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“It just got very, very old and all of us felt that we were whores."
August 27, 2013 9:07 PM   Subscribe

More than half the population of small, rural Madras, Oregon (population: ~6059) and its surrounding community is served by one clinic: Madras Medical. At the beginning of 2006, the clinic's doctors and nurses decided to ban pharmaceutical reps from visiting their practice. No more free lunches. No more free drug samples. No more gifts. And yet.... "It's made us better doctors." (Via)

CJR: "Oregon doctors say no to drug companies"

Wikipedia: Madras, OR

ProPublica: Dollars for Doctors, which includes a search engine which will tell you if "Your Health Professional [Has] Received Drug Company Money."

The Sunshine Act
WSJ: "Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the [The Physician Payments Sunshine Act (Sunshine Act)] provision of the U.S. health-care overhaul. The companies must report data on individual doctors and how much they received to a federal health agency, which will post it on a searchable, public website beginning September 2014."

MSN Money: "'Sunshine Act' is making doctors nervous. The new law requires pharmaceutical companies to publicly disclose dollars they've given to physicians."

American Medical Association: Toolkit for Physician Financial Transparency Reports (Sunshine Act)

Policy and Medicine Blog: Physician Payment Sunshine Act: Final Rule Top 50 Things to Know

PharmExecBlog: "The Sunshine Act Makes for Gloomy Sales Reps"

MedCityNews: "Sunshine Act sheds light on how doctors interact with medical device, pharmaceutical industries, but there may be a dark side"
posted by zarq (40 comments total) 51 users marked this as a favorite

 
But, but, the MARKET!!~!@
posted by Trochanter at 9:11 PM on August 27, 2013 [2 favorites]


Love it. Love that they're taking a stand.
posted by entropone at 9:22 PM on August 27, 2013 [4 favorites]


I've said it before and I'll say it again....any health care system that is based on making money off of sick people will fail at it's purported mission - taking care of the sick - and succeed wildly at its principal mission - making money.

I'm so glad this bunch is taking what I'm sure was not an easy stand for them, and that it's getting attention. Great post, thanks for putting this together.
posted by nevercalm at 9:30 PM on August 27, 2013 [39 favorites]


Good for them, I love that it is resulting in better healthcare for their patients.
posted by arcticseal at 9:55 PM on August 27, 2013 [1 favorite]


I really believe this is an excellent idea, but it makes me wonder what the fallout will be.

The purpose of these companies is NOT to heal people because of their generosity, its to make money. Shit, I bet Pfizer would start pimping pop-up ads if that was more profitable than Viagra for them.

THEIR GOAL IS TO MAKE MONEY...its just a coincidence that the drugs heal. Seriously.

So how are these companies going to react to stuff like this:

I have known many pharmaceutical reps...nearly god damn every one of them was a fit, attractive, and flirty female. They hit up doctors and do their magic...and the company makes money because of the doctor's actions. But seriously, does someone who has a BS in chemistry, and graduated from med school in need of tutoring from a marketing major?

So you take that away...and take away the "medical conferences" in Turks and Caicos...and you just have doctors making decisions based on science. Well, industry won't stand for it.

As we sit here going "yeah man...this is awesome", the sales reps' bosses are getting together and trying to figure out a way to bypass this shit.

"How do we convince doctors that prescribing our shit would be better?"
"Can we just bribe the doctors?"
"Probably not...but lets keep brainstorming..."
"How about we hire them...as doctors...in our OWN hospitals."

Shit.
posted by hal_c_on at 9:57 PM on August 27, 2013 [2 favorites]


From the first article:
The drug firms buy prescribing information from health informatics companies who purchase de-identified records from pharmacies, then match each record with the doctor's prescriber number sold to them by the American Medical Association. In 2006, the AMA allowed doctors to opt out of the reporting and withhold most prescribing information from drug reps and their supervisors. But few do.

posted by mulligan at 10:17 PM on August 27, 2013 [5 favorites]


I have known many pharmaceutical reps...nearly god damn every one of them was a fit, attractive, and flirty female.

Right. And then they just show up and sit in the waiting room with the patients they want to exploit and wind up delaying someone's legitimate appointment.

