Just Say No To Drugs (Reps)
December 4, 2004 9:57 PM Subscribe
Which is worse, giving doctors pens and notepads, or bombarding ordinary people with ads telling them to ask their doctor about Drug X today?
posted by ilsa at 10:14 PM on December 4, 2004
posted by ilsa at 10:14 PM on December 4, 2004
Would it matter if instead of pens and notepads it were dinners (including wife and kids) in Kauai or tickets to the local sports team?
posted by MikeKD at 10:26 PM on December 4, 2004
posted by MikeKD at 10:26 PM on December 4, 2004
"New mothers were lured into giving birth in hospitals funded by infant formula manufacturers. There, these women were encouraged to offer bottles of artificial breast milk substitutes--a practice proven to disrupt breastfeeding.
Mothers and babies were then sent home with a small "free" supply of infant formula. By the time the supply ran out, baby was refusing the breast, mother's own milk supply was diminished, and the typical, impoverished family was unable to pay for any more infant formula. These practices, combined with an unsanitary water supply, lack of sterilization and refrigeration facilities, and poor access to medical care, conspired to kill millions of Third-World babies each year, according to the World Health Organization (WHO). "
"According to Baumslag and Michels in Milk, Money and Madness, the infant-formula industry contributes $1 million annually to the American Academy of Pediatrics (AAP) and provided at least $3 million toward the cost of building the AAP's headquarters. Formula manufacturers routinely host lavish parties and receptions for pediatricians at AAP functions. Other medical groups, such as the American College of Obstetricians and Gynecologists, the American Medical Association, the Association of Women's Health, Obstetric and Neonatal Nurses, and the American Dietetic Association receive cash grants and advertisements for their publications totaling hundreds of thousands of dollars annually.
Individual medical students and doctors receive loans, grants, and "gifts" from the pharmaceutical companies which produce infant formula, and a 1991 study found that the U.S. pharmaceutical industry spends $6,000 to $8,000 per doctor per year in promotion. Increasing amounts of medical research into infant health and nutrition is being underwritten by the infant formula industry. Physicians and nurses who choose to formula-feed their own infants frequently receive a year's free supply of formula. With all of this financial support, it's no wonder the U.S. medical community accommodates infant-formula manufacturers' distribution of advertising and "free samples" to parents in doctors' offices and hospitals, a practice which has been proven to discourage breastfeeding and which is in clear violation of the WHO Code on the Marketing of Breast Milk Substitutes. The infant-formula industry needn't worry, however, since health care providers are the group ethically responsible for reporting Code violations in the first place."
posted by Feisty at 10:48 PM on December 4, 2004
Why should I pay extra for my medication just so the White Coats can go on Big Pharma junkets? It would be nice to be able to deduct the marketing expense for drugs from my doctor's bill.
If the government sponsored that arrangement, you can bet the AMA would get off its ass about prescription drug coverage. And they should do it anyway — Big Pharma is making doctors more and more redundant in the purchase process with the "ask your doctor" advertisements.
If the AMA has any instinct for self preservation, they had better wake up on this issue.
posted by AlexReynolds at 10:56 PM on December 4, 2004
If the government sponsored that arrangement, you can bet the AMA would get off its ass about prescription drug coverage. And they should do it anyway — Big Pharma is making doctors more and more redundant in the purchase process with the "ask your doctor" advertisements.
If the AMA has any instinct for self preservation, they had better wake up on this issue.
posted by AlexReynolds at 10:56 PM on December 4, 2004
There's an aesthetic argument to be made too. Pens and notepads with drug names on them just seem so unbeautiful. It's about as easy to romanticize a drug as it is to romanticize the disease it's meant to fight.
posted by ontic at 11:45 PM on December 4, 2004
posted by ontic at 11:45 PM on December 4, 2004
And tort reform is going to do SO much to fix the health care system too... jesus.
posted by socratic at 11:52 PM on December 4, 2004
posted by socratic at 11:52 PM on December 4, 2004
Why should I pay extra for my medication just so the White Coats can go on Big Pharma junkets? It would be nice to be able to deduct the marketing expense for drugs from my doctor's bill.
