here's a typical scenario.

Doc attends a drug lunch for drug X which treats diabetes. Drug X is a brand new "me too" drug that costs twice as much as generic drug Y. Doc thinks nothing of it, not really paying attention to the drug rep, and then goes to his clinic. In clinic he sees a new patient with diabetes. When pondering the drug choices available, he defaults to drug X instead of drug Y. Again, this is NOT a conscious decision, its more along the lines of a subconscious decision based on increased familiarity with drug X. Drug X is not superior/inferior to drug Y, on health terms they are about equals. So the doctor doesnt think twice about scripting X instead of Y.

Guys, get off your high horse. The science has PROVEN that doctors are affected by pharma marketing, no matter how "high and mighty" you think you are. Again, its not a conscious decision, its SUBCONSCIOUS based on increased familiarity with the expensive "me too" drugs that most pharma companies push on docs.

 

[Mumpu]

Eh, this is all overkill. I don't go to drug dinners/retreats and never will because that's too much. But to go to grand rounds at my school with lunch paid for by some drug company? I go to grand rounds because I'm expected to -- I don't care who pays for the food.

US does not "sponsor" all of the world's drug research. The US drug costs are a reflection of the litigious society based on illiterate jurors (oh no, a fatass midwesterner with uncontrolled DM2 and CAD took one Vioxx and keeled over, let's give him 20 million, it was obviously the Vioxx that did him in). Canada and Europe are free markets that are less corrupted by lawyers, lawsuits, and a completely broken healthcare system. It's like the gas prices -- the pharm industry will charge what the market will bend over and take.

 

[MacGyver]

One more note: we are talking about AVERAGES here, not individuals. You dont base policy on INDIVIDUALS, you sculpt it based on AVERAGES.

Do you really think the big pharma companies are just throwing this money away if it doesnt change script habits?

These guys dont leave ANYTHING to chance. They spend billions of dollars on marketing campaigns, and they do a ****load of market research to make sure its having the desired impact.

Every "free" lunch you partake in, every drug pen you get, every golf trip you get sponsored for is passed on to the patient as higher drug prices.

The big pharma conglomerates arent stupid guys. They KNOW for a fact you guys are suckers just like everybody else for marketing. They dont spend billions of dollars just for the hell of it. The joke is on YOU

 

[MacGyver]

Eh, this is all overkill. I don't go to drug dinners/retreats and never will because that's too much. But to go to grand rounds at my school with lunch paid for by some drug company? I go to grand rounds because I'm expected to -- I don't care who pays for the food.

Of course you dont care. No doctor "cares." But the data PROVE that it changes script habits, which is independent of whether you "care" or not.

 

[EctopicFetus]

Of course you dont care. No doctor "cares." But the data PROVE that it changes script habits, which is independent of whether you "care" or not.

Im not even gonna go over your "points" here is the bottom line and IMO no one can challenge this. I got my MD it is my decision to prescribe whatever I want. I want choice if Pfizer or Merck or anyone else wants to spend money convincing me thats fine. In the end wouldnt it also just balance out? Of course I would be prescribing new (and more costly) drugs but isnt that my prerogative and I dont think anyone should be able to take that away from me.

On another note I have never and prob wont ever go to a dinner because I have a life and I would rather spend it with my family or friends and not some drug rep, even if they give away a $100 meal.

 

[EctopicFetus]

One more note: we are talking about AVERAGES here, not individuals. You dont base policy on INDIVIDUALS, you sculpt it based on AVERAGES.

Good point..

Do you really think the big pharma companies are just throwing this money away if it doesnt change script habits?

No one thinks this.

These guys dont leave ANYTHING to chance. They spend billions of dollars on marketing campaigns, and they do a ****load of market research to make sure its having the desired impact.

Good for them.

Every "free" lunch you partake in, every drug pen you get, every golf trip you get sponsored for is passed on to the patient as higher drug prices.

Are you in med school? Gofl trips are unfortunately illegal now.. Actually the cost rarely gets passed directly to consumers it first goes to insurance and then to the consumer. Do you know that everytime any executive (say Oil since they are a favorite) eats his $98 steak and has a $300 bottle of wine it ends up costing you more in gas? SO FREAKIN WHAT!

The big pharma conglomerates arent stupid guys. They KNOW for a fact you guys are suckers just like everybody else for marketing. They dont spend billions of dollars just for the hell of it. The joke is on YOU

HUh? Yeah they arent dumb. The joke isnt on us.. we are getting the free stuff. Think again.

 

[EctopicFetus]

Of course you dont care. No doctor "cares." But the data PROVE that it changes script habits, which is independent of whether you "care" or not.

At least they arent wasting their money. Good for them. FWIW I havent seen any study show outcomes are worse.

Whats screwing the system much worse is some dude rolling to the ER for the same complaint for the 30th time but because the doc doesnt want to get sued he orders (no joke) the 27th CT Abdomen.. $600+ a pop my friend.. This douche wouldnt use this much pharma his whole life.. $16,200.. Good use of money? But thats "defensive" aka "no tort reform" aka "no common sense" medicine.