My ex and I caught on to this years ago. She worked for an ad agency that did commercials for SKB and I was printing doublespeak brochures for Glaxo. Thousand yard stares, semi-inappropriate babbling sprinkled with their own talking points, and simulated facial tics would usually clear them out. I hope they had nightmares about the terror couple coming for them.

Try it. Bring a friend. It's kind of fun to make someone who does evil run away. And you get to see the marital therapist/shrink/doctor when you are supposed to.

Sorry, I'll shut up now.
posted by Mr. Yuck at 10:43 PM on August 27, 2013 [10 favorites]


I have known many pharmaceutical reps...nearly god damn every one of them was a fit, attractive, and flirty female.

Heh. In my circle, "pharmaceutical rep" is shorthand for a certain type of bland, unthreatening attractiveness.

A few years ago, one told me that the pharmas were phasing them out (perhaps in anticipation of new laws?) Doesn't look like this has happened.
posted by snickerdoodle at 11:16 PM on August 27, 2013 [1 favorite]


Fuckin' health informatics. What a phrase.
"Obamacare bureaucrats claimed the government’s EMR mandate would save money and modernize health care. As of December 2012, $4 billion had already gone out to 82,535 professionals and 1,474 hospitals; a total of $6 billion will be doled out by 2016. What have taxpayers and health-care consumers received in return from this boondoggle? After hyping the alleged benefits for nearly a decade, the RAND Corporation finally admitted in January that its cost-savings predictions of $81 billion a year — used repeatedly to support the Obama EMR mandate — were, um, grossly overstated.

"Question: If these subsidized data-sharing systems aren’t built to share data to improve health outcomes, why exactly are we subsidizing them? And what exactly are companies [...] doing with this enhanced power to consolidate and control Americans’ private health information?"
What a disaster.
posted by phaedon at 11:20 PM on August 27, 2013 [4 favorites]


I've said it before and I'll say it again....any health care system that is based on making money off of sick people will fail at it's purported mission - taking care of the sick - and succeed wildly at its principal mission - making money.

This is kind of wrong, though. The health care system is pretty good at its mission of taking care of the sick. It's also good at the other part of its mission: taking care of the healthy. Which probably reaps more benefits in the long run. Either way, it's still very good at making money.

THEIR GOAL IS TO MAKE MONEY...its just a coincidence that the drugs heal. Seriously.

Well, no. Coincidence it is not. Mostly because the goal is to make money.

But that's true for doctors, too. In my experience, doctors are just as good at working drug reps as drug reps are at working doctors. So for practices that still accept drug reps, it's an ongoing game. No need to put medical conferences in scare quotes. They are usually required as part of continuing education. And they are just as often in places like the Marriot conference room in Salt Lake City, than in Maui.

Some outfits like Southern California Kaiser ban reps altogether. They're a big enough operation to employ specialists who keep current on the latest and most effective pharmaceuticals, standardize the generics, and choose the best non generics in the formulary. This approach does minimize interaction from practitioners and pharma companies while the size allows for bargaining power. I suppose there's a small possibility that this kind of standardization can keep special cases from receiving the absolute best care, but I'm not sure if that works out to significant amount in real life.

Plenty drug reps are fit, attractive, and flirty females. There are also a whole lot of fit, attractive, and flirty males, too. (Though I'm not sure what difference it makes. Some primary care fields that do lots of prescribing seem to attract many female docs.) Overall, reps tended to skew young. The few that were in their 40s or beyond tended to be female and quite professional. And I can't imaging a doc allowing a drug rep elbowing in to take patient time. Again, because the doc's goal is to make money, too. Cutting into patient time would get a rep booted quick.
posted by 2N2222 at 11:27 PM on August 27, 2013 [1 favorite]


For a few months in 1996, I worked as a receptionist in a small psychiatric practice in a mid-sized town in the Midwest. I remember being stunned at the constant stream of drug reps into that office... which only had 2 prescribing psychiatrists. Lunches at least once a week, often times from the pricier chains (Red Lobster instead of Big Boys). A sample closet that could have medicated half the town. I think I still have a stack of Paxil notepads that I picked up at that time. It was a bracing lesson in how marketers made themselves seem indispensible to your average office.

zarq, thanks for posting this. I love how the Madras clinic doctors explained the fears and hesitations of those who resisted cutting off the drug reps, and how the communal lunch was actually one ritual the office really enjoyed.
posted by spamandkimchi at 11:38 PM on August 27, 2013


Thousand yard stares, semi-inappropriate babbling sprinkled with their own talking points, and simulated facial tics would usually clear them out.

