Work to ban drug and device sales reps

[8744]

That was the most ANNOYING post I have ever read. And I think I AGREE with the GUY.

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[8744]

Mr. and Mrs. Thread? Hello. I'm Doctor Bear, one of the residents taking care of your parent thread....please....sit down.

Well, as you know your thread is not doing well. Of course it has a lot to do with the age of the thread, certainly it has gone on longer than most and that's a blessing. It was a good thread but I'm afraid we've done all that we can do to it.

Life support? Well, certainly we can keep the thread going but I think this would be both futile and unnecessarily cruel. Sometimes...often...we arrive at the end of our ability to continue a thread.

You're devout Catholics? Well, I'm a religious man myself and I think we've come to the point where we are fighting God who will take all threads in his own good time. Why? I don't have the answer ot that question.

Oh no. I don't think your thread is feeling any pain.

 

[8744]

Hi. Welcome to this months Morbidity and Conference. The first patient is a long-running thread....yes...you in the back....do you have a question?

Uh...uh....yeah...sure....

Yes, threads like this do suck up a lot of MICU resources and it is true that in Europe they would never take a thread so far. I like to think of this, however, as a testament to the drive of the thread's spirit to live.

Oh, I just want to mention that Marlo from Glaxo provided the lunch today.

 

[EctopicFetus]

Hi. Welcome to this months Morbidity and Conference. The first patient is a long-running thread....yes...you in the back....do you have a question?

Uh...uh....yeah...sure....

Yes, threads like this do suck up a lot of MICU resources and it is true that in Europe they would never take a thread so far. I like to think of this, however, as a testament to the drive of the thread's spirit to live.

Oh, I just want to mention that Marlo from Glaxo provided the lunch today.

Nicely done!!!

 

[tibor75]

Hi. Welcome to this months Morbidity and Conference. The first patient is a long-running thread....yes...you in the back....do you have a question?

Uh...uh....yeah...sure....

Yes, threads like this do suck up a lot of MICU resources and it is true that in Europe they would never take a thread so far. I like to think of this, however, as a testament to the drive of the thread's spirit to live.

Oh, I just want to mention that Marlo from Glaxo provided the lunch today.

actually your "insight" (to use that term loosely) is what kept this thread going with 3 consecutive posts.

I love message board idiots who complain about a thread and are actually one of the lead players in it continuing. Comical.

 

[8744]

actually your "insight" (to use that term loosely) is what kept this thread going with 3 consecutive posts.

I love message board idiots who complain about a thread and are actually one of the lead players in it continuing. Comical.

Tibor75, I've been gentle with you because I can tell that you have a stick so far up your ass that everything tastes, well, "sticky."

Do they have humor in your country?

 

[tibor75]

Tibor75, I've been gentle with you because I can tell that you have a stick so far up your ass that everything tastes, well, "sticky."

Do they have humor in your country?

So you assume I am not American because you don't agree with what I say?

Ah, racist message board idiots...even funnier.

 

[8744]

So you assume I am not American because you don't agree with what I say?

Ah, racist message board idiots...even funnier.

Well, Americans generally appreciate humor (or attempted humor) so it is not unreasonable to suppose that you just got off the boat from some former Soviet Republic east of the Urals where everybody wears cheap, poorly fitting suits.

Still, you'd think they would have confiscated your stick as a foreign botanical when you came through customs.

 

[DrMom]

both of you need to cool it, please.

 

[EctopicFetus]

So you assume I am not American because you don't agree with what I say?

Ah, racist message board idiots...even funnier.

Why is his statement racist?

 

[8744]

It was "stickist."

 

[NoPDM]

You got a senior cardiology fellow (NOT in private practice yet) on this quixotic crusade who feels the need to cast aspersions, stereotype, and essentially calling anyone of us who accept any gifts/dinners as brainwashed drug rep ******.

You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts. Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.

I fully understand the need to be a patient advocate first, as I AM ONE EVERY DAY. DON’T EVER ASSUME that those of us who accept pharm company gifts AND go to the free dinners are not. Remember what they say about ass-u-me (ing) things.

There is no need to shout. Just as I have said pharm and device reps aren't bad people, the people that associate with them aren't inherently bad either. I think they are making poor decisions, but I am not directly saying anyone is behaving out of malice toward their patients. Relax. Try to have a discussion without getting too emotional.

Even though you are a senior fellow, YOU ARE STILL a TRAINIEE

Again, be careful with your assumptions. You don't know anything about me, so no need to make the discussion personal. Discuss facts which you have a clue about and stay on point, otherwise you have NO credibility, regardless of being in private practice or not.

Your quoted “research” is EXTREMELY FLAWED, BIASED, and FULL OF HOLES.

How many of the studies that I referenced in my talk are you referring to? I know the data I used as references may not be perfect (no research is), but the basic principles behind that research are valid and each study has some merit worth considering. Instead of throwing broad statements out about the studies, be specific so we can get something constructive out of this discussion.

So what reference I use to determine which meds are good?? – THE MEDICAL LETTER.

At least we agree on something. I mentioned this reference in my talk and also earlier in this thread. I imagine most schools, for the med students, have free on-line access to this, so all should take a look.

I will echo points made by some of my good colleagues here. In the world of private practice, there are WAYYYYY bigger issues that people have to deal with. For you to be crusading on this nonsensical issue shows your lack of real priorities.

Again, I find your personal attacks amusing. You list a number of important issues, but I am curious what you have done to try to improve any of those areas. In my mind, this is an important issue which needs our attention.


Listen, the bottom line that I have been trying to stress in this thread is that pharm and device companies throw billions of dollars at us not out of charity, but to influence what we do. It works, so they keep throwing money at us. Plain and simple. Do you really think they'd spend that kind of money without a clear ROI? Of course not. Their shareholders would eat them alive.