 

[LADoc00]

Every "free" lunch you partake in, every drug pen you get, every golf trip you get sponsored for is passed on to the patient as higher drug prices.

The joke is on YOU

HUH, no the joke is on you. By your logic we should be getting on the case of every single corporate exec in America because all of their excesses are creating a higher cost of ALL goods and services....

~Okay, I petition to stop Hugh Hefner's largess in order to reduce the newstand price of Playboy. gotcha.

 

[NoPDM]

An unbiased source? There is absolutely no unbiased source in the workplace. This is some of the niavete that I was speaking of. Any information given to you should be questioned, regardless of the source.

Fair enough. I worded my response poorly. I should have said the source (ie. counter-detailing by pharmacists) is less likely to have the type of bias that a rep would have. Are the pharmacists pure and innocent? Of course not, but they are certainly a far cry better than the influence by pharmaceutical companies.

Also, as it stands now, if an academic setting bans drug reps (which are currently a reality of practice), then those in training have no net under them to guide them in thier practice (or alter any potential 'sway' that free dinner might have had). Residents function under attendings and will be forced to justify drug choices (or should be). In theory, academic settings that ban drug reps offer no training or counter to what will become a reality of thier practice.

How on earth did you get to this point? I never said that residents/etc should be educated by drug reps... What a preposterous conclusion! My point was (and your selective quoting certainly did a nice job of confusing it) that drug reps are a fact of life right now.

I included the full quote above. I clearly didn't understand what you were saying. That's the trouble with e-mail and a forum -- issues are easily confused.

If residency programs ban them, then virgin MD's graduate from practice never having been exposed to them. Residency is a great time to get exposed because there is the safety net of attendings/conference and education. Thus if a niave resident starts to quote a drug rep study, then someone is there to teach them about the inherint bias as well as hopefully how to READ and ANALYZE a study.

I disagree here. My residency bans reps and I don't feel worried about reps.

Regarding 'studies', surveys are NOTORIOUSLY weak studies. They have HUGE INHERENT flaws. To make broad sweeping generalizations based on weak studies flaws any arguement. Are some people influenced by drug reps? absolutely. Are ALL people? no.

The assumption you seem to be making is that my complete argument against pharm co's is based on surveys, but this is quite wrong. Some data does come from surveys and obviously that data needs to be judged with skepticism -- as you say, everything should be questioned.

However, some data is also based on randomized, controlled, double-blinded studies. Others evaluate the interactions with retrospective data analyses -- yes, not as good as prospective, but not to be discarded entirely.

Passing inefficient laws are not going to fix what some believe to be the intrinsic problem. Education will.

I couldn't agree more. That's my whole point and my goal is to help educate people.

The depth of problems with drug companies are extensive. This just doesn't seem to be a very important one.

Monopolies, high cost, excessive subsidies, lack of vaccinations because of poor profit margins... etc etc etc. I just havea hard time getting excited about such a minor issue.

What are you referring to with "this" above. The basis of my argument is that the interactions between pharmaceutical companies and physicians needs to be reformed. As I discussed in my talk, there are many facets to these interactions which deserve attention, with the sales rep being one facet. Folks on this forum seem to be latching solely on the 'free lunch' aspect, but that's fine. At least there is a discussion of the issue, which rarely happens.

I dont agree. If someone buys me a beer (who I dont know) am i influenced(in a non etoh kind of way)? Im not stupid enough to think that pharma reps are doing it out of the goodness of their hearts but it doesnt mean i want to be their best friend or prescribe their med.

What we need to understand is that pharm co's know that we are bright, know that we think we are bright, and most importantly, know we think we are infallible. That's what makes us perfect targets. We are ignorant of how their behavior actually affects us. Time and time again, we say we can't possibly be affected and get irritated when someone suggests we could be.

BTW i want you to explain to me why a perk like a free lunch should be eliminated?

As I mentioned earlier in this thread, lunch should be eliminated because the rep is simply trying to get time to talk to us. As I mentioned earlier, time spent with a rep directly is linked to changes in prescribing habits.

These guys dont leave ANYTHING to chance. They spend billions of dollars on marketing campaigns, and they do a ****load of market research to make sure its having the desired impact.

In my researching this subject, I read a number of times that no other industry has studied its target as well as the pharm co's have studied doctors and how to get what you want from them. Sorry, but I can't recall references now.

Of course I would be prescribing new (and more costly) drugs but isnt that my prerogative and I dont think anyone should be able to take that away from me.

Sure you're an adult, an MD, and can do what you want. The problem is that this approach lacks social conscience. If we all went on own way doing things the way we want, I can only imagine this would further impair our health system.

At least they arent wasting their money. Good for them. FWIW I havent seen any study show outcomes are worse.