If I were a doctor in one of those rep meetings, and the moment is just right, his would be my method:

1) Just listen at first, but with a kind of growing intensity in your manner as they talk. Go beyond 'rapt attention'. Display a series of facial expressions that indicate you've just had a "Eureka!" moment. Go to step 2.

2) If they are selling a pill, go to step 3. If not, go to step 4.

3) When there is a natural pause - ask about the pills. "What size? Why that shape? Why aren't there pills in the form of a cone? I have some 3-D models and drawings of cones here my kid made on his computer. I think I have them here. "(search office, go to the reception desk, wander through the examination rooms, then look out the front door, come back, and say I'm going home to get them, he'll be right back in about and hour) Enjoy a nice meal somewhere, and problem solved!

4) Even if the reps are there for something that is not a pill, insist on a pill form of whatever it is. Be offended a little by their disregard for the clear benefits of medication in pill form, cone or not. "Pills! Everything in pills!" Slowly change your voice to become like those classic 'old timers' from the films of the 40s, like Walter Brennan. State "the possibility of them being in the pockets of BigHypo, selling injectable meds, making new holes in you when you have 2 perfectly good holes already for taking medicine. Body's got enough holes as it is!" Continue this rant, which may or may not lead to crying on your part if necessary, until they leave.
posted by chambers at 11:40 PM on August 27, 2013 [10 favorites]


Having flashbacks of the Immodium AD umbrella my RN mom brought home from work once when I was a kid. It was green and white striped, and when it was folded up for storage you couldn't tell it had an embarrassing, poop-related logo printed on it. Woe betide the family member who grabbed the jaunty, green-and-white umbrella just in case of rain, without recalling its provenance. The one time I remember using it, without knowing in advance that it had a logo, was at a wedding. I don't know who was getting married, but man I hope it was at least someone my parents knew from the healthcare industry. Yikes.

I'm glad the logo-plastered knick-knacks are gone. Not only are we saving money and integrity in health care, we must be saving hundreds of preteens around the country from deadly embarrassment.
posted by vytae at 12:35 AM on August 28, 2013 [15 favorites]


its just a coincidence that the drugs heal. Seriously.

I know it's rather conspiracy-minded, but would any major pharmaceutical company EVER support research for a one-time cure for any condition that it sells an every-day-for-the-rest-of-your-life treatment for...


And I wonder how many "logo-plastered knick-knacks" Michelle Malkin received in exchange for the Obamacare hit job phaedon linked to. Oh wait, "doing Obamacare hit jobs" is in the job description for every Nat Review writer.
posted by oneswellfoop at 12:57 AM on August 28, 2013 [4 favorites]


I know it's rather conspiracy-minded, but would any major pharmaceutical company EVER support research for a one-time cure for any condition that it sells an every-day-for-the-rest-of-your-life treatment for...

I've heard this cited as the reason that there's no cure for HIV. It's certainly a reason why we need to have government and nonprofit medical research: there's certain treatments the market's just not good at producing.
posted by NoraReed at 1:18 AM on August 28, 2013 [2 favorites]


Oh wait, "doing Obamacare hit jobs" is in the job description for every Nat Review writer.

From personal experience, I am not at all a fan of the "health informatics" movement, and the supposed improved healthcare and efficiency it will bring to the people, but in all seriousness, you can take me out back and shoot me for linking to Michelle Malkin. That was a colossal, point-negating fuck-up on my part, and I'm not one to say that just to save face in a liberal forum.
posted by phaedon at 1:19 AM on August 28, 2013 [7 favorites]


One alternative is independent academic detailing--drug reviews that are not drug company funded that is presented to doctors so they have summaries of academic peer reviewed information about drug efficacy and safety.

