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Who Is Paying Your Doctor?
January 12, 2011 10:04 AM   Subscribe

As a result of legal settlements, 7 of the major drug companies, representing a little over 1/3 of the prescription drug market in the US, are publishing their direct payments to physicians and other medical professionals. All payments are supposed to be published by 2013. Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?
posted by COD (87 comments total) 17 users marked this as a favorite

 
In Soviet Russia, drugs take . . . oh, screw it. No, I am not bothered because I get those drugs for free through my drinking water.
posted by quadog at 10:12 AM on January 12, 2011 [1 favorite]


Do they publish their direct-to-consumer advertising budgets anywhere? I'm more concerned about that.
posted by Riki tiki at 10:14 AM on January 12, 2011 [4 favorites]


Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?
They should have published this information through Wikileaks, since I'm guessing most everyone already knew about this cozy little arrangement in the pharmaceutical industry.
posted by hincandenza at 10:15 AM on January 12, 2011


How is this not considered a huge ethical breach on the part of the doctors? I guess I'm a little naive but I thought their job was to treat illness, not push drugs.
posted by mullingitover at 10:18 AM on January 12, 2011


If only the medical profession had some kind of governing association that put quality of patients' care ahead of monetary conflicts of interest.
posted by rocket88 at 10:23 AM on January 12, 2011 [2 favorites]


My doctor told me he does not do that becAuse he makes more selling illegal drugs to people that have a strong need for them. He says that is helpin in a special way since so many dealers get locked up and are unable to help those in need.
posted by Postroad at 10:26 AM on January 12, 2011 [3 favorites]


It's a big gray area ethically. Suppose Doctor Smith revolutionizes the treatment of Disease X with Drug Y. The pharma company paying him to fly around the country doing seminars teaching other doctors how to do the same thing with Drug Y could very well be a net benefit to society. No ethical problem there at all.

However, if Doctor Smith starts using Drug Y more because the Pharma Co is paying him to fly around the county doing seminars, and Doc Smith doesn't really have any medical reason to prescribe Drug X over the cheaper Drug Z, well then we have a problem.

Of course, distinguishing between the two scenarios in the real world is going to border on impossible.
posted by COD at 10:26 AM on January 12, 2011 [6 favorites]


Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?

Isn't that why god invented second opinions ?
posted by Pogo_Fuzzybutt at 10:26 AM on January 12, 2011 [1 favorite]


If only the medical profession had some kind of governing association that put quality of patients' care ahead of monetary conflicts of interest.

The AMA is a pretty weak organization in many ways, actually. A significant number (maybe even a majority?) of doctors aren't members. It's not responsible for licensing doctors (that would be the state medical boards) or specialty certification (that's the ABMS). It's only indirectly responsible for accrediting medical schools (that's the job of the LCME, which is co-sponsored by the AMA).
posted by jedicus at 10:27 AM on January 12, 2011 [2 favorites]


mullingitover: "How is this not considered a huge ethical breach on the part of the doctors? I guess I'm a little naive but I thought their job was to treat illness, not push drugs."

It's not considered an ethical breach because they hide it so well (at least from me). I used to do IT work for a pharma company and specifically on their speaker bureau. I used to help the doctors set up their slide shows and PowerPoint presentations. The presentations were presented in a very clinical, unbiased fashion from what I could tell. They never implicitly said "so in conclusion, we feel that Fuckofficin is the greatest advancement in antidepressant medication...." but since they represented our company, well... you know. I always thought is was a murky, slippery slope that they were cavorting on.
posted by KevinSkomsvold at 10:30 AM on January 12, 2011 [1 favorite]


Interesting thing about this kind of stuff. When doctors are surveyed about drug company advertising, paid seminars, etc, they usually say that they don't believe that it influences their own decision making–but it totally influences their colleagues' decision making. Basically "I'm okay, it's those other chuckleheads who can't be trusted."

No Free Lunch is a group that opposes this kind of thing.
posted by jedicus at 10:33 AM on January 12, 2011 [3 favorites]


After reading the completely laudatory New Yorker article about Celebrex, I begged my nurse practitioner to prescribe it for my arthritic shoulder.

Not only was my NP skeptical, but NP's did not have the clearance to write prescriptions for that drug, then. Which was one of the luckiest things that have ever happened to me.
posted by Danf at 10:33 AM on January 12, 2011 [2 favorites]


Isn't that why god invented second opinions ?

Until God invents a public health care option in the US along with strict rules that allow people to take paid time off for as many doctor visits as they need, second opinions are a luxury for those of us who can set our own hours and have a small co-pay.
posted by spicynuts at 10:38 AM on January 12, 2011 [11 favorites]


Isn't that why god invented second opinions ?

So the free market solution is that we all double our health care consumption to account for the lack of transparency in the market?

You aren't a Republican congressman, are you? ;)
posted by COD at 10:41 AM on January 12, 2011 [7 favorites]


I had a friend who worked for a major pharmaceutical. Gorgeous former college cheerleader with a degree in marketing, which she said was pretty standard issue for a sales rep in her company. She made a ridiculous amount of money for being fresh out of college: they paid for her apartment, car, gas, and any meals since she traveled to each office to make her sales pitch. On top of this she was making at least 60k from what I could get her to admit to, and probably more than that.

Her day basically involved going to a doctor's office, carrying free samples of drugs and pens and mugs and all of that marketing stuff. If it was a new client she would make her pitch about the effectiveness of her company's products, usage, and of course all of the benefits of carrying their drug lines. Not only did you get kickbacks, but they also had "clinics" in exotic caribbean locations where they would get together ostensibly to discuss how to better treat their patients. With the participation their personal company sales rep, of course.

From the pictures, it mostly looked like hanging out drinking on the beach.

Now, if she was already selling to a particular doctor, which was usually the case, she was armed with a database of information. And let me tell you the level and depth of information was astounding. She had year-to-year comparisons on everything, for every drug, including how many prescriptions were current, how many new scripts were written, and her market share was compared to her other reps in her area. It even had a little task area for her goals for the monthly sales prizes, which one month was a $10,000 check.

The most disturbing moment is when I pointed to the number of ended prescriptions.

"Does this mean they switched to another drug, or aren't patients anymore?"

"Maybe."

"I guess they don't tell you if a patient is better or if they found a better treatment?"