 

[tibor75]

"I fully understand the need to be a patient advocate first, as I AM ONE EVERY DAY. DON’T EVER ASSUME that those of us who accept pharm company gifts AND go to the free dinners are not"

I love it when ignorant doctorbs make this argument. Just like if a ballplayer said, "Well, I take steroids, but I could still be a great home run hitter without them"

Comical.

 

[Wrigleyville]

I love it when ignorant doctorbs make this argument. Just like if a ballplayer said, "Well, I take steroids, but I could still be a great home run hitter without them"

Comical.

 

[Jocomama]

I finally reviewed this thread. I think it is a good experience to investigate and research, however these forums often become an emotional outlet.
I must advise you to be careful with your opinions both in medical school, and as a resident.
In regards to influence: That is something inside, and crosses every field within society based on capitalism. If you allow it to influence your decision, then you should look at yourself, and not a business that markets.
Welcome to the real world.

Please keep your mind open, try to take some business classes, and continue reading. Whether private practive or academia, there is a place for pharmaceutic support. The first and most important thing to remember is your patients come first. If you take that with you everyday, then outside influence should not affect you whether pharmacy provides financial support, or loss of reimbursement occurs due to managed care issues.
Patients come first.
Keep it simple.

You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts. Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.



There is no need to shout. Just as I have said pharm and device reps aren't bad people, the people that associate with them aren't inherently bad either. I think they are making poor decisions, but I am not directly saying anyone is behaving out of malice toward their patients. Relax. Try to have a discussion without getting too emotional.



Again, be careful with your assumptions. You don't know anything about me, so no need to make the discussion personal. Discuss facts which you have a clue about and stay on point, otherwise you have NO credibility, regardless of being in private practice or not.



How many of the studies that I referenced in my talk are you referring to? I know the data I used as references may not be perfect (no research is), but the basic principles behind that research are valid and each study has some merit worth considering. Instead of throwing broad statements out about the studies, be specific so we can get something constructive out of this discussion.



At least we agree on something. I mentioned this reference in my talk and also earlier in this thread. I imagine most schools, for the med students, have free on-line access to this, so all should take a look.



Again, I find your personal attacks amusing. You list a number of important issues, but I am curious what you have done to try to improve any of those areas. In my mind, this is an important issue which needs our attention.


Listen, the bottom line that I have been trying to stress in this thread is that pharm and device companies throw billions of dollars at us not out of charity, but to influence what we do. It works, so they keep throwing money at us. Plain and simple. Do you really think they'd spend that kind of money without a clear ROI? Of course not. Their shareholders would eat them alive.

 

[zinjanthropus]

why would you ban sales reps? they perform a necessary function? device reps work closely with surgeons and work hard to develop new and useful products. i will take my free lunch and will happily continue participating in an industry that has enough profit to drive research and product innovation, thus making the lives' of physicians and, ultimately in some cases, patients, a little bit easier.

 

[tibor75]

why would you ban sales reps? they perform a necessary function? device reps work closely with surgeons and work hard to develop new and useful products. i will take my free lunch and will happily continue participating in an industry that has enough profit to drive research and product innovation, thus making the lives' of physicians and, ultimately in some cases, patients, a little bit easier.

Their profits drive research?
well, crappy research I guess....

 

[Qtip96]

Their profits drive research?
well, crappy research I guess....

tibor, dude, i just love reading your posts...
just the right combination of judgmental and stupid.

why don't we look at the "crappy research" in your field, tibor... cardiology isn't it?

hmmmm, that's a hard one. . your entire specialty is like WAY dirty.

why don't we try ALL the drug-eluting stent trials (Cordis and Boston Sci)
and like MOST of the statin trials, like PROVE-IT (BristolMS), TNT (Pfizer), etc.
and like ALL the ICD trials, like MADIT, MADIT2, COMPANION (Guidant), etc.
and like ALL the plavix trials, like CURE, CREDO (Sanofi)
the list goes on and on...
and i'm just gettin' warmed up, baby!!!

the products in these "crappy" studies save lives.

don't they teach you guys to read at upittsburgh cards?

perhaps i should just finish this post in the way you usually do...

"i just love {some insult like message board idiots, minions, etc}"
theatrical pause...
then the one word silly whammo, like "Comical." "Funnier." or "Pathetic."

 

[Qtip96]

that being said, i do think that pharm reps should have minimal interactions with us in training, so as not to influence our prescribing practices during these impressionable years. it's a pity too, 'cause this is when i'd most appreciate a free meal!

when we're done and in the open market, ahem, real world... everything is fair game!

 

[zinjanthropus]

at least as far as devices go, i do think that the profits drive research - new US technology, gps systems, shunts/ports, etc...

 

[Jocomama]

Now that is what I like to see: a detailed list, or data when politely letting Tibor know what reality truly is.

Your post is appreciated.

that being said, i do think that pharm reps should have minimal interactions with us in training, so as not to influence our prescribing practices during these impressionable years. it's a pity too, 'cause this is when i'd most appreciate a free meal!

when we're done and in the open market, ahem, real world... everything is fair game!

 

[tibor75]

tibor, dude, i just love reading your posts...
just the right combination of judgmental and stupid.

why don't we look at the "crappy research" in your field, tibor... cardiology isn't it?

hmmmm, that's a hard one. . your entire specialty is like WAY dirty.

why don't we try ALL the drug-eluting stent trials (Cordis and Boston Sci)
and like MOST of the statin trials, like PROVE-IT (BristolMS), TNT (Pfizer), etc.
and like ALL the ICD trials, like MADIT, MADIT2, COMPANION (Guidant), etc.
and like ALL the plavix trials, like CURE, CREDO (Sanofi)
the list goes on and on...
and i'm just gettin' warmed up, baby!!!

the products in these "crappy" studies save lives.

don't they teach you guys to read at upittsburgh cards?

perhaps i should just finish this post in the way you usually do...