One of my favourite stories of research for public good is Banting's patent for insulin. He believed in public access to drugs to ensure speedy use to cure people... so he sold the patent to insulin to the University of Toronto for $1 and the university made it possible for others to use the patent for non-commercial purposes.

From the U of T insulin archive I found this really fun and heartening newspaper clipping about the discovery of insulin: Business Men Rise and Cheer the Discovery of Insulin which goes on to say the men of business go on to loudly support public funding for his research. I wish I could see this headline from the Canadian Club meetings and business leaders of today.
posted by chapps at 1:30 AM on August 28, 2013 [4 favorites]


And I meant to say, my doctor told me he had banned drug reps from his office. Made me happy!
posted by chapps at 1:33 AM on August 28, 2013


I've heard this cited as the reason that there's no cure for HIV.

Hey, want to her OnE WiErD TrIcK for curing HiV? It was found by a West Virginia mom, but THEY don't want you to find out about it. Just click here!
posted by kaibutsu at 2:56 AM on August 28, 2013 [5 favorites]


Oh, yes. No more sample packs! Let the fucking patients pay for their drugs, by god. If they can't afford it, they don't deserve it!

Wait, what? Is everyone here so privileged they've never had to depend on sample packs? Are you also so ignorant/naive that you actually think most doctors have time to keep up with the literature? You don't want those nassstyyy drug reps informing your doctor that the prescriptions he writes are a couple decades out of date?

Oh, that's right. You've convicted all pharmaceutical companies as a group. You know they're evil! I mean really, free note pads? EVIL! They should have to steal them like everyone else, right?

Now explain how this is materially different from the crap wingnuts spout.
posted by Goofyy at 3:03 AM on August 28, 2013 [3 favorites]


Wait, what? Is everyone here so privileged they've never had to depend on sample packs?

No, not all of us. Some of us are privileged enough to live in countries where prescription drugs are subsidized, and where advertising prescription drugs directly to the public is illegal.

Amazing it works, I know.
posted by Jimbob at 3:22 AM on August 28, 2013 [18 favorites]


... the crap wingnuts spout.

Did we read the articles at all?
Because all of those straw-manned concerns, although they're very handsome in their little straw hats, are thoroughly addressed. Starting in the first paragraph of the first linked article.

Apologies if that sarcasm was satirical, my meter for that might be miscalibrated this morning.
posted by hap_hazard at 3:24 AM on August 28, 2013 [3 favorites]


Would that be that nice non-biased article describing how the drugs are "pushed"? Pardon me if I don't continue reading after encountering such heavy bias. Also, I read the thread, and the thread is what I was addressing. So there is that. So, you have anything material to add, or just attitude?

Most doctors don't keep up with the literature. Sad, but true. For many, they simply don't have time. It's a trade-off between patients, keeping up, and their own lives and families. Difficult.

I shouldn't have to point out that blanket convictions by class are what we call "prejudiced". I know, it's fashionable when it comes to drug companies, but fashion does not confer validity.
posted by Goofyy at 3:30 AM on August 28, 2013


Well, yeah, since you ask what I meant is that the article repeatedly quotes the doctors to the effect that the samples were unnecessary for their patients. LIke
For a while, it was a stalemate as the practitioners debated what to do. In 2004, however, they hired another physician, Dr. Gary Plant, shifting the balance of the internal politics. Plant was accustomed to choosing generics over brand-name drugs and was bothered by the notion that patients were being prescribed drugs that were not better, just more expensive.

They offered reps a compromise. They would listen to the sales pitch if the reps would give them the money they would normally spend on lunches and promotional materials so they could help low-income patients buy generic drugs.

“Don't buy us lunch; give us $100 and we'll buy 25 people a month's worth of their blood-pressure pills," Plant said.
...
“Of course, that went over like a lead balloon," Lieuallen said.
and, here quoting a drug-company-rep-turned-physician
Samples are primarily given to promote the use of the more expensive, brand-name drugs, which in the end may be no more effective than lower-cost generics. But studies show that once a patient is started on a medication with a free sample, he is rarely switched to a lower-cost alternative.

“It's not really charity, or that we're giving out drugs because we're nice people," Ahari said. “Once you're on it and you establish a therapeutic effect, most doctors will be reluctant to switch you to an equally effective but cheaper generic."