"It doesn't show us. They could be dead for all I know, but that's not important. What is important is that my numbers go up, and not down."
posted by notion at 10:45 AM on January 12, 2011 [17 favorites]


My doc always has a copious amount of free samples to give us (in lieu of actually writing a script) whenever one of us needs a short dose of meds. Especially the expensive meds with no generic equivalent. I mean, the guy fills a paper bag with the freebies. So, I guess it wouldn't surprise me if he was getting some cash back from the pharmas.
posted by Thorzdad at 10:59 AM on January 12, 2011 [1 favorite]


My mother is a nurse. I remember way back in the day when I was a young kiddo, probably in the early nineties, some drug company held an event where they practically rented a theme park (Carowinds) gave us free breakfast, lunch and dinner and one hundred dollars each to go wild with in the park. The only cost was that my mother had to go to a short workshop/presentation about the diabetes drug that that company sold. I played lazertag.
posted by fuq at 11:01 AM on January 12, 2011 [1 favorite]


How can this possibly be news to anyone who's been to a doctor in the last thirty years? Between the aggressive marketing of "miracle" cures for "dubious" ailments directly to impressionable patients, to the trade-show-schmoogies scattered all over doctors' offices, I can't believe there are people to whom the idea never occurred that the pharmas were providing cash incentives to those in position to write a scrip...
posted by OneMonkeysUncle at 11:05 AM on January 12, 2011 [1 favorite]


The fact they are doing it is not news. The list of names is though.
posted by COD at 11:11 AM on January 12, 2011 [2 favorites]


"It doesn't show us. They could be dead for all I know, but that's not important. What is important is that my numbers go up, and not down."

If she cared about that kind of thing, she would have gone into the health professions and not the sales profession. Plus, adverse events are reported to the FDA. She's just a cog and necessarily has to focus on her numbers because it's her bread and butter.

I can see how healthcare professionals can start becoming apathetic. Even the most wonderful and caring doctors/nurses have to fight feeling drained and burned out. I think a lot of people in the health/helping professions need some assistance in dealing with compassion fatigue and that, hopefully, in turn, would help with recommitting to helping their patients to the best of their ability. I can see how easy it could get to be cynical when people are openly disrespectful to you. You don't end up with great financial gain because you end up inevitably mixing with people who seem to work less and achieve greater financial gains. And I say "seem to" because when you're you and assessing how hard/easy other people have it, you can't make a real accurate judgment.

I can see easily how a doc might be like, "What the hell, why not? Free trip." I'd probably do it for for free booze and the chance to pet a dolphin. Hell, if I was a doc and they brought me a basket of puppies to pet and play with, I'd do it, especially if I didn't know how one prescription worked better or worse than another for a particular patient (and they don't have a way of figuring it out sometimes, like with birth control. I took a bc pill that was low dose and suffered nonstop heavy bleeding for months. It was horrible. And the doc was surprised because it was a very low dose of hormones.)
posted by anniecat at 11:14 AM on January 12, 2011 [1 favorite]


Am I wrong in thinking that nearly every profession makes recommendations of products, and that the use of payoffs, cash, gifts, trips, isn't used to promote this?

Hell, our government is run this way....

I'm not saying it's right, I'm saying that anyone that doesn't consider this as they run their life is probably an example of Darwin's theory at work...
posted by HuronBob at 11:15 AM on January 12, 2011 [1 favorite]


Surprised to not see my midwife on there. With the way that she tried to push the $50 per month Extra! Special! prenatal vitamins and then when I was anemic, the $50 per month Extra! Special! iron supplements I would have thought that drug companies were holding her puppies hostage.

We actually had a yelling argument when I refused to leave until she wrote a prescription for generics.
posted by gaspode at 11:20 AM on January 12, 2011 [1 favorite]


I'm really surprised these companies are only 34% of the market.
posted by smackfu at 11:20 AM on January 12, 2011


my doctor isnt in that list; but that's why his clinic is the deviation and not the norm :\
posted by liza at 11:21 AM on January 12, 2011


Also, the numbers they have are not really that high, compared to how much doctors make. Is $2000 really selling out?
posted by smackfu at 11:22 AM on January 12, 2011 [1 favorite]


My doc always has a copious amount of free samples to give us (in lieu of actually writing a script) whenever one of us needs a short dose of meds. Especially the expensive meds with no generic equivalent. I mean, the guy fills a paper bag with the freebies. So, I guess it wouldn't surprise me if he was getting some cash back from the pharmas.

Mine too. I'd get a big bag of medicine that would last months. Usually enough time to last to the next appointment. I don't know if she was sticking it to the man, but I'll take the free meds.
posted by birdherder at 11:23 AM on January 12, 2011


Is $2000 really selling out?

I think you'd be surprised at what people will do for a little extra money. And remember, a lot of times there are perks that go along with the cash: paid for trips to conferences or seminars, dinners, etc. It's a truism that everyone has their price. The really surprising thing is just how low that price is in many cases.
posted by jedicus at 11:25 AM on January 12, 2011 [1 favorite]


I found this database via a local news story about the doctors in the community that are in the dB. The number 1 guy is an endocrinologist that my wife saw for 2 years. Or more accurately, she went to his office every 3-4 months for about 2 years. She never actually saw the doctor. She only saw his PA. The PA was good, however the doctor made some medical decisions based only on seeing her charts that made us uncomfortable. How can a doctor legitimately run a practice and not interact with his patients?

He was on the list of $35K in 2009. I think we know why he was so inaccessible now.
posted by COD at 11:32 AM on January 12, 2011 [1 favorite]


I worked in pharma for a short time.

My impression always was that the company genuinely believed that their product was superior, and that marketing efforts were focused on getting doctors' eyes on case studies and reports that said as much. (They were also rather scared of doctors prescribing drugs to patients who were at high risk for side effects -- lawsuits are expensive -- so a lot of the doctor education focused on that.)

A lot of this focuses on the fact that many doctors can't be bothered to learn about new developments on their own, forcing pharma companies to spoon feed it to them. Of course, there's the escalation aspect too -- the companies are in competition trying to one-up the other.

I'm not sure that Big Pharma would be terribly disappointed if the government outlawed these marketing practices, as they'd all remain on a level playing field, and this sort of marketing isn't exactly cheap.

Also, take a peek at recent financials for the pharmaceutical industry. It's not very profitable at the moment, and even when it was, they couldn't even touch the Financial sector in terms of profits and lavish salaries. Researching, testing, and marketing drugs is insanely expensive; not all of them even make it to market; and drug patents only last 8-12 years, depending on how long the testing process takes (the patent is valid from the date of filing, not from the date of first sale).

Basically, my point is that lots of people are to blame for the current clusterfuck in the industry. If anything, the actions of the corporations themselves can quite easily be explained by natural market forces and a lack of trade regulation. They're basically forced to work this way.
posted by schmod at 11:32 AM on January 12, 2011 [1 favorite]


Wow, even the doctor I see (without insurance) in this tiny Eastern WA town is on that list. Amazing. Now I want to know what the speaking engagements he did on behalf of the drug company were about.
posted by hippybear at 11:34 AM on January 12, 2011 [1 favorite]


It's not just doctors that they're paying cash too--check out this registry (PDF) of all the grants that Eli Lilly gives to different organizations. And at least historically, they've donated large sums of money to the American Medical Association, so the idea that the AMA has the credibility and independence to really deal with this issue is questionable.