You know all those free samples your doctor gives you?
posted by tricky_t at 12:03 AM on December 5, 2004
You know all those free samples your doctor gives you?
posted by tricky_t at 12:03 AM on December 5, 2004
There's also this whole free text- and reference book thing that happens. I can't really get into details, but I've witnessed thousands and thousands of dollars (probably a fairly small fraction, though extrapolation is difficult from my position) worth of drug company-bought books going out to the doctors. Books which the publishers arrange with the drug companies to get to the docs because they just happen to mention the drugs involved. Also sponsored journals and so on.
posted by fidelity at 12:25 AM on December 5, 2004
posted by fidelity at 12:25 AM on December 5, 2004
You know all those free samples your doctor gives you?
Any drug dealer can tell you the first taste is free, but the ones that follow do not.
posted by AlexReynolds at 12:33 AM on December 5, 2004
Any drug dealer can tell you the first taste is free, but the ones that follow do not.
posted by AlexReynolds at 12:33 AM on December 5, 2004
Isn't this situation the logical outcome of pharma companies being corporations that need to make a profit? Why do we view them in a different light than, say, General Motors? They are just doing what every other corporation does if they want to stay in business, and they are using the tools, i.e. marketing, to inflate that bottom line.
So why does their behavior piss me off so much?
posted by Enron Hubbard at 3:19 AM on December 5, 2004
So why does their behavior piss me off so much?
posted by Enron Hubbard at 3:19 AM on December 5, 2004
Enron: I can't speak for you, but for me the anger comes from that gnawing suspicion that your doctor may not actually be giving you the best advise about your health.
If GM bullshits you your next car can be a Ford. If your GP bullshits you you may spend a fortune and suffer who knows what because of ineffective treatment.
Pharma companies behaviour may be logical, but that doesn't make it ethical.
posted by bangalla at 4:15 AM on December 5, 2004
If GM bullshits you your next car can be a Ford. If your GP bullshits you you may spend a fortune and suffer who knows what because of ineffective treatment.
Pharma companies behaviour may be logical, but that doesn't make it ethical.
posted by bangalla at 4:15 AM on December 5, 2004
I did some temping work for a medical market research company in the UK. They had been hired by a drug PR firm, working for a manufacturer. I had to transcribe interviews with doctors, so had the interview script as well as the recordings.
I was amazed at the amount of manipulation involved - out of about 60 doctors, half of them were very anti the drug in question. Yet the interviewer managed to trick many of them into giving the quotes he needed. By the end of it only about 5 doctors had the savvy to avoid the interviewers' technique.
There was even a ranking system - doctors were marked off as 'cynical GPs', while others were tagged as to their beliefs for future trials.
posted by einekleine at 4:57 AM on December 5, 2004
I was amazed at the amount of manipulation involved - out of about 60 doctors, half of them were very anti the drug in question. Yet the interviewer managed to trick many of them into giving the quotes he needed. By the end of it only about 5 doctors had the savvy to avoid the interviewers' technique.
There was even a ranking system - doctors were marked off as 'cynical GPs', while others were tagged as to their beliefs for future trials.
posted by einekleine at 4:57 AM on December 5, 2004
Not all drug companies are like this.
Unfortunately I don't feel comfortable saying more about why I know this since my livelihood depends on services for drug companies.
posted by tomierna at 5:26 AM on December 5, 2004
Unfortunately I don't feel comfortable saying more about why I know this since my livelihood depends on services for drug companies.
posted by tomierna at 5:26 AM on December 5, 2004
Is this some kind of "drug designer against IK*A" viral marketing again?
posted by denpo at 6:55 AM on December 5, 2004
posted by denpo at 6:55 AM on December 5, 2004
I can concur that the ever increasing presence of promotional materials in the doctor's office is disturbing. It seems that more and more, a doctor visit entails several recommendations of a new perscription, and yes, from a patient's standpoint there's something a bit unsettling about a doctor writing something down with a drug company promotional pen.