Search back a couple pages in the thread. Yes, the pharmaceutical companies' behavior has absolutely led to poor outcomes. First, look at how suicide data with SSRI's in adolescents was withheld from the very people doing the study at the pharm co's demand/request. Second, look at the treatment of COX-2's by Merck regarding MI's. Alternatively, look at how sales reps inherently lead to higher costs, either for the patient or insurance providers. So, clearly, there IS data showing worse outcomes.

 

[tibor75]

You don't know what the hell you are talking about.

I worked a Burger King and you better believe that I got perks. I could stop by whenever I wanted and get free food.

I bartended in college. I got in for free and drank for free all night long. I only had to pay half cover for any concerts

I worked at a gas station. All of the vendors that came by gave me free stuff; posters, t-shirts, inflatable beer signs, cases of soda, and chips.

I worked construction/roofing for a while. All the sub-contractors let me use their equipment when I was building furniture for myself. The also let me use any "extra" materials they had.

You call getting free drinks at a restaurant you work for a good example?

Sorry, the equivalent of that is that doctors get preferential treatment when they are patients. I am sure that if I got sick or my spouse or child I could name the physician that I wanted to see and I would see that person without any wait.

Saying you could get "free drinks" isn't even close to getting a hundred dollar meal for free at a 4 star restaurant.

Never thought people could be so ignorant.

 

[tibor75]

You are kidding right? 1st how can you call me ignorant if you dont know me? Every job has some perk, if I build cars for GM me and my union buddies get discounts on the cars. When we attend meetings we get a free lunch. Electrical engineer without perks? Please... Unless he was self employed. You might not look at it like a perk but im sure he got some free things thrown his way. Maybe a bag at an E.E. conference or a book? .

As a doctor, if you got sick, do you think you'd have to wait in the waiting room of your hospital? Of course not, you'd get taken right in. It's called professional courtsey. Every other job has this. this is similar to how a GM employee will get a "perk" if he buys a GM car.

To use this as an equivalent to a doctor getting thousands of dollars over the years in free merchandise from companies who should not be his employer shows the level of ignorance on this topic that you have.

 

[Mumpu]

The problem with COX-2s and SSRIs was not with the docs. The docs followed the evidence and F-#$*ing-DA approved indications. The government agency charged with protecting Americans from unsafe medications but acting like the drug industry PR firm failed them yet again. Big surprise.

There is not a damn study you can believe anymore. Every 10,000 patient megatrial, whether drug money funded or not, employs an army of statisticians who desing it to be successful and show exactly the outcomes the PI wants. Anyone who has ever done research knows how easy it is to manipulate data, especially when your n is so high.

 

[f_w]

The government agency charged with protecting Americans from unsafe medications but acting like the drug industry PR firm failed them yet again. Big surprise.

Did you know that the salaries in the drug approval division of FDA are directly paid for by the drug company whose product the respective reviewers are working on ?

It is called 'user fees', or 'pay to play'. If you want an 'expedited' approval by FDA (meaning less than 15 years), the drug companies have to pay for the man-hours spent by FDA employees. From the money that these fees bring in, the FDA approvals division which used to employ a couple of 100 people has swollen to 10 times its original size. What was that thing with the bread and the song ?

Yes, there are problems in the triangle between drug industry, goverment and physicians. But it is not the surf and turf, the Cab and the 20 year old Port I just had (courtesy of J&J).

 

[remedios]

The problem with COX-2s and SSRIs was not with the docs. The docs followed the evidence and F-#$*ing-DA approved indications. The government agency charged with protecting Americans from unsafe medications but acting like the drug industry PR firm failed them yet again. Big surprise.

There is not a damn study you can believe anymore. Every 10,000 patient megatrial, whether drug money funded or not, employs an army of statisticians who desing it to be successful and show exactly the outcomes the PI wants. Anyone who has ever done research knows how easy it is to manipulate data, especially when your n is so high.

Are you saying that there is no evidence that COX-2 was not over-prescribed for a huge number of patients for whom a generic NSAID would have been equally effective, and, as it turned out, safer?

The logic is:

1. Drug reps helped pushing COX-2 inhibitors, changing prescription patterns by physicians.
2. This led to over-prescription of COX-2 inhibitors for patients who did not need it.
3. If you accept that COX-2 inhibitors has added cardiovascular risks, then you must accept that the hyper promotion of these drugs is a significant factor in the excess number of patients exposed to these risks.

FDA/governments are easy scape goats. Just because there are many parts of the system that are broken, doesn't mean that you shouldn't fix the parts that really need fixing.

 

[f_w]

The logic is:
1. Drug reps helped pushing COX-2 inhibitors, changing prescription patterns by physicians.
2. This led to over-prescription of COX-2 inhibitors for patients who did not need it.
3. If you accept that COX-2 inhibitors has added cardiovascular risks, then you must accept that the hyper promotion of these drugs is a significant factor in the excess number of patients exposed to these risks.

In addition to the marketing through drug-reps, there was massive consumer advertising for these drugs (anytime I hear 'Ask your Doctor' I want to throw something at the TV).
It was a new class of drugs that had a principle that 'common sense' told us was superior to the old drugs. Patients loved it due to the different dosing, and yes, it worked for their nsaid needs.