Studies have also shown that most samples don't end up in the hands of the most needy patients anyway. They're more likely to end up in the hands of higher-income, insured patients, or taken home by staff for their own family.

“There are some physicians who manage to get samples for their poor patients, but they're the exception, not the rule," Ahari said. “And if the drug rep generally speaking isn't getting something out of it, you'll see your supply dry up."

then
Samples tend to be the most expensive drugs, new drugs that companies are trying to establish, or drugs that are vying for market share after another drug has left the market. In 2002, for example, the most widely distributed sample was Vioxx.[which as detailed in the article turned out to be not so awesome if you're trying to avoid having heart attacks for no good reason]

“Truthfully, the pharmacy reps don't leave anything that's useful to our patients," said Judy Carroll, a nurse at Madras Medical. “It's the expensive stuff that no one in this area can afford."
furthermore
As long as the doctors had a sample closet, they could convince themselves they were helping patients by giving them free medications. Removal of the sample closet, they said, forced them to prescribe more based on cost and efficacy, eliminating their irrational prescribing patterns.

For example, patients might come in with a garden-variety infection needing antibiotic therapy. If they couldn't afford it, doctors wouldn't have any first-line antibiotics to give them. The samples invariably were for newer broad-spectrum antibiotics best reserved for treating difficult, drug-resistant cases.

“When you're getting it out of the sample closet," Lieuallen said, “what you've got is the latest gorillacillin."
So there's that too.

Point being, the whole damned *point* of the article is that these doctors decided that no, it *wasn't* helping them help their patients. Which you can certainly disagree with, but I don't think you can claim that nobody's thought of your objections to the concept.
posted by hap_hazard at 3:42 AM on August 28, 2013 [27 favorites]


No Free Lunch
posted by cenoxo at 4:14 AM on August 28, 2013 [2 favorites]


Wait, what? Is everyone here so privileged they've never had to depend on sample packs?

Even when I was living on ramen and fifteen cent macaroni and cheese, none of the doctors I visited would give me samples. I didn't have any idea until now there was such a thing as a sample closet.
posted by winna at 4:46 AM on August 28, 2013 [2 favorites]


The drug firms buy prescribing information from health informatics companies who purchase de-identified records from pharmacies, then match each record with the doctor's prescriber number sold to them by the American Medical Association. In 2006, the AMA allowed doctors to opt out of the reporting and withhold most prescribing information from drug reps and their supervisors. But few do.
I might not be able to convince my doctors to ban reps, but I can talk to them about opting out of reporting, dadgumit.
posted by tilde at 5:29 AM on August 28, 2013 [2 favorites]


We live in a world where Wal-Mart is essentially handing out generics for $4 for a 30 day supply to people WITHOUT INSURANCE. To top it off, I can think of a dozen pharmacies with in a 25 mile radius of myself that do nothing but get necessary meds into the hands of people who can't afford them.

I'd be willing to wager large sums of borrowed money that if you cross referenced the meds that these organizations are giving out... and the meds that pharm reps are handing out... that they are not the same meds.
posted by Blue_Villain at 6:11 AM on August 28, 2013 [3 favorites]


I shouldn't have to point out that blanket convictions by class are what we call "prejudiced".

Speaking of privilege, it must be nice to shovel that shit our way from Switzerland. This article is about America, where everyone tries to fuck you six ways from Sunday. When you cast the gimlet eye at someone who has proven themselves time and again to be untrustworthy, it's not "prejudiced," it's "not being a gullible dumbass".
posted by Steely-eyed Missile Man at 6:31 AM on August 28, 2013 [1 favorite]


This kind of marketing is a problem in OB-GYN practices and maternity wards, where doctors and midwives are wooed by the formula companies. My doctor's office is covered in formula paraphanialia. Pregnant and new moms are given free samples and coupons for formula, even if they intend to breastfeed. Research shows that moms who receive these samples breastfeed for less time than moms who don't, and they introduce solids sooner. The WHO code for marketing breast milk substitutes forbids these giveaways, but the US is one of only 6 nations who have taken no action to enforce the code. Hospitals designated as "baby friendly" have voluntarily done away with the free formula packets.
posted by Biblio at 7:06 AM on August 28, 2013 [4 favorites]


I shouldn't have to point out that blanket convictions by class are what we call "prejudiced".