"i just love {some insult like message board idiots, minions, etc}"
theatrical pause...
then the one word silly whammo, like "Comical." "Funnier." or "Pathetic."

Wow, you mentioned 10 studies. Do you know how many are published on a monthy basis? Maybe if you actually read the journals and saw the amount of biased and crappy studies that are done (Statins are Antiarrythmic based on a ****ty retrospective study with 2 unequal arms), you'd realize the amount of money these companies waste and why they rip off hte american consumer with sky high prices.

 

[Qtip96]

Wow, you mentioned 10 studies. Do you know how many are published on a monthy basis? Maybe if you actually read the journals and saw the amount of biased and crappy studies that are done (Statins are Antiarrythmic based on a ****ty retrospective study with 2 unequal arms), you'd realize the amount of money these companies waste and why they rip off hte american consumer with sky high prices.

i've only named a handful of SIGNIFICANT studies, so your pea-sized brain can digest it. your obvious lack of recognition of landmark studies is testimony to your ignorance.

i've read important statin trials like the Heart Protection Study(Merck), PROVE-IT TIMI22(BristolMS), TNT(Pfizer), to name a few. you obviously waste your time reading the garbage you listed above.

face it bub, you got your ass handed to you on a platter.

 

[EHRHelp]

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.

www.nofreelunch.org

Doctors and Big Pharma are not on the same side.

 

[EctopicFetus]

Gimme my free lunch.. Yummy..

We arent on the same side? We use their drugs? We make them rich.. Good for them. Most of the advances in healthcare have to do with meds and not with how great we are at our physical exam skillz.

Fetus.... out

 

[3dtp]

www.nofreelunch.org

Doctors and Big Pharma are not on the same side.

Completely anonymoussite. No name on the site, no one taking responsibility, but making astounding claims that being "no free lunch certified" in the not so distant furure "will be as prestigious as 'Board Certified' as an indicator of quality."

Hmmm...no one on this web site has the jubbers to put his/her name on it. Instead, an anonymous email address, a NYC PO Box.

but...

Web site is registered to a Chicago hosting company and by doing a bit of "digging" and a check of the friendly neighborhood DNS servers we find that it belongs to one Robert Goodman of NYC. The domain registrar lists a six (6) digit phone number for both voice and fax and the same PO Box. Didn't know NYC had 6 digit phone numbers. So, no way to figure out just who Bobby is that way.

So, doing a google for Bobby comes up with a long list of Robert Goodmans, but of the longish list, one in NYC comes to light. One and the same? who knows? pure speculation since we can't cross check addresses or phone numbers. Clever...verrry clever.


I do like its "Drug Free Practitioners" listing concept. Just say no to prescriptions! Then we can use a gamma knife which ain't cheap neither. (and perhaps more lucrative than the clinac SRS?)

 

[EctopicFetus]

Drug free practitioners? Sweet I can become an urban witch doctor! AWESOME..

I loathe this thread..but getting to 10K is a must!

 

[Tired]

Doctors and Big Pharma are not on the same side.

Yeah, we're not on the same side, but the moment we want free drugs for poor people, suddenly we get all friendly . . .

 

[sirus_virus]

www.nofreelunch.org

Doctors and Big Pharma are not on the same side.

What kind of jobless savage has enough time on their hands to build that website.

 

[sprinkibrio]

This is the stupidest thread I've ever seen. Get off your high horses....... UGH.

 

[Mumpu]

But where will I get my supply of pens advertising drugs for urinary incontinence and hemorrhoids? That's like my #1 white coat piece of flair.

 

[Tired]

My two favorite drug-ad products were a Campral USB Storage Device (only 30mb though), and easily the best, a Viagra scrub top.

 

[Dr. V]

Yes, let's ban the reps from the OR.

That way the hospital or patient has to buy all the sizes and types of insert/prostetics instead of only the ones they need.

That'll really save money.

Plus the surgeons will have to take special courses for each device they use or each new change to the device/delivery system. That'll sure save money and time as well.

I mean, after all if it's me or my wife on the OR table I don't want someone that has experience with the mechanics of the device in there with the surgeon, really I'd rather take my chances that the surgeon was previoiusly an engineer.

LMBO

 

[NoPDM]

Completely anonymoussite. No name on the site, no one taking responsibility, but making astounding claims that being "no free lunch certified" in the not so distant furure "will be as prestigious as 'Board Certified' as an indicator of quality."

Hmmm...no one on this web site has the jubbers to put his/her name on it. Instead, an anonymous email address, a NYC PO Box.

but...

Web site is registered to a Chicago hosting company and by doing a bit of "digging" and a check of the friendly neighborhood DNS servers we find that it belongs to one Robert Goodman of NYC. The domain registrar lists a six (6) digit phone number for both voice and fax and the same PO Box. Didn't know NYC had 6 digit phone numbers. So, no way to figure out just who Bobby is that way.

So, doing a google for Bobby comes up with a long list of Robert Goodmans, but of the longish list, one in NYC comes to light. One and the same? who knows? pure speculation since we can't cross check addresses or phone numbers. Clever...verrry clever.

I do like its "Drug Free Practitioners" listing concept. Just say no to prescriptions! Then we can use a gamma knife which ain't cheap neither. (and perhaps more lucrative than the clinac SRS?)

He's actually a pretty nice guy and is putting his time behind what he believes in. Can you say you put your time into a cause that you believe in? Also, I'm not sure why you are trying to act like a super-sleuth. You want a cookie because you can find out who registered a site?! I think my 2 year old can probably do it too...and she wouldn't act like she was something special for having done it. Bob's a nice guy and doesn't hide his name at all. Sending him an email gets a rapid reply with his name in it, so he's certainly not hiding. Why don't you spend some of your free time trying to educate yourself about this issue instead of trying to pretend there is a controversy behind NoFreeLunch.

 

[CatsandCradles]

Why don't you spend some of your free time trying to educate yourself about this issue instead of trying to pretend there is a controversy behind NoFreeLunch.