So, really, you have to wonder, not just who is paying your doctor, but who is your doctor working for? Whose interests is he or she really looking out for?

Big Pharma has also paid researchers to attach their names to articles and books written by the pharmaceutical companies. And all this is just what they've gotten caught doing.

Here's a quote that sums up a lot of how I feel about this:
As commercial interests gain an increasing role in determining our “medical knowledge,” it is important to understand that the fundamental reason that companies help create and distribute this information is to promote their products and improve their corporate bottom lines. Our health is relegated to, at best, a secondary consideration. We need to question whether doctors should be given financial incentives to follow clinical practice guidelines, as some now are, when those guidelines may be based on incomplete or biased research...

The commercial take-over of our medical knowledge is, at its core, not a scientific problem but a political one.
posted by overglow at 11:37 AM on January 12, 2011 [3 favorites]


Aaaand this is why Pharmac is one of the most hated institutions in New Zealand. If you're a large drug conglomerate. And why it'll be first against the wall when "free trade" comes with the US.
posted by rodgerd at 11:39 AM on January 12, 2011


Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?

You mean the Cipro tote bag, the Pepcid wall clock, the Viagra perscription pad, and the Plavix pen weren't just a coincidence?!?
posted by The 10th Regiment of Foot at 11:41 AM on January 12, 2011 [2 favorites]


If this kind of thing bothers you, and it certainly bothers me, a little research will make it easier for you to avoid doctors that do this. In many areas of the country, entire health systems are making it against the rules for their docs to accept this stuff from pharmas. My husband isn't allowed to take so much as a pen from drug reps. The downside is that he also can't give out free samples, which when you are talking about a poor patient with crappy or no insurance, sucks too. His patients want to know why he doesn't have samples of this expensive new drug and his response about how Mayo is trying to prevent doctors from being biased and therefore doesn't allow them to cozy up to pharmaceuticals doesn't go over well.
posted by supercapitalist at 11:47 AM on January 12, 2011 [2 favorites]


"How is this not considered a huge ethical breach on the part of the doctors? I guess I'm a little naive but I thought their job was to treat illness, not push drugs."

I should start this by saying that my last job was as a liaison between pharmaceutical reps and a provincial pharmacare program, so I've had enough experience with the salespeople to thoroughly answer this, I think.

In addition to the freebies/cash incentives, the pharmaceutical companies are armed with a ton of research. Many companies do non-inferiority studies where the result is that their product is no worse but not necessarily better than its competitors. There are no better/worse statements there for a doctor to analyze, nor are the doctors necessarily sufficiently able to rigorously challenge their hypotheses, simply because they aren't biochemists and don't have access to study data. Also, existing drugs aren't out there re-doing research comparing their medication to newer ones, both out of financial strain and, frankly, because they don't know whether they're better.

So, your doctor receives all of its information from the companies themselves. This is also true for many governing bodies, which is why drugs like Celebrex make it through the FDA process. There isn't the money there, or the time, to compare every drug independently or to do the long-term trial work (in the 20 year patent cycle, it can take 6-15 years to get the drug developed and ready for trial, so human trials can't be as long as most would be comfortable with), so nobody is out there right now telling anyone which drug is better or what's going to happen long-term.

So, when someone walks into your office and says "drug X is no worse than drug Y but the patients suffer less of side effect Z/its an easier regiment/its a pill not an injection/etc." and then offer you money to prescribe it, why wouldn't you? You've no basis to refute it and no literature exists to say that drug X is better than drug Y for patient A, other than on an interactive basis with other medication. In theory, you're doing what's best for your patient based on the information you have, and you're being rewarded in the process.

Like most things, if it's too good to be true, it is. Doctors likely know this, but what can they do to get clear, comparative research on similar products when everyone's saying we're no worse?
posted by dflemingecon at 11:50 AM on January 12, 2011 [4 favorites]


I've been to 3 different types of presentation like this.
1) Drug company supports a scientific meeting financially while having no say regarding the topic covered. Usually pretty decent information
2) Drug company pays for a scientific meeting and chooses the lecturer. Usually significantly less interesting.
3) Drug company pays an expert in the field to visit an institution/health center and give information. Usually dreadful.
In my experience the more influence a private company has on the topic the worse it is.
posted by abx1-se at 11:50 AM on January 12, 2011 [1 favorite]


notion: I had a friend who worked for a major pharmaceutical. Gorgeous former college cheerleader with a degree in marketing, which she said was pretty standard issue for a sales rep in her company.

Apparently this is industry practice. A 2008 article from the Georgia Straight, the local independent weekly paper in Vancouver:
When Shahram Ahari went to work at pharmaceutical giant Eli Lilly straight out of college in New Jersey, he was hired to do a job that few people know exists. Even the job title would be a mystery to most people. Ahari was going to be a "detailer".

His job was to schmooze with doctors in order to get them to prescribe Lilly's drugs. He was really a salesman, but he was also much more. His tools included everything from free drugs to offers of lucrative speaking engagements, even trips. He'd bring medical residents pizza for lunch or invite a doctor to dinner at an exclusive restaurant. He’d do anything to improve sales in his New York City district, which meant a bigger bonus.

The first hint of the strange world Ahari had entered came when he was brought to Indianapolis for Lilly's intensive, six-week boot camp for detailers. There, he met his fellow trainees. They were hundreds of fellow college grads, mostly in their mid-20s, perhaps two-thirds of them women, the vast majority beautiful.

"They were 200 or 300 of the most attractive people I had ever seen," he said in a phone interview. "The physical appeal was only part of it. They were vivacious, well-coiffured, well-dressed, engaging people."
A paper co-written by Ahari on techniques used by pharmaceutical reps.

What kinds of safeguards can be used against these sorts of marketing techniques? An interesting letter on this subject, by two former editors-in-chief of the New England Journal of Medicine:
For 14 years, British Columbia's Ministry of Health has relied on UBC's Therapeutics Initiative to assess the cost-effectiveness of prescription drugs, and to advise it on which drugs to include on the formulary of drugs covered by the publicly-supported program, Pharmacare. The assessments are based on the best scientific evidence, and completely independent of industry influence. Probably as a consequence, drug costs in B.C. are the lowest in Canada, and the province's skepticism about industry claims has protected residents from dangerous drugs that were more widely used elsewhere. For example, B.C. restricted the use of Vioxx, the arthritis drug that was pulled from the market because it increased the risk of heart attacks, and reportedly prevented some 500 deaths by doing so.