In other news, you are a bad and prejudiced person if you think Klansmen are racist.
posted by ROU_Xenophobe at 7:16 AM on August 28, 2013


Biblio: "My doctor's office is covered in formula paraphanialia."

From my perspective, those samples were a godsend. Specialized powdered formula for my twins ran about $50 for a large can from our local "big box" store, which it lasted about a week. Our pediatrician was able to give us some free sample cases during the kids' switch to formula at the 4 month mark, and it saved us a ton of money and stress.

When the pressure from pharmas causes doctors to give bad medical advice to their patients (or pressures them into not doing what's best for their patients,) that's terrible and should absolutely be stopped. But not every mother can breastfeed. Not every mother can keep up with demand. And when my kids' needed them and the samples were available I was quite grateful.
posted by zarq at 7:29 AM on August 28, 2013 [4 favorites]


I wish some things would really sane up in the prescription drug field. For example, Humira, which is a TNF inhibitor, is prescribed to treat Crohn's disease, typically for patients who do not respond to other treatments. Humira is an injection drug and can cost the patient upwards of $800//month and creates a decent volume of hazardous waste. LD Naltrexone, which comes in pill form, taken nightly, has been shown to be at least as effective and costs around $32/mo in high dose form, probably slightly less in LD. It is, however, a cheap off-label alternative and can't won't be used. Hell, even Thalidomide could be used for appropriate patients as it is also an effect TNF-α inhibitor. Won't happen, though. No money in it.

How do I know this? I have a friend who was a doctor at an emergency clinic and was treating a number of patients who had become addicted to pain killers (opiods) because they couldn't afford the medication to treat their Crohn's disease, but they could afford the pain killers to treat the pain that comes from untreated Crohn's disease. She treated the addition with Naltrexone and the patients reported that they went into remission, which turns out to be a known thing, but can't be prescribed by a GI.

Wait - hold on- the system does work: you have a disease that is treated by a medicine you can't afford, but you can afford something palliative that causes undesirable side-effects so that you can be prescribed the medicine to treat the palliative drug's side effects, which in turn has a side-effect that treats your disease in an affordable way!
posted by plinth at 7:51 AM on August 28, 2013 [4 favorites]


which turns out to be a known thing, but can't be prescribed by a GI.

Naltrexone is unscheduled, and it could be prescribed off-label by a GI for Crohn's if, in the doctor's professional judgment, it would be safe and effective. Even if it were a controlled substance, plenty of GIs have DEA numbers.
posted by jedicus at 9:11 AM on August 28, 2013 [1 favorite]


From my perspective, those samples were a godsend.

Agreed. I'm freelance so don't have a drug plan and my Doctor "goes to the cupboard" when he can and gives me boxes and boxes (because the samples are so small) of what I need a prescription for. He did see a former girlfriend of mine marking papers in the waiting room (she is a teacher) and did not go to the cupboard for her since she had a plan.
posted by juiceCake at 10:06 AM on August 28, 2013 [1 favorite]


I completed residency two months ago and left a program which did not allow drug reps to visit, give samples, etc.

My current practice does. I am a specialist, so we don't have the huge influx of reps that primary care offices have, but we do see our fair share of drug reps bringing samples of [new nasal spray of the moment] and [tried and true yet expensive ear drop].

I also see a lot of medicaid and self-pay patients who can't afford even some generic drugs. I tolerate the reps for five minutes once or twice a week because they bring samples that I can provide to that patient base. I honestly don't feel like they influence my medical decision making because I pretty much use generic drugs unless that drug would just completely not work, in which case I do a quick, informal cost/benefit analysis and pick the cheapest and most effective brand-name drug.

The golf trips to Cozumel are a thing of the past and Hooray for that! But I hope they still keep bringing the samples until the folks at the low end of the socioeconomic chain start getting help from another source.

(This was typed on a keyboard with a Viagra sticker on it. I have no idea where it came from. We are an ear, nose, and throat clinic.)
posted by robstercraw at 12:14 PM on August 28, 2013 [3 favorites]


I honestly don't feel like they influence my medical decision making

In study after study of this kind of thing, doctors say "drug marketing doesn't affect my prescribing habits" but then they say "drug marketing does affect the prescribing habits of other doctors." Funny how that works.