posted by Uther Bentrazor at 7:09 AM on December 5, 2004
posted by Uther Bentrazor at 7:09 AM on December 5, 2004
The ethical (and legal) dilemma arise out of the fact that the people receiving the gifts (the docs) are not the ones purchasing the products with their own money. So if GM wants to give me free lessons at a race driving school to induce me to purchase their new hot rod that is fine as it is just between us. With medicine the doc is making the decision on behalf of the patient (and then there is usually a third party payer like the govt. or insurance co.). Too much benefit to the doc and the promotion starts to look more like a kickback. I doubt any doctor is going to be unduly influenced in prescribing a drug based upon a free pen or coffee mug. Superbowl tickets are another story. The problem is where to draw the line. The AMA has some guidelines for doctors.
posted by caddis at 7:53 AM on December 5, 2004
posted by caddis at 7:53 AM on December 5, 2004
I remember the first time I was prescribed Zoloft. I asked the scriptwriter why he had chosen Zoloft instead of any of the many alternatives. As he gave me an explanation, which did seem plausible, I noticed the clipboard he was writing the Rx on was a Zoloft clipboard, the pen he was writing the Rx with was a Zoloft pen, and his desk had a Zoloft clock. Then he gave me a week's worth of free samples of Zoloft to "get started on". Pretty suspicious.
On the other side of this equation, when I was without health insurance that would cover it, a friendly local street clinic MD would give me a month or more worth of free samples of Zoloft. Some of the high cost of Zoloft is to pay for the marketing of Zoloft, which includes distributing free samples. So everyone else's very expensive health insurance, which is expensive largely because of the high cost of prescription drugs, was subsidizing prescription drugs, via free samples, that I, without expensive health insurance, was receiving. So thanks everybody.
When insurance companies are paying the bills nobody notices how expensive prescription drugs are. Meanwhile the insurance companies pass along their high expenses in the form of higher premiums, so they don't really care. Plus the government has many programs that cover drug costs for low-income people so taxes are higher. So everybody's happy. The doctors get nifty clocks, the insurance companies get higher premiums, the drug companies get higher prices, and the patients don't notice because somebody else is paying for it, or at least it seems like it, and I've been happy because I got free drugs that make me happy. So everybody's happy except nobody's happy.
posted by TimeFactor at 8:26 AM on December 5, 2004
On the other side of this equation, when I was without health insurance that would cover it, a friendly local street clinic MD would give me a month or more worth of free samples of Zoloft. Some of the high cost of Zoloft is to pay for the marketing of Zoloft, which includes distributing free samples. So everyone else's very expensive health insurance, which is expensive largely because of the high cost of prescription drugs, was subsidizing prescription drugs, via free samples, that I, without expensive health insurance, was receiving. So thanks everybody.
When insurance companies are paying the bills nobody notices how expensive prescription drugs are. Meanwhile the insurance companies pass along their high expenses in the form of higher premiums, so they don't really care. Plus the government has many programs that cover drug costs for low-income people so taxes are higher. So everybody's happy. The doctors get nifty clocks, the insurance companies get higher premiums, the drug companies get higher prices, and the patients don't notice because somebody else is paying for it, or at least it seems like it, and I've been happy because I got free drugs that make me happy. So everybody's happy except nobody's happy.
posted by TimeFactor at 8:26 AM on December 5, 2004
I was crippled in an accident at work last year...a series of blown out discs, none of which are operable :( Pharma reps have been a point of much contention between myself and my pain management doc...his office is typical I guess...clocks, posters, pens, clipboards, mugs etc from a myriad of pharma companies.
His point was that without the drug reps, it would be impossible for him to stay up to date on all the available meds. My rebuttal is that he should be reading medical journals to learn this stuff. The debate came to a head when he put me on Neurontin...since I ask him about every med he swore up and down that this stuff was ok. A week into taking it Neurontin started *really* messing with me...complete disassociation, the inability to do anything and major depression. The doc took me off it, and a couple months later I find out about the Neurontin lawsuits for illegally marketing it for uses the FDA never approved.