Now, B.C. is replacing this rigorous, evidence-based system with one likely to be dominated by the pharmaceutical industry, despite the industry's obvious interest in getting more brand-name drugs on the formulary, and doing it faster.
posted by russilwvong at 11:50 AM on January 12, 2011 [2 favorites]


Am I wrong in thinking that nearly every profession makes recommendations of products, and that the use of payoffs, cash, gifts, trips, isn't used to promote this?

Exactly. It seems more egregious, because this is your very health/life that's at stake, but it's all around us. How about your financial health? Did you ever go to a financial consultant? You do realize that many push a particular financial instrument/stock/fund, because they're paid to do so, and much more blatantly so than the doctors. And no, just because you are paying a hefty fee doesn't mean your interests are #1 in the mind of the consultant - the #1 always remains his/her own interest. Many people had seriously bad outcomes due to this, with their retirements seriously impaired.

Throughout 2010 I went through the process of changing dentists, so I tried a bunch. I'd audition them by having my teeth cleaned. And most of the visits amounted to a non-stop marketing show and pitches for products - electric toothbrushes, mouthwashes, pitches for teeth whitening etc., etc., etc., - my dental needs as a patient were firmly placed last.

The state of drug approval and effectiveness in this country is a scandal. The FDA at this point is almost entirely useless, so we don't actually know what the true efficacy of new drugs is... but this is a subject for a new FPP.
posted by VikingSword at 11:51 AM on January 12, 2011 [1 favorite]


Electronic component manufacturers never sent me on any tropical vacations. I did get some free samples, although I had to order them through an online web app, rather than a hot sales rep.
posted by ryanrs at 12:02 PM on January 12, 2011


Oh, and sales reps. Last year I was in an amusing situation that seemed to me to perfectly sum up the whole picture. I was in the waiting room at a clinic. I was the only patient - the remaining 5 people were all different drug company reps with suitcases on wheels full of samples, all waiting to get a crack at the doctors. And people wonder why health care costs keep escalating - as premiums go up, there are fewer patients available, and even more marketing by drug companies to this shrinking pool of patients. At some point, something's got to give. As I looked at these reps - all well-dressed and attractive and ambitious, I wondered - how do they feel when they themselves go to a doctor for their checkup or with some complaint... do they feel like the machine is consuming them too, a snake eating its own tail?
posted by VikingSword at 12:03 PM on January 12, 2011 [2 favorites]


(the sad part is that the ugly web app strongly influenced my purchasing decisions)
posted by ryanrs at 12:05 PM on January 12, 2011 [1 favorite]


Your health is irrelevant, exactly the way you are irrelevant -- you exist solely to serve as a unit of economic production, and retain utility only insofar as others may extract economic value from your continued existence. The healthcare system is merely yet another mechanism by which value can be extracted from your carcass, or redirected from other areas of your existence into the pockets of someone meaningful. Your body is the battlefield for a host of companies, each vying for a slice of your territory, trying to outmaneuver their enemies.

As long as someone makes money by having you remain alive, you may receive treatment. The moment your death becomes economically favorable, you will suddenly find people talking about letting you "die with dignity" -- an option strangely unavailable until the fiscal wars shift elsewhere and render your body/battlefield obsolete.
posted by aramaic at 12:11 PM on January 12, 2011 [5 favorites]


I work as an internal auditor for one of the large Pharma companies listed in the article. As someone with intimate knowledge of the process I can assure you that there is a lot of effort and resources put into ensuring that there is nothing unethical or unlawful around this practice.

If you consider the breakdown of payments you can see that the majority of the money is paid for speaking and consulting. Prior to contracting with a professional companies document the business rationale, potential conflicts of interest, and evidence of their expertise. Then, there must be proof of service, calculation proving the payment is at fair market value, and evidence of reimbursements.

These precautions are taken to ensure that the professional is not being influenced, but rather educated, by the company. Many of the companies listed voluntarily adhere to the PhRMA code which lays out guidelines for interactions with professionals.

Also, companies adhering to the PhRMA code no longer hand out promotional material such as pens, bags, clocks etc.
posted by sidewaysglance at 12:27 PM on January 12, 2011


KevinSkomsvold: "Fuckofficin is the greatest advancement in antidepressant medication"

Take two of these, and don't ever call me again.
posted by idiopath at 12:27 PM on January 12, 2011 [1 favorite]


This is pretty incredible. I checked my city and was glad to see there were only 3 or 4 docs I had never heard of on the list.

Honestly, if you can't make a decent living in medicine you are doing it wrong.
posted by docpops at 12:33 PM on January 12, 2011 [1 favorite]


The moment your death becomes economically favorable, you will suddenly find people talking about letting you "die with dignity" -- an option strangely unavailable until the fiscal wars shift elsewhere and render your body/battlefield obsolete.
posted by aramaic at 12:11 PM on January 12 [1 favorite +] [!]


Don't be stupid on purpose. There are millions of people that would be economic assets as corpses and as living organisms are a massive sinkhole for health care dollars. You may be one of them. If you aren't now, you will be at some point.

Dying with dignity has nothing to do with it.
posted by docpops at 12:36 PM on January 12, 2011 [1 favorite]


sidewaysglance: I work as an internal auditor for one of the large Pharma companies listed in the article. As someone with intimate knowledge of the process I can assure you that there is a lot of effort and resources put into ensuring that there is nothing unethical or unlawful around this practice.

First, welcome to MetaFilter.

Second, I would respectfully suggest that from an outsider's point of view, drug companies shouldn't be paying doctors at all. When they do, there's an inherent conflict of interest. This is basic business ethics: anyone involved in a purchasing decision should not be receiving kickbacks from the supplier!

I'm sure you're absolutely correct, that a lot of effort goes into attempting to ensure formal compliance with the relevant laws and regulations. That's not at all the same as saying that "there is nothing unethical" about these practices.

Marcia Angell (former editor-in-chief of the New England Journal of Medicine), Drug Companies & Doctors: A Story of Corruption:
Perhaps the most egregious case exposed so far by Senator Grassley is that of Dr. Charles B. Nemeroff, chair of Emory University's department of psychiatry and, along with [Dr. Alan] Schatzberg, coeditor of the influential Textbook of Psychopharmacology. Nemeroff was the principal investigator on a five-year $3.95 million National Institute of Mental Health grant--of which $1.35 million went to Emory for overhead--to study several drugs made by GlaxoSmithKline. To comply with university and government regulations, he was required to disclose to Emory income from GlaxoSmithKline, and Emory was required to report amounts over $10,000 per year to the National Institutes of Health, along with assurances that the conflict of interest would be managed or eliminated.