I give up!!

I admit it.

I confess to everyone on SDN that I have been shamefully been allowing myself to be manipulated by the cheesburgers and cheestakes of Britol Myer's Squib.

I also confess that I have been shamefully using the pens and pencils of Welysh Allen and Co. There free otoscope looking pens are sitting on my desk as I write this.

And I confess that I have been using tissue boxes by Johnson & Johnson that are made to look as if they have pharmacutical products in them. I used these tissue boxes because they were giving them out for free and I have allergies.

And I confess to the accusations that I have used Astra Zenca wrapping paper for Christmas wrapping paper. My parents were suprised to see 2ug HCI injections with Crestor wrapped presents under the Christmas tree.

I confess that when the lights went out the other day, I was using a yellow and white flashlight that was given to me. It had the label of the all mighty Pfizer Co. on it. I'm so sorry. I couldn't resit using it. I had too. What else was I to do?

And I further confess that my book bag has a Merk patch on it. I try to hide the Merk patch, but some of my fellow students saw it and yelled at me! I almost cried and ran out of the anatomy lab screaming in tears!

And my 350 megabite flash drive was given to me from Guidant (Now Boston Scientific)...I cannot live without my flash drive! Please, I'm addicted to using it! Help me ~ !!

So...I confess to almighty SDN forum, and to you, my brothers and sisters, that I have sinned through my own fault, in my thoughts and in my words, in what I have done and what I have failed to do; and I ask my fellow SDNers, all the moderators and donors, and you, my brothers and sisters, to pray for me to escape from the wicked evilness of the pharamacutical companies.

Oh and also I confess that I have a John Deere hat too. It is green with dark yellow letter on it. It has a cute little small deer on it. I am a slave to this hat, and a slave to John Deere. As a matter of fact, there is also everyone's favorite biochemistry faculty member wears a John Deere hat too. We couldn't help it, they were handing out free hats and I had to take one. Please fogive both of us, we have been manipulated by that evil and wicked farm tractor manufacture John Deere Co! I wear this hat every day. I have willing allowed myself to be a walking billboard throughtout the hospital and school!

So you see it is John Deere that is worst than Pfizer or Merk!

But it's not my fault!! Really. It was all John Deere's fault! They were giving out free cool looking hats. I just had to take one! All the medical students and staff comment on my hat because our school is in a farming community. Everybody wants a John Deere hat because we think it is cool and our favorite teacher wears one too!

So you see, it is John Deere that is the worst of all the wicked capitalistic companies. They are giving away the most popular items in my medical school!

You want to blame someone who is manipultaing doctors at my school? Forget about Astra Zeneca and Pfizer. They are nothing, sure they are giving out cheesburger and cheestakes and we eat them. But they don't advertise their company like the way John Deere does with the cool hats. Don't get me wrong, a Pfizer cheeseburger is very nutrious - but not as publicly and commerically swaying as a John Deere hat at our school.

 

[3dtp]

He's actually a pretty nice guy and is putting his time behind what he believes in. Can you say you put your time into a cause that you believe in? Also, I'm not sure why you are trying to act like a super-sleuth. You want a cookie because you can find out who registered a site?! I think my 2 year old can probably do it too...and she wouldn't act like she was something special for having done it. Bob's a nice guy and doesn't hide his name at all. Sending him an email gets a rapid reply with his name in it, so he's certainly not hiding. Why don't you spend some of your free time trying to educate yourself about this issue instead of trying to pretend there is a controversy behind NoFreeLunch.

Obviously, there is controversy here. And yes I do put my time into several causes I very much beleive in. I disagree with this one. I do not like web sites with grandiose prophetic statements anonymously. Bob probably is a very nice guy. There's no indication on the site, which touts itself as the next ABMS equivalent certifying site who is paying for it and how it is funded, while soliciting people to sign up for its list Obviously it was easy to get this information or I wouldn't have spent the time getting it.

I have educated myself on this issue. I'm not convinced it's a big deal. People are either buyable or they're not.

Frankly, I'd rather see a drug rep detailing his product to me, in my office where I can grill them on the studies or at a dinner meeting watching their paid speakers tout the drugs they are pushing and ask how come 78% according to the [Pick one] study could not tolerate the full course? We in the field have been educated and trained to separate the wheat from the chaff. The general public has not. There's a big difference.

I'd much rather them give me the drug samples for the indigent community and spend their money on dog and pony shows that we can all see through than to see them advertise ED on Superbowl Sunday at millions of dollars a minute to the viewing public, only to have my office swamped with hundreds of people looking for their advertised ED drug of choice the following Monday. Then I have to spend office visits telling my unstable angina patient why ED drugs are not a good idea despite what the commercial with the football flying through the tire tells them.

Like it or not, we live in a capitalistic society and sales and marketing are designed to make people aware of the products and services we need and use. A side product of that is to generate a perceived need for a product to create a market. On this we must remain vigilent. And we are not and that, my friend is a far greater problem. Marketing money will surely be spent on something. The profits from sales will enrich the executives and the shareholders who, hopefully will reinvest and we will all be better for it.

It is the height of folly to suggest that stupid prescribing practices will end if physicians are denied direct information from the competing drug companies. I don't have time to take a deep sea fishing trip. Now, where did I leave my John Deere Hat? Ahh, its over there on my Simplicity Tractor.

TANSTAAFL.

 

[3dtp]

Cats, You ELCA or LCMS?

 

[dksamp]

Ok…I know I am SOOOOOO on the LATE BOAT with my response. Been very busy lately. I thought that this thread would die a natural death. However it just keeps coming back. So in the spirit of beating a dead horse, and LATE on top of that, I will respond to NOPDM’s response to me.
First people have been speculating who is exactly is this NOPDM guy. From his postings, he says he is a senior cardio fellow at Pitt. When I challenged him on his lack of real-world private practice experience to be making such a wild generalization about physicians and their practice patterns, he replied as follows:

“You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. “

This induced me to do a little detective work. Now I am TOTALLY GOING OUT ON A LIMB HERE AT RISK ON COMPLETELY FALLING ON MY ASS….And if I am wrong, and discussing the wrong person, then I will just apologize and shut up at this point before making a further fool of myself, however, IF I am NOT, read on….