This is how progress is made, how we get new classes of drugs and how people remain employed. In the process, there will be the occasional person who dies or suffers an untoward event like an MI (and yes, in the process we probably spend more money than your cheapo HMO would have done). But no drug is benign, every couple of months I end up seeing someone happily squirting red-stuff from his NSAID ulcer. People are sick, the drugs we give to treat will occasionally kill them, get over it.

The COX-2 disaster was an issue of non-disclosure. The data was there, but the drug company ****** at the FDA allowed Merck to explain the problems away. If the Vioxx bottle had contained a warning: 'If taken longer than 6 months in maximal dose and if you are in a fairly decrepit age range, this drug might increase your risk of heart attack', we would have been fine.

Patients don't mind taking risks. If they can take control of their disease, they are willing to deal with the risks. If they want to be 'early adopters' (the marines of medical progress), we should give them the opportunity to do so. In some areas, FDA is actually way to restrictive (there are excellent approaches to cancer therapy that took years to make their way from other countries to the US bc FDA dragged their feet).

FDA/governments are easy scape goats. Just because there are many parts of the system that are broken, doesn't mean that you shouldn't fix the parts that really need fixing.

Yeah, fix the parts that need fixing:
- The company funded studies whose results can be suppressed through gag-contracts with the respective universities.
- The 'speakers bureaus' and 'expert panels' (that allways seem to meet in sunny places with golf-courses).
- The drug company paid employees at FDA whose livelihood depends on approving drugs not on critically evaluating them.
- The lack of ongoing independent post-marketing surveillance. And I am not talking about phony adverse events recording systems run by the manufacturers but rather pool-financed large-scale evaluation studies.

 

[remedios]

In addition to the marketing through drug-reps, there was massive consumer advertising for these drugs (anytime I hear 'Ask your Doctor' I want to throw something at the TV).
It was a new class of drugs that had a principle that 'common sense' told us was superior to the old drugs. Patients loved it due to the different dosing, and yes, it worked for their nsaid needs.

This is how progress is made, how we get new classes of drugs and how people remain employed. In the process, there will be the occasional person who dies or suffers an untoward event like an MI (and yes, in the process we probably spend more money than your cheapo HMO would have done). But no drug is benign, every couple of months I end up seeing someone happily squirting red-stuff from his NSAID ulcer. People are sick, the drugs we give to treat will occasionally kill them, get over it.

The COX-2 disaster was an issue of non-disclosure. The data was there, but the drug company ****** at the FDA allowed them to explain the problems away. If the Vioxx bottle had contained a warning: 'If taken longer than 6 months in maximal dose this drug increases your risk of heart attacks', we would have been fine.



Yeah, fix the parts that need fixing:
- The company funded studies whose results can be suppressed through gag-contracts with the people doing the studies.
- The 'speakers bureaus' and 'expert panels' (that allways seem to meet in sunny places with golf-courses).
- The drug company paid employees at FDA whose livelihood depends on approving drugs not on critically evaluating them.
- The lack of ongoing independent post-marketing surveillance. And I am not talking about phonye adverse events recording systems run by the manufacturers but rather pool-financed large-scale evaluation studies.

I agree, non-disclosure and the direct to consumer marketing are also big problems, and perhaps regulations on these issues will have a larger impact than regulations on interactions between drug reps and physicians. The difference is that it is easier to achieve the latter than the former, and if we believe physicians have a duty to improve the health care system, rather than just say, "the system is screwed up, but i'll just try to be above it if i can, and ride it for what it's worth"--then it behooves us to push for the changes that are in the right direction.

 

[f_w]

"the system is screwed up, but i'll just try to be above it if i can, and ride it for what it's worth"--

Actually, the system is not screwed up. It works quite nicely. There will be friction loss (monetary and in lives lost), but in the end we have tools and meds at our disposal that we didn't have only 10 years ago (and again, some dumb### will come and say 'but there is no randomized controlled goverment financed trial that modern medicine is doing any better than rubbing herbs and bloodletting'. In that case I just have to give up, arguments don't seem to cut it.)

 

[remedios]

Actually, the system is not screwed up. It works quite nicely. There will be friction loss (monetary and in lives lost), but in the end we have tools and meds at our disposal that we didn't have only 10 years ago (and again, some dumb### will come and say 'but there is no randomized controlled goverment financed trial that modern medicine is doing any better than rubbing herbs and bloodletting'. In that case I just have to give up, arguments don't seem to cut it.)

I disagree with you there. I think there are better ways to still encourage innovation without the drastic waste (what you call "friction loss") that still do not deliver optimal care. For example, even if we fixed the things you just mentioned, it will be a much better system.

 

[f_w]

I think there are better ways to still encourage innovation without the drastic waste (what you call "friction loss") that still do not deliver optimal care.

How ?

(the greatest motivator for innovation is: $$$. You take the $$$ away, people will sit on their goverment fattened a^^^^ and nothing happens. The goverment used to be in the vaccination business. Their facility for the production of anthrax vaccine had not been updated since the 1940s, when the FDA finally came around to inspect the place it had to be closed in a hurry.)