But according to Senator Grassley, who compared Emory's records with those from the company, Nemeroff failed to disclose approximately $500,000 he received from GlaxoSmithKline for giving dozens of talks promoting the company’s drugs. In June 2004, a year into the grant, Emory conducted its own investigation of Nemeroff's activities, and found multiple violations of its policies. Nemeroff responded by assuring Emory in a memorandum, "In view of the NIMH/Emory/GSK grant, I shall limit my consulting to GSK to under $10,000/year and I have informed GSK of this policy." Yet that same year, he received $171,031 from the company, while he reported to Emory just $9,999--a dollar shy of the $10,000 threshold for reporting to the National Institutes of Health.
Look at it from Nemeroff's point of view. He's being asked to sacrifice hundreds of thousands of dollars of income. Only a saint would be able to do this. He's much more likely to tell himself that the money he's receiving isn't going to affect his findings.
posted by russilwvong at 12:44 PM on January 12, 2011 [5 favorites]


As a Brit, why yes. Yes it would bother me. A lot. Anyone who can't see the innate moral difficulty with this is a doctor on the take or a pharma rep... sorry! I meant to say idiot.

It's a big gray area ethically. Suppose Doctor Smith revolutionizes the treatment of Disease X with Drug Y. The pharma company paying him to fly around the country doing seminars teaching other doctors how to do the same thing with Drug Y

I am quite prepared to believe that this happens every bit as frequently as the situation where random doc is on the take for prescribing something in-surgery when s/he really doesn't give much of a shit about what's best either way. Of course, I'm extremely drunk at the moment.
posted by Decani at 12:52 PM on January 12, 2011 [1 favorite]


Am I the only one who thought "oh good, now I can know which doctor might actually have free samples of a drug I know that works for me, but costs $100 a bottle with insurance, or which new doctor will continue to prescribe me the drugs that work for me rather than x, y and z "alternatives" that don't"?

Just me?
posted by strixus at 12:58 PM on January 12, 2011 [1 favorite]


I work as an internal auditor for one of the large Pharma companies listed in the article. As someone with intimate knowledge of the process I can assure you that there is a lot of effort and resources put into ensuring that there is nothing unethical or unlawful around this practice.

Your reassurance doesn't really assure me, especially since you're an auditor. I still wouldn't feel better. Look at Arthur Anderson and Enron. Just because the law says something is okay doesn't mean it's terrific and not at all shady.
posted by anniecat at 1:11 PM on January 12, 2011 [2 favorites]


Receiving money from a pharmaceutical company is an automatic conflict of interest. Unless you are a dog, in which case money has no utility other than something to throw up onto the rug.
posted by docpops at 1:16 PM on January 12, 2011 [5 favorites]


Also, companies adhering to the PhRMA code no longer hand out promotional material such as pens, bags, clocks etc.

I wonder what would happen if they could ban reps from visiting the offices or approaching doctors at all. You can give your pitch over the phone. No trotting pretty girls with big boobs or guys with firm jawlines, full heads of hair, sparkling eyes, and smiles that make you melt into the office....

What will all those beautiful people do for a living then? Permanent contestants on the Bachelor and Bachelorette?
posted by anniecat at 1:19 PM on January 12, 2011 [2 favorites]


Holy crap. One guy in DC made over $100K from this. Professional Advising: $5000.00, Expert-Led Forums: $86250.00, Meals: $1277.00, Business Related Travel: $8878.00
posted by anniecat at 1:28 PM on January 12, 2011


especially since you're an auditor

When you distrust an auditor because they're an auditor, I think you are lost.
posted by smackfu at 1:39 PM on January 12, 2011 [1 favorite]


FYI, a great book about the problems in medicine right now, including the influence of pharmaceutical money, came out recently. It's called White Coat, Black Hat: Adventures on the Dark Side of Medicine by Carl Elliott.

I was completely floored to read how easily studies themselves are compromised or dishonestly or unethically constructed off the bat -- and how easy it is to get those approved and administered and covered up to your liking since you can shop around; it used to be that most studies took place in medical schools or teaching hospitals and were reviewed by the faculty volunteers, but now the majority take place in private labs and are approved by private institutional review boards. If one private IRB says your study is unethical, you just try another one.

Not to mention the amount of reach pharmaceutical companies have in what gets published and how slanted it is. Apparently the majority of articles in medical journals are ghost-written by agencies hired by pharmaceutical companies now, and they routinely pay respected physicians for the use of their name as author so it's difficult to tell what's legit and what isn't. And not just that, they'll routinely seed the literature months and years in advance of a drug release to play up the problem and discredit existing treatments.

You'd think you'd do well to just be wary of anything saying a particular drug works well, but they'll publish studies where nothing patented is involved; you'll get the idea that a herb or vitamin that actually works well in particular case has horrible side effects when in fact it doesn't, for example. Not to be anti-pharmaceuticals or woo woo about it either; generally I think most serious diseases require pharmaceutical treatment and most supplements are over-hyped -- I don't even take a multivitamin anymore, and I am on prescription medication -- but it is the case that some conditions respond well to things found in nature and it seems pretty whack to misrepresent that. I, personally -- and the book itself, it seems -- don't buy into an anti-pharmaceutical mindset at all and think targetted medicines are great. It's rather a "the influence of money has gotten out of hand" mindset -- though I have to admit this lends some credence to the idea that pharmaceutical companies try to suppress natural remedies because, empirically, it does happen given an example in the book. I just don't know to what extent.

Not to mention that there are entire fake journals created whole-cloth by pharmaceutical companies working with publishing companies.

There's a lot more in the book even worse than that.

To the point of the thread, there's a whole chapter on how countless studies show pharmaceutical money irrefutably influences doctors, even though they (sincerely) believe it doesn't; once the doctors accepts money, they inevitably start prescribing markedly more of the drug. Often enough they come to know a drug rep and believe the drug rep is helpful, and that they're being truthful when they say the drug works better than others. And that's just the effect in the best-case scenarios where the doctor is genuinely an honest, well-meaning person. Much worse can and does happen if the doctor isn't so principled.

Anyway, I'm only halfway through so far, but I very much recommend the book. I have to say, though, as a layperson, it's not comforting to think that even if I have a sharp, principled doctor he might be lead astray by no fault of his own and it could have consequences for me. And as a skeptical empiricist who likes to think I can at least do some digging on my own, it's really frustrating to think that in medicine, especially for the past decade or two, I can't know if a study published even in the most respected medical journals is bullshit or not -- right down to the methodology and test subjects and what was left out, even if I could determine whether it was ghost-written or not. The current state of things seems deeply, deeply wrong to me.
posted by Nattie at 1:49 PM on January 12, 2011 [4 favorites]


* er, when I say accepts "money," I don't mean always literally money -- like for speaking events -- but gifts of any kind.
posted by Nattie at 1:57 PM on January 12, 2011


I work for a doctor on this list (below $5,000). I can't speak to how the other 99% of doctors operate, I can offer a different perspective from those other comments above me.