To find out who this NOPDM is, I looked at the link provided to HIS powerpoint presentation:
http://www.pitt.edu/~jmf29/

That leads us to a senior card fellow at pitt with the initials J.M.F. Upon looking at the list of cards fellows, there is one who matches the initials JMF (one with a Greek surname). His listed background is as follows….

B.S. – 1992
PhD – 1998
MD - 2002
Now since I.M. is 3 years, that would have you finishing in 2005. Since Cards is 2 years, that would make you a senior right about now. Now I am no math genius, but I don’t see any significant time gap that would leave room for independent private clinical practice. Moonlighting as a resident is not private practice. Working under the auspices of a PhD is NOT private clinical practice. Therefore I can ‘assume’ that you have no private practice experience as a practicing physician YET.
Like I said, if I am talking about the wrong person, I will apologize and shut up and eat crow.

“Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts.”

Private clinical practice is NOT necessarily the be-all-and-end-all ultimate goal for everybody, however, it is where the MAJORITY of people leaving fellowships and residencies WIND UP. The majority do NOT wind up committed to academic medical centers. Private practice can take may forms:

-Group practice
-Solo practice
-Employed practice
-Hospital-based hospitalist practice (both hired and independent)
-Independent practitioner loosely affiliated with a university for teaching purposes (like myself)


“Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.”

I am not taking this personally, however, whenever I am subjected to left-wing-communistoid-AMSAesque drivel which is tamtamount to doctor-bashing, I WILL SPEAK OUT. I have ZERO guilt on my prescribing patterns, because I practice in the real world and not in the artificial bubble. I have already explained in the previous thread:

Where I practice is an urban area that is mostly managed care. The main driver for prescribing patters is the ALMIGHTY MANAGED CARE FORMULARY…I repeat the ALMIGHTY MANAGED CARE FORMULARY. Drugs are TIERED, and the goal is to keep most of the meds at tier 1, and if you have to write a brand, pick one that is on tier 2. Tier 3 are to be avoided unless absolutely necessary because of their high cost. IRRESPECTIVE of what a drug rep does/says, THEY ARE NOT THE CLINICIAN AND MOST HAVE NO CLINICAL TRAINING, despite what they are taught to parrot from their seminars.

Most recently, furthering the skew/shift in the prescribing patterns of docs in my area and in other areas too was an unexpected source……(drumroll……….)

WALMART!!!...Yes, that’s right you heard it….WALMART!!

Huh?? How can walmart exert any influence??

By the fact that they flat priced most of the common generics at $4.00, IRRESPECTIVE of whether you have insurance or not. So if you have an HMO and your tier 1 copay is 10.00, if you fill that generic at Walmart, YOU PAY $4.00
This makes a HUGE difference.

Here is their generics home page.

http://www.walmart.com/catalog/catalog.gsp?cat=546834&fromPageCatId=5431

Now Interaction with Pharm Reps IS important for the following reasons.

1-they give you a heads up on the newest things coming down the pike. Doesn't mean that you have to use/prescribe it.

2-they provide you with samples that help patients try something first (in those cases where the patient NEEDS a Brand) and you need to see if they react to the med well BEFORE paying that tier 2 copay on the med.

3-they provide valuable coupons and vouchers which can minimize and/or neutralize the cost to the patient in those cases where a brand is deemed necessary.

4-they provide the practitioner with information about programs that may benefit the patient. Remember, we are the patients advocate and as such should be aware of resources and programs out there that can benefit the patient. Just because something is sponsored by a pharm company, doesn’t make it inherently bad.

Now where I am at, I do NOT see many lunches sponsored by reps. That is more in the university setting, because in the private world, offices are too busy and the doc is not always available. It is just not practical. Me personally, I am VERY PICKY eater and I wouldn’t eat 90% of the stuff they bought anyway, so a sponsored lunch in my office would be COMPLETELY USELESS.

As for the dinners, they are of some use, because the dinners provide a venue for docs to get together who otherwise would NOT be getting together. You sit down, have a meal, chat and network. The “lecture” is there, and is usually a colleague known to the docs present or an outside speaker. Irrespective of what is said in the lecture, even though most of it is biased towards the drug, 90% of docs recognize that and go back to their usual prescribing patterns. Anybody who is THAT influenced is already weak-minded to begin with.

As for reps, I will gladly speak to them, especially if they are pretty ;-P. If I do not write their drug, I tell them upfront. If they never come back to my office, well, as we say in freemasonry…So Mote It Be. I gotta do right by the patient and keep their costs down. I guess I am a PISS-POOR R.O.I. (Return on Investment)

Remember, it does not benefit ANYONE by locking people out. You get places in life by INTERACTING with people. Remember, we are ALL adults. We are NOT kids who need to be told who we can talk to. For a university to legislate whom people can talk to is downright FASCIST. NOPDM (J.M.F.) if your moral compass is that fragile/insecure that you feel that interacting with certain groups of people will skew your prescribing pattern, then YOU’RE the one with the problem.

I know…I know…I DEREK SAMPSON SERIOUSLY NEED TO GET A LIFE!!...LOL…But hey, it’s Sunday, it is my day off, so in the spirit of tossing off a few hours of my free time, I decided to finally respond.

Now let this thread die a natural death…I will GLADLY cosign the D.N.R.
and NOPDM, if I misidentified you, then I truly apologize and will gladly accept egg on my face.

PEACE!!