I have since moved to a new pain mgmt doc, but I am sad that people that work in life and death situations can be so easily swayed by a trip to hawaii or some other such spiff.
posted by gren at 8:59 AM on December 5, 2004
His point was that without the drug reps, it would be impossible for him to stay up to date on all the available meds. My rebuttal is that he should be reading medical journals to learn this stuff. The debate came to a head when he put me on Neurontin...since I ask him about every med he swore up and down that this stuff was ok. A week into taking it Neurontin started *really* messing with me...complete disassociation, the inability to do anything and major depression. The doc took me off it, and a couple months later I find out about the Neurontin lawsuits for illegally marketing it for uses the FDA never approved.
I have since moved to a new pain mgmt doc, but I am sad that people that work in life and death situations can be so easily swayed by a trip to hawaii or some other such spiff.
posted by gren at 8:59 AM on December 5, 2004
Isn't this situation the logical outcome of pharma companies being corporations that need to make a profit? Why do we view them in a different light than, say, General Motors?
Because the GM product is not as personal as, say your body.
And because cars do not have a histroy of Not-for-profit status that Hospitals and the medical profession had for years up until 1970's.
posted by rough ashlar at 9:02 AM on December 5, 2004
Because the GM product is not as personal as, say your body.
And because cars do not have a histroy of Not-for-profit status that Hospitals and the medical profession had for years up until 1970's.
posted by rough ashlar at 9:02 AM on December 5, 2004
"I've been happy because I got free drugs that make me happy. So everybody's happy except nobody's happy."
Exactly. They give you a few pennies worth of drugs when you really need it, and they reap the profits for years to come. I'd encourage everyone to ask generic drugs on principle. My doctor is great about this. It's more transparent with anti-depressants, since there are many generic alternatives. It's really terrible when someone is in severe pain and a doctor needs to sort out the best course of treatment quickly. Personally, I wouldn't want my doctor looking through pamphlets while I was writhing in pain.
On a tangent, I work in a medical library. We have Pharma reps posing as doctors all the time to get free services, to ask reference questions, to borrow our books, and even to print off the internet. They are well dressed, well paid, but often know little more than they have to know to shill drugs. The clincher was last week, when a Boston Consulting Group sent our library a request for information on behalf of Pharma company.
It's almost like big Pharma has no time for the field of medicine, only for its products.
posted by gesamtkunstwerk at 9:19 AM on December 5, 2004
Exactly. They give you a few pennies worth of drugs when you really need it, and they reap the profits for years to come. I'd encourage everyone to ask generic drugs on principle. My doctor is great about this. It's more transparent with anti-depressants, since there are many generic alternatives. It's really terrible when someone is in severe pain and a doctor needs to sort out the best course of treatment quickly. Personally, I wouldn't want my doctor looking through pamphlets while I was writhing in pain.
On a tangent, I work in a medical library. We have Pharma reps posing as doctors all the time to get free services, to ask reference questions, to borrow our books, and even to print off the internet. They are well dressed, well paid, but often know little more than they have to know to shill drugs. The clincher was last week, when a Boston Consulting Group sent our library a request for information on behalf of Pharma company.
It's almost like big Pharma has no time for the field of medicine, only for its products.
posted by gesamtkunstwerk at 9:19 AM on December 5, 2004
So why does their behavior piss me off so much?
Because we are constantly told that drug prices have to remain high and that drug companies need to be allowed to game the patent system because it's so crucial that they receive huge returns to recover their R&D costs that they paid for, up front. When it turns out that most of the money is spent on marketing the drugs, not developing them, we feel cheated-- at least, we should feel that way.
That said, I will confess that I made it through high school with a lot of free pens given to me by my father that he received from drug companies at conferences.
posted by deanc at 9:38 AM on December 5, 2004
Because we are constantly told that drug prices have to remain high and that drug companies need to be allowed to game the patent system because it's so crucial that they receive huge returns to recover their R&D costs that they paid for, up front. When it turns out that most of the money is spent on marketing the drugs, not developing them, we feel cheated-- at least, we should feel that way.