To be clear doctors do not get paid to write prescriptions. Pharm reps do monitor prescribing habits by obtaining data directly from pharmacies, and they will constantly nag when my doc doesn't write any scrips for their brand new reformulated-to-keep-making-money-after-the-original-goes-generic drug. They will beg to know why he won't write their drug, but he never gives them a straight answer because he knows no matter what he says they will throw back a company line that's been hammered into their head by their managers. The free samples are the only reason he still lets them into the office and play out this game. Many of our patients can't afford their prescriptions, so he tries to help them out as much as he can.

His reasoning for prescribing X over Y: First, which medication is more proven by data and/or past experience to help the patient the most. Then the possible side effects of the medication are considered in relation to the patient's condition and history. Finally the issue of cost is weighed. Do we have a free sample of this medication for the patient? Does this patient even have insurance? Unfortunately the more frequent question is will this patient with insurance even bother to fill out a prescription or will they balk at having to pay a $35 copay and demand free samples? A surprising number of those patients then blame the doctor's office for their decline in health because we didn't have free samples for them.

Economic issues are what interfere with quality of care. Not the conflict of interest generated by flashing a pair of tits or paying for your dinner. (Again can't speak for all docs though.)

As for getting paid to speak on behalf of a company's drug. The process usually goes like this. Pharmaglobotech approaches the doc to speak on their behalf and gives the doc a slide deck (around 50 slides) of data on the drug. The doc then throws out all but 5-10 slides he thinks are relevant. At the actual talk he goes over the data and points out all the areas in which the data doesn't provide clear evidence of this particular drug's superiority. If there's certain aspects of this drug he does like or finds works well in certain cases he will of course talk about that before spending even more time talking about the competing drug he thinks works better or is more practical.

If it's what he honestly believes, he will openly put down the drug he's paid to talk about, and promote the drugs he's not paid to talk about. The pharma company does not freak out and shut down the talk. The pharma company does not blacklist him. Many times the pharma company will offer to pay him to speak again (although he doesn't like doing too many). That he's respected by other doctors in the area may be a factor in this.

Again, I only speak for one doctor. I have no idea how others work, but in discussions about articles like these he's the type of doctor nobody talks about. There exist good doctors that both play the game and will not be gamed.

Oh and as to the comment that good doctors shouldn't need the extra money, you are misinformed. This may be true of any specialist, but in the USA primary care doctors are asked to do more work in return for less pay. That's why there's an alarming shortage of primary care doctors, and why everyone in med school is studying a specialty. Family practice is expected to coordinate the care of an aging population with more chronic diseases like diabetes, hypertension and high cholesterol but be paid the exact same per visit as someone with a runny nose. The entire reimbursement model is based on procedures, not quality long term care and coordination of care between a number of specialists.
posted by el sol at 2:24 PM on January 12, 2011 [5 favorites]


el sol - I am a primary care doc. Again, if you have to supplement your income by shilling for a pharm company, then you are losing sight of what it means to be a physician.
posted by docpops at 2:33 PM on January 12, 2011 [2 favorites]


health care economics in a nutshell: "Doug Elmendorf says that if he has learned anything from being a health economist over the past 30 years, it is that doctors are very good at figuring out new and expensive things to do that are medically appropriate." cf. also see the incidental economist and uwe reinhardt's posts on us health care costs
posted by kliuless at 2:36 PM on January 12, 2011


The entire reimbursement model is based on procedures, not quality long term care and coordination of care between a number of specialists.

And now we get to the core of the problem.
posted by hippybear at 2:44 PM on January 12, 2011 [6 favorites]


Ok, so pharmaceutical companies are evil and use dirty tricks to market their products.
But on the other hand they also make drugs, if possible drugs that add a few years to your life or increase your quality of life as these are the drugs that they can sell. There are a lot of industries and companies that use equally dirty tricks to market their products but not many have a better benefit/harm ratio for their costumers.

Doctors who receive payment from pharmaceutical companies are also obviously evil. But then to make drugs you need a few doctors who will require payment. And some of those drugs actually help people in a real way. You might even argue that a physician who helps develop and then market an important drug actually saves more lives than if he had used the time to receive patients. I don't think that person would have lost sight of what it means to be physician.

On the other hand some of these docs probably are scum and it's great to be able to look up their payments for this kind of work.
posted by abx1-se at 2:44 PM on January 12, 2011


docpops - I may be wrong about you being misinformed, but I disagree. It is a reckless and insulting generalization to say anyone taking money from a pharm company has lost sight of what it means to be a physician.

Has a doctor who sees some patients for free because they wouldn't get care otherwise forgotten what it is to be a physician?


How about a doctor who makes a free housecall to a patient dying from a treatable illness and spends hours running IVs and consoling the family forgotten what it is to be a physician?
posted by el sol at 2:45 PM on January 12, 2011 [1 favorite]


el sol - I didn't say it had anything to do with whether or not the physician was a good doc, or a moral person. It is that taking money from pharm companies is unequivocally an action that has zero defensible explanation than one of monetary gain, and is automatically a conflict of interest if you plan to utilize the same class of drug for a patient in the future, because you will forever be biased. It simply has no place in medical practice. There are plenty of primary care jobs out there that pay a better wage if you truly are getting screwed.
posted by docpops at 2:52 PM on January 12, 2011 [1 favorite]


To be clear doctors do not get paid to write prescriptions

Technically true, but there are some specialties in which the doctors commonly bill directly for medications used in the course of treatment. One of the more prominent examples is oncology.

In general it's great that the doctor you work for seems to be able to avoid being tainted too much by the pharmaceutical company he takes money from. But frankly it smacks of the studies I referred to upthread in which doctors all say they're fine, it's the other doctors who are influenced by the drug companies. It can be very difficult to see bias in oneself.

Also, free samples are a big problem. Beyond their insidious effect on physician prescribing habits, they can lead to patients who only use the free samples and then balk at paying for a generic alternative when the samples run out. It would better if the doctor were firm in the first place and simply wrote a prescription for the cheap alternative, if the patient is cost-sensitive. They aren't really 'freebies' or a way to 'game the system.' At the level of the health care system as a whole, they're bad for doctors and bad for patients.
posted by jedicus at 2:52 PM on January 12, 2011 [2 favorites]


When you distrust an auditor because they're an auditor, I think you are lost.

Who watches the watchmen?
posted by Blazecock Pileon at 3:05 PM on January 12, 2011


Anyone who didn't know this wasn't paying attention, although the mechanics of the monitoring of the pharmacies was new to me.