 

[remedios]

How ?

(the greatest motivator for innovation is: $$$. You take the $$$ away, people will sit on their goverment fattened a^^^^ and nothing happens. The goverment used to be in the vaccination business. Their facility for the production of anthrax vaccine had not been updated since the 1940s, when the FDA finally came around to inspect the place it had to be closed in a hurry.)

Quoting your earlier post:

Yeah, fix the parts that need fixing:
- The company funded studies whose results can be suppressed through gag-contracts with the people doing the studies.
- The 'speakers bureaus' and 'expert panels' (that allways seem to meet in sunny places with golf-courses).
- The drug company paid employees at FDA whose livelihood depends on approving drugs not on critically evaluating them.
- The lack of ongoing independent post-marketing surveillance. And I am not talking about phonye adverse events recording systems run by the manufacturers but rather pool-financed large-scale evaluation studies.

I'm all for market forces and for companies profiting through real, efficacious drug discoveries. But from what you wrote, even you must agree that there is a lack of oversight to correct for the distortions that are in place.

 

[f_w]

I'm all for market forces and for companies profiting through real, efficacious drug discoveries. But from what you wrote, even you must agree that there is a lack of oversight to correct for the distortions that are in place.

Yeah, but what does that have to do with the dinner I had tonight ?

 

[remedios]

Yeah, but what does that have to do with the dinner I had tonight ?

Quoting my earlier post:

non-disclosure and the direct to consumer marketing are also big problems, and perhaps regulations on these issues will have a larger impact than regulations on interactions between drug reps and physicians. The difference is that it is easier to achieve the latter than the former, and if we believe physicians have a duty to improve the health care system, rather than just say, "the system is screwed up, but i'll just try to be above it if i can, and ride it for what it's worth"--then it behooves us to push for the changes that are in the right direction.

Also, refer to NoPMD's posts about the effects of drug reps.

 

[sdn1977]

I will admit I haven't read all 6 pages of this topic, so forgive me...However, I will point out my persepctive as a pharmacist (someone alluded to us earlier)..

You can prescribe anything you want, but don't think your patient will take what you prescribe. Hopefully, they won't just walk away & decide not to treat their diabetes because you decided to write for Glucophage XR & their insurance company won't pay for it (after all - they don't feel sick!). Hopefully, they will let me initiate contact with you to get you to change it to generic metformin so it is more in line with what they can afford. But...if you insist they take the Glucophage XR, more often than not, they won't take the medication or they'll take it sporadically.

This same scenario happens with new dosage forms, new drug classes, new forms of an otc product (think Clarinex) & many other circumstances I can't think of now. IMO - the motivator for your prescribing practices is the insurance formularies - is it any wonder one of the largest drug insurers (PAID Rx) is owned by Merck?

 

[sdn1977]

How ?

(the greatest motivator for innovation is: $$$. You take the $$$ away, people will sit on their goverment fattened a^^^^ and nothing happens. The goverment used to be in the vaccination business. Their facility for the production of anthrax vaccine had not been updated since the 1940s, when the FDA finally came around to inspect the place it had to be closed in a hurry.)

I'm not sure I get your point here, but the govt is more into vaccines than they ever used to be. Yeah - the anthrax vaccine use to be made by the Michigan Biologic Production Insitute for the State of Michigan & it was later bought by BioiPort, the sole consumer of the anthrax vaccine continues to be the federal govt.

Also - in the 80's most manufacturers of vaccine products were on the verge of withdrawing from the market due to liability lawsuits. The govt stepped in & passed the National Childhood Vaccine Injury Act which collects a tax on every vaccine sold which goes into a no-fault insurance to cover vaccine injuries. Healthcare providers & manufacturers cannot be sued for a injuries suffered from receiving dip, tet, pertussis, polio, meales, mumps, rubella, hep B, Hib, pneumococcal or varicella. So - the govt is involved in a big way in assuring vaccination without liability.

Perhaps this supports your argument or not...sorry for not understanding!

 

[sdn1977]

The fault lies with the idiot physician, not with the drug reps.

Learn the frickin' pharmacology. Make friends with your Pharm D. Look at literature for drugs you commonly prescribe (PPIs, antihypertensives, etc.) and draw your own educated conclusions.

The reason we have rampant fluoroquinolone resistance is NOT because drug reps push it. It's because brainless docs write "levo 500" for every damn thing without pausing for a half a second to think about it. How many UTIs have you seen treated with levo when cephalexin or nitrofurantoin or TMP/SMX would work just as well? There was another great quinolone (forget the name) that was run off the market because everyone and their mom used it for everything.

There is a couple of places where generics don't work safely. Antiseizure meds is one -- if you stick to a brand you have guaranteed consistent bioavailability and kinetics. Pharmacies tend to change from one generic manufacturer to another from month to month and I've seen bad things happen with that. SSRIs is another place -- I've seen rapid paroxetine withdrawal when a pharmacy changed from one generic mfr to another.