That said, I will confess that I made it through high school with a lot of free pens given to me by my father that he received from drug companies at conferences.
posted by deanc at 9:38 AM on December 5, 2004
my livelihood depends on services for drug companies.
whores make the world go 'round.
posted by quonsar at 10:09 AM on December 5, 2004
whores make the world go 'round.
posted by quonsar at 10:09 AM on December 5, 2004
This marketing is especially aimed at academic medical centers for two reasons: physicians in training will pick up life long prescribing habits and the lower pay scale at these institutions means that gifts, especially food and textbooks are that much more appreciated.
It always amazes me when I go to a large medical meeting and see doctors who make $200K a year or more lined up 10-15 deep to get free pens and tote bags
Another thing that always amazes me is the way that whenever several heavily promoted, competing drugs come on the market at about the same time, they are always priced within a few dollars or even cents of each other. Surely I am not the only one who finds this suspicious?
I didn't have time to read all of Gyan's links in detail, but another nefarious marketing tool is drug company funding of advocacy groups; just check out the first few links here.
Not all drug companies are like this.
As far as I can tell, the companies that don't market like this are the generic drug manufacturers, who are compteing on price rather than creating an artificially high demand for their product.
Finally, the info in Gyan's links regarding infant formula is right on. My wife is due in Feb. and has already started getting free samples of formula along with handy carrying cases for bottles and such from the formula reps. Big pharma is no slouch when it comes to marketing at all levels.
Great post.
posted by TedW at 10:28 AM on December 5, 2004
It always amazes me when I go to a large medical meeting and see doctors who make $200K a year or more lined up 10-15 deep to get free pens and tote bags
Another thing that always amazes me is the way that whenever several heavily promoted, competing drugs come on the market at about the same time, they are always priced within a few dollars or even cents of each other. Surely I am not the only one who finds this suspicious?
I didn't have time to read all of Gyan's links in detail, but another nefarious marketing tool is drug company funding of advocacy groups; just check out the first few links here.
Not all drug companies are like this.
As far as I can tell, the companies that don't market like this are the generic drug manufacturers, who are compteing on price rather than creating an artificially high demand for their product.
Finally, the info in Gyan's links regarding infant formula is right on. My wife is due in Feb. and has already started getting free samples of formula along with handy carrying cases for bottles and such from the formula reps. Big pharma is no slouch when it comes to marketing at all levels.
Great post.
posted by TedW at 10:28 AM on December 5, 2004
I was crippled in an accident at work last year...a series of blown out discs, none of which are operable :( Pharma reps have been a point of much contention between myself and my pain management doc...his office is typical I guess...clocks, posters, pens, clipboards, mugs etc from a myriad of pharma companies.
His point was that without the drug reps, it would be impossible for him to stay up to date on all the available meds. My rebuttal is that he should be reading medical journals to learn this stuff. The debate came to a head when he put me on Neurontin...since I ask him about every med he swore up and down that this stuff was ok. A week into taking it Neurontin started *really* messing with me...complete disassociation, the inability to do anything and major depression. The doc took me off it, and a couple months later I find out about the Neurontin lawsuits for illegally marketing it for uses the FDA never approved.
I have since moved to a new pain mgmt doc, but I am sad that people that work in life and death situations can be so easily swayed by a trip to hawaii or some other such spiff.
I know personally how difficult it is to deal with a serious accident, but with due respect, you don't know what you are talking about. Neurontin may or may not have worked for you, but you might consider the possibility that someone in your situation was apt to develop depression regardless of neurontin. Your physician's mistake was that he may not have listened to and respected you complaints following the drug trial.
Referencing a bunch of cheesey legal links, ignores the fact that there are countless well-designed studies that have shown the benefits of neurontin in treating neuropathic pain, along with a variety of other "off-label" diseases. Indeed, doctor's prescribe this and other medications quite frequently before the FDA weighs in for obvious (and not insidious) reasons. Neurontin is the first-line drug of choice at this time for neuropathic pain. Period. It's not perfect, it's often quite sedating, but it is the standard of care. Any neurologist, anesthesiologist, or other decent doc would tell you the same. To assume that the medication has earned this reputation through viral marketing alone is truly an insult to those who have made countless sacrifices and devoted their lives to improving the quality of life of others.