I had a screaming match with a doctor once who refused to prescribe the drug I requested, that I'd used before, that had a good outcome with minimal side effects, unless I took another scrip for a drug that had terrible side effects and did nothing to actually address the problem. I told him it was fine for him to waste his time writing the prescription, but not to imagine I was going to fill it.

I guess that's how he paid for those hand-made Italian loafers he was wearing.
posted by winna at 3:19 PM on January 12, 2011


The problem is not corrupt or uncaring MDs; GP's are having a hell of a hard time staying in the middle class these days. It's not big pharma/bio/devices; they are businesses that operate in a particular climate taking advantage of what they (legally mostly) can, to gain competitive advantage.

The problem is the climate itself. If anyone here thinks for a second that a non-trivial number of people working for CBER/CDER aren't in some indirect way "on the take" regarding, well, everything from trial design to stats requirements, you are being unrealistic. It's a classic "revolving door" between the Agency and the companies.

I've made some (possibly incriminating) statements about this in the past, and I do know first hand that this will only change when we write effective laws with proper and ongoing Congressional oversight.

Which of course, will never happen until it's too late for many folks.
posted by digitalprimate at 3:58 PM on January 12, 2011


This all just fucking makes me sick. Seriously.
posted by dbiedny at 4:06 PM on January 12, 2011 [1 favorite]


This reminds me of when I was rotating through the ophthalmology service a little while ago. Lots of people would come in with a scratched cornea, or something similar, and the residents would invariably prescribe a fancy antibiotic that has no proven superiority to the cheap, old-fashioned ones. I asked them about it, and they said that because the occasional patient had a bug that was resistant to the old, cheap drug, the staff doctors preferred to use the new antibiotics. "But," I said, "won't that just encourage resistance to the new antibiotics?" They agreed, somewhat sheepishly, but said they were just doing what the staff expected them to do, and also that the new drugs were better because...they had free samples of them available.
posted by greatgefilte at 4:08 PM on January 12, 2011


dbiedny: This all just fucking makes me sick. Seriously.

We have a drug for that.
posted by greatgefilte at 4:09 PM on January 12, 2011 [2 favorites]


schmod: A lot of this focuses on the fact that many doctors can't be bothered to learn about new developments on their own

Then maybe they don't actually know what the hell they're talking about so they shouldn't be doctors? FFS how can you say that someone being too lazy to do a key part of their job is in any way acceptable? Nobody said it's an easy job, but researching drugs and treatments is a huge part of it, and if you aren't doing that then you aren't really doing your job for shit.
posted by paisley henosis at 5:06 PM on January 12, 2011 [1 favorite]


Then maybe they don't actually know what the hell they're talking about so they shouldn't be doctors?

Well, in their defense, there is so very much to keep up with, it's neigh impossible to both see enough patients to make a living as a GP (whose main job is actually being a kind of diagnostician) and to keep up with what's most efficacious and has the best side effects profile.

The problem is there is no better source of information than the big pharma/bio/devices. And that is an information asymmetry our government is not willing to address.
posted by digitalprimate at 5:27 PM on January 12, 2011


I've taken "honoraria" in the past for the opportunity to give an unrestricted question and answer "expert lunch" with primary care providers. My rationalization was that I was giving an educational session with no agenda, answering questions without talking points or an agenda about matters within my area of expertise, and getting an amount of money that amounted to about a third of a day's income for a busy clinic day. I was also getting to know the local providers with the goal that they might refer their patients to me for expert care.

All fine and good, I thought, especially for a doctor trying to get a new clinic off the ground. But....the pharmaceutical representative was still looming with his/her drug information/handouts. I found myself going out of my way to point out issues with the sponsor's drug to "prove" my lack of bias. My confidence in my lack of bias couldn't stop these mind games and concerns about what the audience was thinking. Thankfully, I stopped long enough ago that I'm not on this list.

I know many physicians who've take these relatively small honoraria under similar circumstances in the past, and it makes me cringe to think that this list will taint their reputation.

I still take rep visits with samples despite misgivings. In my specialty, this means mostly inhalers. There are NO generic options for asthma inhalers, and that means I get samples of all the available inhalers. It's essential that patients understand how to use inhalers correctly, and it's great to be able to demonstrate with the real thing. It also means that we can make sure the medication works before the patient makes the considerable investment in filling the prescription. There's very little to choose between these inhalers as far as efficacy, and what determines my prescription is cost/insurance coverage and not-so-little things about an inhaler that enhances compliance and safety. For example, only one company provides a built-in dose counter for the common albuterol rescue inhaler -- I like the idea of my patient knowing how many doses are left in their life-saving puffer. That being said, I could see my clinic being posted in a list of those that entertain pharmaceutical representatives some day in the future.
posted by beesoar at 5:35 PM on January 12, 2011 [2 favorites]


The problem is there is no better source of information than the big pharma/bio/devices. And that is an information asymmetry our government is not willing to address.

What, seriously? I can think of half a dozen easy-to-access tools/websites/etc that provide clear, concise, evidence-based information about drug/treatment choices.
posted by greatgefilte at 5:36 PM on January 12, 2011


What, seriously? I can think of half a dozen easy-to-access tools/websites/etc that provide clear, concise, evidence-based information about drug/treatment choices.

I think there's a general distrust of the process at every juncture, so many of these tools/websites will not be worth much. From design of trials to interpretation to supervision to conclusion and so forth. IMNAD, just an interested lay person, and I can say for sure that increasingly, I tend to discount studies altogether. I've become too aware of just how many ways these can go wrong, and I don't have the hours in the day to launch lengthy investigations to vet the integrity of every study design and conclusions. Doctors are busy people. Who can blame them for not having the time to play detective? At the same time, unquestionably, it's very important to keep up with new developments. So what's the solution?

I think we need to radically restructure and fund the FDA, so that doctors can actually rely on outcome studies. There needs to be a huge emphasis on integrity at every stage of the process, otherwise the bad will drive out the good. As is, when I now hear that study X found this, that and the third, I tend to think "they did, huh?".

The more we entangle monetary into that process, the worse it becomes. Soon we'll be reduced to anecdotes, word of mouth and badger entrails, just like in the middle ages. We need to rescue medical science from the assault by profiteering; how to do that, I don't know.
posted by VikingSword at 5:52 PM on January 12, 2011 [1 favorite]


oops: The more we entangle monetary [gain] into that process,
posted by VikingSword at 5:57 PM on January 12, 2011


Schmod wrote: ... marketing efforts were focused on getting doctors' eyes on case studies and reports that said as much. (They were also rather scared of doctors prescribing drugs to patients who were at high risk for side effects [...]