I'm not saying you in particular are being influenced, just that the empirical evidence suggests that doctors (like everyone else) maybe aren't so great at judging how much their own behavior is affected by marketing.
posted by jedicus at 1:21 PM on August 28, 2013


David V. Evans, who once practiced at Madras Medical Group, is now an assistant professor of family medicine at the University of Washington. He and his colleagues at the Oregon State University College of Pharmacy and at University of Oregon Health & Sciences University analyzed the clinic and published a paper this past May in the Journal of The American Board of Family Medicine: Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation The full paper is available to read, not just the abstract.

SocialCapitalReview has a breakdown:
"First, Madras Medical staff collected data on the extent of detailers’ presence. They found that over a six-month period detailers visited the clinic 199 times, or an average of just more than 33 times monthly, and sponsored 23 in-clinic lunches over a nine-month stretch.

Staff also found that for 46 drugs identified in the sample cabinet, “reasonable less expensive alternatives could be found for 38″ saving “the ultimate payer $70 per therapy per month.”

In interviews with the clinic’s staff, researchers found they enjoyed getting coffee mugs, pens and pads from the pharma detailers and brought the items home: that they also used the contents of the drug sample cabinet themselves; and enjoyed the pharma-sponsored lunches with work colleagues.

The two provider “champions” of reform within the practice presented during staff meetings peer-reviewed articles on the effects of pharmaceutical marketing on prescribing practices, patient safety and drug costs, and also initiated talks on the “the ethics of gifting.” As a result the doctors and staff agreed to initiate a “pharma-free policy.”

The practice covered the cost of monthly staff lunches instead of relying on pharma sales personnel to do so, and also found objective educational materials to shape discussion of new and old drugs, at monthly educational meetings. All branded office supplies from pharma firms was disposed of and replaced, at a cost of less than $200.

Evans and co-authors write that less than one quarter of the 800,000 U.S. doctors work in academic medical settings, where policies restricting the influence of Big Pharma marketing are more likely to have been adopted. So it’s especially important, they maintain, that smaller and independent medical practices be able and willing to consider taking the kinds of steps demonstrated by Madras Medical.

posted by zarq at 1:35 PM on August 28, 2013


Reliance on free samples is completely understandable... but it is not a solution.

Many times, as mentioned, the samples serve to get you started on the most expensive and newest drug, rather than the cheaper and just as good previous version or even generic. For some people they have long term uses where they go through a cycle up to more expensive drugs, but for most generics are good.

And I agree, doctors can't always keep up. This is why I think we need to fund independent drug detailers to give non-advertising information to doctors.

The solution is really inclusion of medicines into a public system (and before you say, "Fine, person from Canada" you should know that Canada is the only developed nation with a national health program that does not include prescription drug formularies in the public plans -- except of course in Quebec but then plus ca change...).

Also, can I recommend pill splitting ... In US and Canada (not UK I think) pills are cheaper per mg if you buy larger pills... so splitting larger pills can save you money.

And if you are in BC, check out this price comparison tool "Pharmacy Compass" to find the cheapest drug near where you are right now (thanks blue cross, you non-profit union founded health insurer you!). A big cost to prescriptions is dispensing fees... and costco sells drugs as a loss leader... NOw I will also say that nothing beats a pharmacist who is an ongoing part of your team for ongoing concerns but where cost is #1 issue, this is great.
posted by chapps at 3:32 PM on August 28, 2013


I've been handed the free samples. I was freshly divorced and my insurance didn't cover much, and I was getting antibiotics for regular sinus infections. (Eventually solved by moving somewhere drier.) My experience was that the samples were helping middle-class me stay more middle-class, which is nice, but I don't mistake it for helping poor people.

What I really wonder about is the drug reps and home health care for the elderly, particularly those who can't get out like folks in nursing homes. I'd love to see some work correlating drug rep visits with ProPublica's Prescriber Checkup. That could get you some really interesting data.
posted by immlass at 8:42 AM on August 29, 2013


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