-Derek Sampson, MD

 

[beetlerum]

Ok…I know I am SOOOOOO on the LATE BOAT with my response. Been very busy lately. I thought that this thread would die a natural death. However it just keeps coming back. So in the spirit of beating a dead horse, and LATE on top of that, I will respond to NOPDM’s response to me.
First people have been speculating who is exactly is this NOPDM guy. From his postings, he says he is a senior cardio fellow at Pitt. When I challenged him on his lack of real-world private practice experience to be making such a wild generalization about physicians and their practice patterns, he replied as follows:

“You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. “

This induced me to do a little detective work. Now I am TOTALLY GOING OUT ON A LIMB HERE AT RISK ON COMPLETELY FALLING ON MY ASS….And if I am wrong, and discussing the wrong person, then I will just apologize and shut up at this point before making a further fool of myself, however, IF I am NOT, read on….

To find out who this NOPDM is, I looked at the link provided to HIS powerpoint presentation:
http://www.pitt.edu/~jmf29/

That leads us to a senior card fellow at pitt with the initials J.M.F. Upon looking at the list of cards fellows, there is one who matches the initials JMF (one with a Greek surname). His listed background is as follows….

B.S. – 1992
PhD – 1998
MD - 2002
Now since I.M. is 3 years, that would have you finishing in 2005. Since Cards is 2 years, that would make you a senior right about now. Now I am no math genius, but I don’t see any significant time gap that would leave room for independent private clinical practice. Moonlighting as a resident is not private practice. Working under the auspices of a PhD is NOT private clinical practice. Therefore I can ‘assume’ that you have no private practice experience as a practicing physician YET.
Like I said, if I am talking about the wrong person, I will apologize and shut up and eat crow.

“Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts.”

Private clinical practice is NOT necessarily the be-all-and-end-all ultimate goal for everybody, however, it is where the MAJORITY of people leaving fellowships and residencies WIND UP. The majority do NOT wind up committed to academic medical centers. Private practice can take may forms:

-Group practice
-Solo practice
-Employed practice
-Hospital-based hospitalist practice (both hired and independent)
-Independent practitioner loosely affiliated with a university for teaching purposes (like myself)


“Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.”

I am not taking this personally, however, whenever I am subjected to left-wing-communistoid-AMSAesque drivel which is tamtamount to doctor-bashing, I WILL SPEAK OUT. I have ZERO guilt on my prescribing patterns, because I practice in the real world and not in the artificial bubble. I have already explained in the previous thread:

Where I practice is an urban area that is mostly managed care. The main driver for prescribing patters is the ALMIGHTY MANAGED CARE FORMULARY…I repeat the ALMIGHTY MANAGED CARE FORMULARY. Drugs are TIERED, and the goal is to keep most of the meds at tier 1, and if you have to write a brand, pick one that is on tier 2. Tier 3 are to be avoided unless absolutely necessary because of their high cost. IRRESPECTIVE of what a drug rep does/says, THEY ARE NOT THE CLINICIAN AND MOST HAVE NO CLINICAL TRAINING, despite what they are taught to parrot from their seminars.

Most recently, furthering the skew/shift in the prescribing patterns of docs in my area and in other areas too was an unexpected source……(drumroll……….)

WALMART!!!...Yes, that’s right you heard it….WALMART!!

Huh?? How can walmart exert any influence??

By the fact that they flat priced most of the common generics at $4.00, IRRESPECTIVE of whether you have insurance or not. So if you have an HMO and your tier 1 copay is 10.00, if you fill that generic at Walmart, YOU PAY $4.00
This makes a HUGE difference.

Here is their generics home page.

http://www.walmart.com/catalog/catalog.gsp?cat=546834&fromPageCatId=5431

Now Interaction with Pharm Reps IS important for the following reasons.

1-they give you a heads up on the newest things coming down the pike. Doesn't mean that you have to use/prescribe it.

2-they provide you with samples that help patients try something first (in those cases where the patient NEEDS a Brand) and you need to see if they react to the med well BEFORE paying that tier 2 copay on the med.

3-they provide valuable coupons and vouchers which can minimize and/or neutralize the cost to the patient in those cases where a brand is deemed necessary.

4-they provide the practitioner with information about programs that may benefit the patient. Remember, we are the patients advocate and as such should be aware of resources and programs out there that can benefit the patient. Just because something is sponsored by a pharm company, doesn’t make it inherently bad.

Now where I am at, I do NOT see many lunches sponsored by reps. That is more in the university setting, because in the private world, offices are too busy and the doc is not always available. It is just not practical. Me personally, I am VERY PICKY eater and I wouldn’t eat 90% of the stuff they bought anyway, so a sponsored lunch in my office would be COMPLETELY USELESS.

As for the dinners, they are of some use, because the dinners provide a venue for docs to get together who otherwise would NOT be getting together. You sit down, have a meal, chat and network. The “lecture” is there, and is usually a colleague known to the docs present or an outside speaker. Irrespective of what is said in the lecture, even though most of it is biased towards the drug, 90% of docs recognize that and go back to their usual prescribing patterns. Anybody who is THAT influenced is already weak-minded to begin with.

As for reps, I will gladly speak to them, especially if they are pretty ;-P. If I do not write their drug, I tell them upfront. If they never come back to my office, well, as we say in freemasonry…So Mote It Be. I gotta do right by the patient and keep their costs down. I guess I am a PISS-POOR R.O.I. (Return on Investment)

Remember, it does not benefit ANYONE by locking people out. You get places in life by INTERACTING with people. Remember, we are ALL adults. We are NOT kids who need to be told who we can talk to. For a university to legislate whom people can talk to is downright FASCIST. NOPDM (J.M.F.) if your moral compass is that fragile/insecure that you feel that interacting with certain groups of people will skew your prescribing pattern, then YOU’RE the one with the problem.

I know…I know…I DEREK SAMPSON SERIOUSLY NEED TO GET A LIFE!!...LOL…But hey, it’s Sunday, it is my day off, so in the spirit of tossing off a few hours of my free time, I decided to finally respond.