I object to this!!! We do not change brand of seizure medications! That is a uniform policy & if it must be changed, we notify the prescriber as well as the patient....but I can say in 20 years - I have never had a supply problems that warrants this with this particular group of medications! That does not keep your patient from going from one pharmacy to another to get a different brand, but within one pharmacy, brands on phenytoin, carbamazepine, lanoxin & warfarin stay consistent!

 

[NoPDM]

Did you know that the salaries in the drug approval division of FDA are directly paid for by the drug company whose product the respective reviewers are working on?

It is called 'user fees', or 'pay to play'. If you want an 'expedited' approval by FDA (meaning less than 15 years), the drug companies have to pay for the man-hours spent by FDA employees. From the money that these fees bring in, the FDA approvals division which used to employ a couple of 100 people has swollen to 10 times its original size. What was that thing with the bread and the song?

Absolutely agree. These policies were brought about after the public was dissatisfied with the FDA-processing times of HIV meds in the late 1980's. So, in 1992, fast-tracking fees to the FDA by the pharm co's became a reality. Then, for some odd reason {obvious sarcasm} direct-to-consumer marketing ban was nearly completely rescinded in 1997. We're one of the few countries in the world that allows the direct-to-consumer marketing that takes places. I read that in Canada you can mention a drug name, but cannot mention what is being treated. I'd be curious if someone in Canada can verify or refute this.

Yes, there are problems in the triangle between drug industry, goverment and physicians. But it is not the surf and turf, the Cab and the 20 year old Port I just had (courtesy of J&J).

How can you be so bright about things like the FDA problems above, yet deny your role in the problem. Your short-sightedness and/or selfishness is a prime example of why we'll have a terrible time reforming the system. We need to be more responsible and stop taking pharm co's money when it is clearly trying to influence our prescribing behavior in ways that potentially are detrimental (e.g. cost) to our patients.

 

[NoPDM]

As I mentioned in my talk, two other areas of concern:

1. Did you know 90%+ of the funding for our CME comes from pharm co's? They can, therefore, directly influence how we get our information. When the ACCME tried to reign in the influence of pharm co's, pharm co's fired back with threats of 1st amendment violations.

2. Conferences are heavily funded by pharm co's, which also affects its content. Take, for example, No Free Lunch's attempts to get into conferences (e.g. AAFP 2005) were blocked because they were not in line with the conference, but McDonald's and Coca Cola were permitted to have a booth. They were also blocked from ACP 2005. When allowed in in 2006, they distributed the ACP guidelines for conflict of interest at the conference. ACP turned around and sent a flyer to all other sponsors (ie. pharm co's) and said they had nothing to do with No Free Lunch distributing the COI information. Sounds like some serious pandering to the pharm co's by ACP to protect their funding. Think there's no influence there by the pharm co's? Of course there is. The next time you're handed a conference bag with the big "Lipitor" or "Crestor" on the side, turn it down and carry your own bag. Otherwise, your carrying their bag shows the pharm co's they've got your in their pocket.

 

[EctopicFetus]

You call getting free drinks at a restaurant you work for a good example?

Sorry, the equivalent of that is that doctors get preferential treatment when they are patients. I am sure that if I got sick or my spouse or child I could name the physician that I wanted to see and I would see that person without any wait.

Saying you could get "free drinks" isn't even close to getting a hundred dollar meal for free at a 4 star restaurant.

Never thought people could be so ignorant.

Go see the recent time article.. The so called "preferential" treatment isnt as great as you think.

 

[EctopicFetus]

As a doctor, if you got sick, do you think you'd have to wait in the waiting room of your hospital? Of course not, you'd get taken right in. It's called professional courtsey. Every other job has this. this is similar to how a GM employee will get a "perk" if he buys a GM car.

To use this as an equivalent to a doctor getting thousands of dollars over the years in free merchandise from companies who should not be his employer shows the level of ignorance on this topic that you have.

Your nonsensical banter shows you are clearly in the preclinical years or you just have no idea how the world works. You aren't comparing apples to apples.

If you want to get more specific, any employee who makes decisions to purchase items will get "perks" from people trying to sway his decision. When a businessman takes another businessman out for some "golf" this is a perk and would be an apples to apples comparison. It happens all the time.

No one can explain why after finishing my MD I shouldnt be allowed to make whatever decision I want when it comes to prescribing. In the end it is my responsibility to do what it right and this shouldnt be legislated or governed by anyone.

 

[EctopicFetus]

Are you saying that there is no evidence that COX-2 was not over-prescribed for a huge number of patients for whom a generic NSAID would have been equally effective, and, as it turned out, safer?

The logic is:

1. Drug reps helped pushing COX-2 inhibitors, changing prescription patterns by physicians.
2. This led to over-prescription of COX-2 inhibitors for patients who did not need it.
3. If you accept that COX-2 inhibitors has added cardiovascular risks, then you must accept that the hyper promotion of these drugs is a significant factor in the excess number of patients exposed to these risks.