Surely this means that there is a selection effect: the highly-promoted drugs will seem safer because they aren't prescribed to patients at risk of side effects. Cheap drugs and generics will be preferentially prescribed to those at-risk patients, so they'll look more dangerous. And you'll end up with drugs that pass the safety tests getting recalled after a few years because they have either started to be prescribed to at-risk patients, or the original patients are older and more at risk of side effects. Someone up-thread mentioned Celebrex, which fits this pattern. I wonder if that's what happened?
posted by Joe in Australia at 6:40 PM on January 12, 2011 [2 favorites]


Am I wrong in thinking that nearly every profession makes recommendations of products, and that the use of payoffs, cash, gifts, trips, isn't used to promote this?

Hell, our government is run this way....


Doctors are in a unique position. They make the purchase decision but someone else pays, either the patient, the government or a private insurer. An inducement to you to buy a Ford rather than a Chevy is just good marketing when you are buying yourself a car. If you were buying one for your company and the salesman offered to split his take with you so that you would get the Ford then that is a bribe. An outright payment to induce a doctor to prescribe a certain way is clearly illegal and can get both the pharma company and the doctor into serious legal trouble, including criminal penalties. The contracts between pharma companies and doctors do not have explicit clauses regarding prescribing levels etc. They are for legitimate purposes such as speaking etc. However, how does one get selected to speak? If you get a lot of money from company X aren't you more likely to use their products? Where does a legitimate relationship end and an illegal inducement begin? There are few black and white cases. It is all grey.
posted by caddis at 6:54 PM on January 12, 2011 [1 favorite]


If you were part of a clinical study, would it bother you to know that it was being run by guys from McDonalds rather than doctors? Because as a takeaway from the excruciating Interactions with Healthcare Providers training I'm required to take every year, I can say that such a study would be one acceptable reason to make such a payment.

It's excruciating because my personal interaction with healthcare providers mostly involved taking deep breaths, turning my head and coughing and leaving an undisclosed gift of a little jar of warm yellow fluid on the shelf in the rest room.

Running a clinical study in a country with state run hospitals is such a legal morass that I'm afraid to by aspirin in a foreign airport.
posted by Kid Charlemagne at 10:50 PM on January 12, 2011


I'm glad this list exists. I cringe for our profession when I read the [Ahari] list of all the ways the drug reps manipulate us, that russilwvong posted. Someday this will be yet another unethical thing our profession used to do but doesn't do any more. I wish I'd had this thread with all the good points and great links to read in med school.

We have a duty to our patients to prescribe (or not) the most effective, safe, and inexpensive drugs for them that we can, and to do our own homework to find out what these drugs are. Pharmabucks pervert this obligation and thus are an unethical conflict of interest.

Samples are the most insidious tactic, as we are made to think it's for the benefit of our patients rather than ourselves... however in the end it seems to lead to precribing higher cost drugs to the uninsured:

Miller, D.P., et al, South Med J 101(9):888, September 2008
[Conclusion of a summary of the study:] This suggests that drug sample availability might influence physicians to prescribe more costly brand-name drugs, thereby ultimately increasing drug costs for uninsured patients.
posted by kevinsp8 at 11:29 PM on January 12, 2011 [1 favorite]


OK, so taking a moment to be serious, last year my corporate masters made payments to 103 doctors in Missouri. In 2000 there were more than 12000 practicing physicians in Missouri. Draw your own conclusions on that.

Anyhow, I scrolled down the Missouri list until I found someone here in town who we were paying more than $10K to. I picked Dr. Mario Castro. I'm not sure what, exactly, we're paying him to do, but poke around on the bio, research and publications links. Whatever it is, we're apparently getting a hell of a deal - In addition to just boring old MD he's also Associate Professor of Medicine and Pediatrics, Adjunct Associate Professor of Public Health, Senior Fellow of the Center for Health Policy and Director of the Pulmonary Function Laboratory and was involved in 28 publications from 2005 to 2008.

Hell, now it bothers me that this guy isn't my doctor and I don't even have anything resembling what he specializes in.
posted by Kid Charlemagne at 11:55 PM on January 12, 2011


Hell, our government is run this way....

You mean the Cipro Lockheed tote bag, the Pepcid L3 wall clock, the Viagra perscription Xe post-it pad, and the Plavix Patton Boggs pen weren't just a coincidence?!?
posted by The 10th Regiment of Foot at 4:55 AM on January 13, 2011


There's something I've been wondering about my doctor (a specialist who's taking care of all my prescription-writing for $20 a visit until my Medicare kicks in). He had me taking this one med for a while that was very effective but impractical to keep taking once I lost my job (with insurance it ran about $130/mo., without it was more than $1250 a month). A fancy pill at a high dose. So he gave me samples for about a year! Anyhow, I ended up taking myself off it because withdrawal syndrome was awful and I couldn't assure myself of a constant supply (sometimes he'd be out of samples etc). Much easier to take things with inexpensive generic versions, despite the variance in quality among generic drugs*. Now every time I visit him he tries to get me to take a prescription for it... wonder how much it has to do with this sort of thing; didn't see him on the list anywhere.

* both my doctor and fellow pill-o-vores have told me that generic manufacturers have a 20% allowed variance in bioavailability from the trademarked form but this page at the fda website calls that a myth

posted by jtron at 6:54 AM on January 13, 2011


Yeah Cymbalta/duloxetine is having a big marketing push. Let's see, from Wikipedia:

"In three out of six well-designed properly controlled pre-marketing trials duloxetine performed better than placebo; the three other trials were inconclusive"

"Duloxetine failed the US approval for stress urinary incontinence amidst concerns over liver toxicity and suicidal events"

"Its efficacy relative to established treatments such as anticonvulsants and tricyclic antidepressants has not yet been studied."

Sounds like a blockbuster to me.
posted by kevinsp8 at 9:21 AM on January 13, 2011 [1 favorite]


FYI, in Britain the more flagrant abuses are avoided by the national death panel, otherwise known as the National Institute of Health and Clinical Excellence, which centrally approves on a cost/effectiveness basis whether or not a drug can be prescribed by the NHS.

I'm not sure whether or not doctors can be paid to do seminars etc. I've never heard of it, but that doesn't mean it doesn't happen. I can however confirm that doctors offices are stacked full of cheap pens and other such detritus, and marketing people are allowed to go into hospitals and talk to doctors.
posted by Marlinspike at 10:16 AM on January 13, 2011


You know what the best thing about Cymbalta is? If you drink alcohol while taking it, you risk suffering massive liver damage! Yaaaaaaaay!

It did work quite well for me, but I transitioned onto a less-burly antidepressant and have been doing fine. I'm surprised that it failed the stress urinary incontinence test, though. Let's just leave it at that.
posted by jtron at 10:36 AM on January 13, 2011 [1 favorite]


Didn't anyone else see that episode of Scrubs with Heather Locklear?
posted by Uther Bentrazor at 4:51 PM on January 14, 2011


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