Now let this thread die a natural death…I will GLADLY cosign the D.N.R.
and NOPDM, if I misidentified you, then I truly apologize and will gladly accept egg on my face.

PEACE!!

-Derek Sampson, MD

To you and everyone else who thinks these gifts have no influence on decision making, please answer a simple question: why do the pharm companies spend millions and millions of dollars on these gifts (which they categorize as marketing in their budgets) if the gifts have no effect?

 

[Dr. V]

To you and everyone else who thinks these gifts have no influence on decision making, please answer a simple question: why do the pharm companies spend millions and millions of dollars on these gifts (which they categorize as marketing in their budgets) if the gifts have no effect?

Because it reminds us that IF we need that drug it IS available and it does make us aware of the touted differences as well as the legitimate differences to the old drugs when they give their presentations.

It also allows us to more easily say "no you don't need new and improved drug X just because you saw it on TV, here's why the cheaper, proven drug Y is still your best bet."

If an ink pen or a sandwich can persuade you to write a certian drug for a patient that gets no real benifit from it you have personal issues with honesty and integrity that have nothing to do with the drug rep.

 

[EctopicFetus]

let this stoopid thread die.. please

 

[beetlerum]

Because it reminds us that IF we need that drug it IS available and it does make us aware of the touted differences as well as the legitimate differences to the old drugs when they give their presentations.

It also allows us to more easily say "no you don't need new and improved drug X just because you saw it on TV, here's why the cheaper, proven drug Y is still your best bet."

If an ink pen or a sandwich can persuade you to write a certian drug for a patient that gets no real benifit from it you have personal issues with honesty and integrity that have nothing to do with the drug rep.

This doesn't make sense. They could provide all that information without the gifts. The question is why they provide the gifts, not why they market informationally to physicians.

 

[tibor75]

let this stoopid thread die.. please

yeah, a great way to let a thread die is to bring it back up saying "let it die"

Great logic.

 

[dksamp]

To you and everyone else who thinks these gifts have no influence on decision making, please answer a simple question: why do the pharm companies spend millions and millions of dollars on these gifts (which they categorize as marketing in their budgets) if the gifts have no effect?

Why?? because they CAN, and just because they CAN spend money, doesn't mean they have to do it in a logical manner. There is a LOT of marketing out there that doesn't make sense. Look at coke vs. pepsi. ZILLIONS are spent marketing coke and pepsi, yet people already have their preferences. (mine is diet pepsi), not because of a marketing ploy, but because I like the taste of pepsi better. Just because someone can market something doesn't mean it will be successfull. Let us examine some pharmaceutical marketing BOMBS shall we...

Tequin...HEAVILY marketed, but wound up getting pulled from the market because of too many adverse side effects. But the reps defended it to the death, and I GLOATED in the fact that I was telling them that the drug is no good ONE FRIGGIN YEAR prior to it getting pulled, yet I had no problem attending their dinners and eating their free food ;-)

VIOXX...nuff Said

Bidil...Heavily marketed to Blacks with CHF...ANOTHER BOMB that never caught on. I have YET to encounter a single Black patient on the medication

MOBIC...Heavily marketed, but RARELY USED...No evidence that it is superior to other NSAIDS or the generic PIROXICAM, and the copay is PROHIBITIVE.

Then there is the FLIP SIDE...drugs that SELL THEMSELVES and don't need the heavy marketing, yet they are heavily marketed (i.e. VIAGRA)...If they never made another single trinket with the Viagra logo on it ever again, people would STILL be asking for it in DROVES. And yet, they BLOW Millions of $$$ in marketing for a drug that SELLS ITSELF.

A company can spend ALL THE MONEY THEY WANT...doesn't mean it will work, NOR does it have to make sense. Also, keep in mind that all the marketing people were trained under the old school of thought that said VISUAL EXPOSURE = SALES. Thats why you see pens, and notepads, and computer mouses with viagra. Remember, we are in a FREE ENTERPRISE Capitalistic economy...THIS IS NOT CUBA...Companies can spend their marketing dollars AS THEY WISH, no matter how illogical it is.

Nuff said..I'm going to bed..

-Derek

 

[EctopicFetus]

yeah, a great way to let a thread die is to bring it back up saying "let it die"

Great logic.

Again.. die thread.. i only post when this is at or near the top (top 2-3 threads)..

 

[NoPDM]

1-they give you a heads up on the newest things coming down the pike. Doesn't mean that you have to use/prescribe it.

I realize they give you updates, but I think the goal is to limit face time, because it is that exposure which affects our behavior. Why can't they send informational fliers to us? Oh, that's right, because we'd just trash them in our busy days.

2-they provide you with samples that help patients try something first (in those cases where the patient NEEDS a Brand) and you need to see if they react to the med well BEFORE paying that tier 2 copay on the med.

I understand the individual benefit of using samples, but since you took the time to find the site I linked, hopefully you saw the negatives of samples. They may help an individual try a new drug for cost and/or side effect purposes and/or efficacy issues, the choice of drugs is far from perfect. They are usually only the latest and greatest as opposed to being alternative tried-and-trues. As you mention below, there are other models of free/cheap samples such as vouchers that can be pursued. A problem we have as docs is that patients feel good if they get something for free and like getting meds right away instead of having to go to the pharmacy. So, patients will also like the samples. It's an uphill fight, but I think the current sample system is in need of reform. Easy? Of course not. Worthwhile to consider? Yes.

3-they provide valuable coupons and vouchers which can minimize and/or neutralize the cost to the patient in those cases where a brand is deemed necessary.

This can/should be done without face time. The whole goal of the rep is to get face time with you. If you got something impersonal from the company (e.g. monthly or quarterly batch of coupons or vouchers), you wouldn't be as interested or motivated to talk to a rep.