FDA/governments are easy scape goats. Just because there are many parts of the system that are broken, doesn't mean that you shouldn't fix the parts that really need fixing.

The FDA is not just an easy scapegoat but also who is responsible to test for safety. As for #2 these were prescribed because it was thought it would be easier on pts stomachs and not lead to the same problems as ASA because of a lack of Cox-1 inhibitors. Sure we can make a point on this but there are going to be other examples where they pushed these drugs (hmm say statins) and now all these other benefits are found (we will see if this is true) FWIW anyone who has done research (like I have) nows how easy it is to manipulate data.

I dont think ANYONE on this thread thinks there arent MAJOR problems with the current pharma system. Rather I think people think the problems are much much bigger than students, residents and attendings getting a free sandwich or a pen.

 

[EctopicFetus]

In addition to the marketing through drug-reps, there was massive consumer advertising for these drugs (anytime I hear 'Ask your Doctor' I want to throw something at the TV).
It was a new class of drugs that had a principle that 'common sense' told us was superior to the old drugs. Patients loved it due to the different dosing, and yes, it worked for their nsaid needs.

This is how progress is made, how we get new classes of drugs and how people remain employed. In the process, there will be the occasional person who dies or suffers an untoward event like an MI (and yes, in the process we probably spend more money than your cheapo HMO would have done). But no drug is benign, every couple of months I end up seeing someone happily squirting red-stuff from his NSAID ulcer. People are sick, the drugs we give to treat will occasionally kill them, get over it.

The COX-2 disaster was an issue of non-disclosure. The data was there, but the drug company ****** at the FDA allowed Merck to explain the problems away. If the Vioxx bottle had contained a warning: 'If taken longer than 6 months in maximal dose and if you are in a fairly decrepit age range, this drug might increase your risk of heart attack', we would have been fine.

Patients don't mind taking risks. If they can take control of their disease, they are willing to deal with the risks. If they want to be 'early adopters' (the marines of medical progress), we should give them the opportunity to do so. In some areas, FDA is actually way to restrictive (there are excellent approaches to cancer therapy that took years to make their way from other countries to the US bc FDA dragged their feet).


Yeah, fix the parts that need fixing:
- The company funded studies whose results can be suppressed through gag-contracts with the respective universities.
- The 'speakers bureaus' and 'expert panels' (that allways seem to meet in sunny places with golf-courses).
- The drug company paid employees at FDA whose livelihood depends on approving drugs not on critically evaluating them.
- The lack of ongoing independent post-marketing surveillance. And I am not talking about phony adverse events recording systems run by the manufacturers but rather pool-financed large-scale evaluation studies.

Do we actually agree here..

Well said f_w

 

[NoPDM]

No one can explain why after finishing my MD I shouldnt be allowed to make whatever decision I want when it comes to prescribing. In the end it is my responsibility to do what it right and this shouldnt be legislated or governed by anyone.

How do you go from my wanting to reform the interactions between pharm/device co's and MD's to someone trying to impair your prescribing habits from a legislative or regulatory stand-point? The point of contention needs to remain focused on how the drug co's influence your prescribing habits. I, too, can't stand when I'm forced to choose a drug (e.g. work at any VA) and want to retain my ability to choose what's best for my patients. Regardless, let's keep our eye on the ball and stay focused on the fact that pharm co's dump billions of dollars into marketing to ensure we use their particular drug of interest.

 

[EctopicFetus]

As I mentioned in my talk, two other areas of concern:

1. Did you know 90%+ of the funding for our CME comes from pharm co's? They can, therefore, directly influence how we get our information. When the ACCME tried to reign in the influence of pharm co's, pharm co's fired back with threats of 1st amendment violations.

2. Conferences are heavily funded by pharm co's, which also affects its content. Take, for example, No Free Lunch's attempts to get into conferences (e.g. AAFP 2005) were blocked because they were not in line with the conference, but McDonald's and Coca Cola were permitted to have a booth. They were also blocked from ACP 2005. When allowed in in 2006, they distributed the ACP guidelines for conflict of interest at the conference. ACP turned around and sent a flyer to all other sponsors (ie. pharm co's) and said they had nothing to do with No Free Lunch distributing the COI information. Sounds like some serious pandering to the pharm co's by ACP to protect their funding. Think there's no influence there by the pharm co's? Of course there is. The next time you're handed a conference bag with the big "Lipitor" or "Crestor" on the side, turn it down and carry your own bag. Otherwise, your carrying their bag shows the pharm co's they've got your in their pocket.

Let me say I see the point of the OP and honestly I think you have been real nice throughout this thing but some people like me just dont agree with your beliefs. Additionally, when people go on bashing McDonalds and Coca Cola (which you didnt really do but i think it happened in eariler pages) I just think one thing.. Personal responsibility, people need to man up and say you know Im a fat DM2 HTN COPDer because I eat too much, smoke too much and dont exercise. McDonalds is just an outlet if you dont like it vote against it by not buying anything. The answer isnt to eliminate it. FWIW, my beliefs in the pharma business is the same. You dont want to take free stuff, then dont..