4-they provide the practitioner with information about programs that may benefit the patient. Remember, we are the patients advocate and as such should be aware of resources and programs out there that can benefit the patient. Just because something is sponsored by a pharm company, doesn’t make it inherently bad.

I agree that pharm money isn't all bad, but I think the link from dollar to specific company raises concerns of influence. The idea of companies pooling their money, such as in funding derm residency slots, is slightly better, because you can't link an individual dollar to a company. So, have the pharm companies pool their money and then use that pool to fund educational processes. The patient would still benefit, but the company is less likely to do it because they don't get as good of a return on their dollar. Naive? Possibly, but pharma is already showing they are willing to pursue some models of pooling money, so why not others?

Now where I am at, I do NOT see many lunches sponsored by reps. That is more in the university setting, because in the private world, offices are too busy and the doc is not always available. It is just not practical. Me personally, I am VERY PICKY eater and I wouldn’t eat 90% of the stuff they bought anyway, so a sponsored lunch in my office would be COMPLETELY USELESS.

In the private setting where I work, it's not uncommon to see the lonely rep sitting, waiting for a glimpse of the doc. Often the staff will even wander by to visit. You're right in that it's not a good setting to get face time compared to academic setting, but they still do get some time, which is better than none.

As for the dinners, they are of some use, because the dinners provide a venue for docs to get together who otherwise would NOT be getting together. You sit down, have a meal, chat and network. The “lecture” is there, and is usually a colleague known to the docs present or an outside speaker. Irrespective of what is said in the lecture, even though most of it is biased towards the drug, 90% of docs recognize that and go back to their usual prescribing patterns. Anybody who is THAT influenced is already weak-minded to begin with.

See, this is the problem. Docs are a very smart bunch and think only the other guy is influenced. It's our arrogance that the pharm companies play off of. Why did congress just pass lobby reform legislation about free lunches? Because it's clear free things affect choices in our government and buys influence. Why on earth would the doctor's office be different? Because we're smarter? Now that's naive.

This doesn't make sense. They could provide all that information without the gifts. The question is why they provide the gifts, not why they market informationally to physicians.

Agreed. Gifts buy an obligatory moment for you to say "thank you", so then they have you for a moment to talk about what they want.

If an ink pen or a sandwich can persuade you to write a certian drug for a patient that gets no real benifit from it you have personal issues with honesty and integrity that have nothing to do with the drug rep.

It amazes me how often this comes up as a reply. I've been doing this long enough that this is one of the most common responses I hear. The studies I referenced in the talk have addressed this issue and suggest we are more often influenced than we realize. That's the whole point of why the companies interact with us. We aren't always aware of all the factors we use in making drug choice decisions.

Why?? because they CAN, and just because they CAN spend money, doesn't mean they have to do it in a logical manner. There is a LOT of marketing out there that doesn't make sense. Look at coke vs. pepsi. ZILLIONS are spent marketing coke and pepsi, yet people already have their preferences. (mine is diet pepsi), not because of a marketing ploy, but because I like the taste of pepsi better. Just because someone can market something doesn't mean it will be successfull.

A company can spend ALL THE MONEY THEY WANT...doesn't mean it will work, NOR does it have to make sense. Also, keep in mind that all the marketing people were trained under the old school of thought that said VISUAL EXPOSURE = SALES. Thats why you see pens, and notepads, and computer mouses with viagra. Remember, we are in a FREE ENTERPRISE Capitalistic economy...THIS IS NOT CUBA...Companies can spend their marketing dollars AS THEY WISH, no matter how illogical it is.

I agree that these massive companies can, and should, market their products through whatever means they can. They need to make money for themselves and for their shareholders, otherwise they will collapse. Point blank. The problem is that we as physicians are in a unique position. As you have already mentioned in prior posts, we are our patients' advocates. We're not just deciding which drink we want with lunch, we're deciding what pill our patients' will take. We're making decisions for those that place implicit trust in us and that trust comes with responsibility. Do I think that writing with a Coreg pen will suddenly have me switching from atenolol? Of course not, but I think it's important for us to discuss that there are consequences to our interacting with pharm reps and we need to be aware of them. It just seems too often that some docs don't want to consider the possible effects of these interactions.

 

[EctopicFetus]

I realize they give you updates, but I think the goal is to limit face time, because it is that exposure which affects our behavior. Why can't they send informational fliers to us? Oh, that's right, because we'd just trash them in our busy days.

We have been thru this and the studies you and others with your agenda cite are at best crappy. There havent been great studies done.

Gosh I hope I get a free lunch today. Also I do my best to only use pens given to me by pharma. After all since the hospital I work in doesnt provide free pens I feel I should use the pens given to me by pharma since they are free.

 

[8744]

This doesn't make sense. They could provide all that information without the gifts. The question is why they provide the gifts, not why they market informationally to physicians.

What gifts? I'm still waiting for all of the cool **** I was promised. Where's my trip to Cancun? All I got so far was bunch of crappy pens that I don't even use. And the only "flair" on my white coat is a Marine Corps emblem.

 

[NoPDM]

...the only "flair" on my white coat is a Marine Corps emblem.

At least you can wear something with pride on your coat that shows you put your money where your mouth is. All the rest of us get is our college alma mater's logo or a darn viagra pen. Congrats and thanks.

 

[Frijolero]

We have been thru this and the studies you and others with your agenda cite are at best crappy. There havent been great studies done.

Gosh I hope I get a free lunch today. Also I do my best to only use pens given to me by pharma. After all since the hospital I work in doesnt provide free pens I feel I should use the pens given to me by pharma since they are free.

Hey, at least he's posting something. Though I haven't read through the roughly half a million posts in this thread, I don't recall you posting any evidence debunking his claims. I think the data is convincing. Even if you don't, don't you think it makes sense to err on the side of caution? I'm malleable, show me some data that shows physicians or outcomes aren't influenced.