Ill go on with my personal disclosure. I do accept pens, I only use the good quality pens though, I eat their food too. I dont take bags because I have enough of that bs. I take their books if they are helpful, some drug co just gave out the 2006 Tarascon's pharma book. I dont take their little pamphlets because I dont care. discuss..

 

[f_w]

How can you be so bright about things like the FDA problems above, yet deny your role in the problem.

With 'bright' you mean 'agree with me' (I actually concur for once with LADoc here: you must be female).

I don't deny that I am under the spell of big pharma and equipment companies, I just don't see it as major a problem as you seem to do.
I see the reps as part of the mechanism that gives me covered stents that fit through a 6Fr sheath and safer anticoagulants that don't linger around for days and wipe out my patients platelets. This stuff wouldn't exist if it wasn't for inappropriate utilization in the early adoption phase. I know, there is a conflict, I am willing to accept that conflict for the greater good. You see pharma and equipment makers as the devil incarnate, I see them as the white knight that gives the the tools I need for my trade.

 

[tibor75]

Your nonsensical banter shows you are clearly in the preclinical years or you just have no idea how the world works. You aren't comparing apples to apples.

If you want to get more specific, any employee who makes decisions to purchase items will get "perks" from people trying to sway his decision. When a businessman takes another businessman out for some "golf" this is a perk and would be an apples to apples comparison. It happens all the time.

No one can explain why after finishing my MD I shouldnt be allowed to make whatever decision I want when it comes to prescribing. In the end it is my responsibility to do what it right and this shouldnt be legislated or governed by anyone.

So doctors should be like businessmen? How comforting to our patients.

Obviously you are completely clueless in your ability to know what is right.

 

[OSUdoc08]

As I mentioned in my talk, two other areas of concern:

1. Did you know 90%+ of the funding for our CME comes from pharm co's? They can, therefore, directly influence how we get our information. When the ACCME tried to reign in the influence of pharm co's, pharm co's fired back with threats of 1st amendment violations.

2. Conferences are heavily funded by pharm co's, which also affects its content. Take, for example, No Free Lunch's attempts to get into conferences (e.g. AAFP 2005) were blocked because they were not in line with the conference, but McDonald's and Coca Cola were permitted to have a booth. They were also blocked from ACP 2005. When allowed in in 2006, they distributed the ACP guidelines for conflict of interest at the conference. ACP turned around and sent a flyer to all other sponsors (ie. pharm co's) and said they had nothing to do with No Free Lunch distributing the COI information. Sounds like some serious pandering to the pharm co's by ACP to protect their funding. Think there's no influence there by the pharm co's? Of course there is. The next time you're handed a conference bag with the big "Lipitor" or "Crestor" on the side, turn it down and carry your own bag. Otherwise, your carrying their bag shows the pharm co's they've got your in their pocket.

If I have a Viagra, Levitra, AND Cialis pen, am I really being influenced? I still have to choose which one to prescribe, now don't I! If you really base your decisions on writing prescriptions on what the pen in your hand says, then maybe you shouldn't be taking them. Fortunately, I don't even know what the pen I wrote with today said.

"Ne Free Lunch" was not allowed into the conference, because they don't give out free lunches. As a result, noone likes them.

I'm taking a free Lipitor bag, by the way. I'm not going to be prescribing lipitor in the ED anyway, so I just don't care. I want my free stuff.

You should really quit being such a whiner, by the way.

 

[OSUdoc08]

So doctors should be like businessmen? How comforting to our patients.

Obviously you are completely clueless in your ability to know what is right.

This post is a pathetic insult with no material content. If you are going to disagree with Ectopic, give a valid argument. You obviously have not.

 

[f_w]

So doctors should be like businessmen? How comforting to our patients.

Doctors ARE businessmen !

 

[remedios]

The FDA is not just an easy scapegoat but also who is responsible to test for safety. As for #2 these were prescribed because it was thought it would be easier on pts stomachs and not lead to the same problems as ASA because of a lack of Cox-1 inhibitors. Sure we can make a point on this but there are going to be other examples where they pushed these drugs (hmm say statins) and now all these other benefits are found (we will see if this is true) FWIW anyone who has done research (like I have) nows how easy it is to manipulate data.

I dont think ANYONE on this thread thinks there arent MAJOR problems with the current pharma system. Rather I think people think the problems are much much bigger than students, residents and attendings getting a free sandwich or a pen.

Sure there are bigger problems. But why don't we work on fixing the part that already directly affect us, so that, 1., we already make some small improvement in the system, and 2., when we push for bigger changes, we have the moral capital?

And FYI, I have done research, I'm sure so has the OP, and other people who responded. Just because data can all be manipulated doesn't mean you can use that as a reason to dismiss ALL data (or, more to the point, dismiss the data you want to dismiss, the ones that doesn't fit your world view/current position). Surely you must agree that you should and can evaluate the data for yourself.