I can tell you from my experience, that while this sort of marketing does affect some private doctors in the community, most doctors are smart enough to know that if all their patients come back complaining of terrible side-effects and ineffective medications, they won't have patients for much longer. And also, from the perspective of someone who works in an large academic setting, speaking only for myself, this sort of marketing doesn't hold a candle to the pressures of delivering the most up-to-date evidence-based medicine. Such is the competition among doctors.
posted by drpynchon at 10:45 AM on December 5, 2004
His point was that without the drug reps, it would be impossible for him to stay up to date on all the available meds. My rebuttal is that he should be reading medical journals to learn this stuff. The debate came to a head when he put me on Neurontin...since I ask him about every med he swore up and down that this stuff was ok. A week into taking it Neurontin started *really* messing with me...complete disassociation, the inability to do anything and major depression. The doc took me off it, and a couple months later I find out about the Neurontin lawsuits for illegally marketing it for uses the FDA never approved.
I have since moved to a new pain mgmt doc, but I am sad that people that work in life and death situations can be so easily swayed by a trip to hawaii or some other such spiff.
I know personally how difficult it is to deal with a serious accident, but with due respect, you don't know what you are talking about. Neurontin may or may not have worked for you, but you might consider the possibility that someone in your situation was apt to develop depression regardless of neurontin. Your physician's mistake was that he may not have listened to and respected you complaints following the drug trial.
Referencing a bunch of cheesey legal links, ignores the fact that there are countless well-designed studies that have shown the benefits of neurontin in treating neuropathic pain, along with a variety of other "off-label" diseases. Indeed, doctor's prescribe this and other medications quite frequently before the FDA weighs in for obvious (and not insidious) reasons. Neurontin is the first-line drug of choice at this time for neuropathic pain. Period. It's not perfect, it's often quite sedating, but it is the standard of care. Any neurologist, anesthesiologist, or other decent doc would tell you the same. To assume that the medication has earned this reputation through viral marketing alone is truly an insult to those who have made countless sacrifices and devoted their lives to improving the quality of life of others.
I can tell you from my experience, that while this sort of marketing does affect some private doctors in the community, most doctors are smart enough to know that if all their patients come back complaining of terrible side-effects and ineffective medications, they won't have patients for much longer. And also, from the perspective of someone who works in an large academic setting, speaking only for myself, this sort of marketing doesn't hold a candle to the pressures of delivering the most up-to-date evidence-based medicine. Such is the competition among doctors.
posted by drpynchon at 10:45 AM on December 5, 2004
hey I am not the medical market, i am a designer and I just LOVE Rx pens, I have a nice collection. They are just so cool looking. If you have some, email me I'll take them off your hands!
posted by Dome-O-Rama at 11:35 AM on December 5, 2004
posted by Dome-O-Rama at 11:35 AM on December 5, 2004
Disclaimer: I don't have any medical qualifications, nor am I involved in medical/pharma industry, nor do I play a doctor on TeeVee, but I could (I guess). I just finished reading Powerful Medicines, which sparked my interest, and whose Notes section provided some of the links.
Some key points stood out from that book:
1)All that's required for a drug to be FDA-approved is that clinical trials must show that the subject drug is better than a placebo. No comparision required against existing drugs in the same class. In other words, only relevant question = is the drug better than nothing?
2)The clinical trials the company must conduct, need not reflect the real-world market where the drug will be used. There are relatively very few elderly people in trials, and they tend to be healthier in general than the average, even if the intended core market are the elderly.
3)Companies are required by FDA to conduct postapproval studies to monitor drug performance/side-effects. Many companies don't.
4)After FDA-approval for so-and-so use, there is no mechanism to prevent/monitor how doctors prescribe that drug. They may prescribe it for another condition..etc.
5)Sales reps, and their promotional material, naturally don't include all info about a drug's performance in trials.
6)Many doctors are not aware of drug costs, thus crippled from prescribing cost-effectively (prescribing cheaper & equally effective drugs over the latest patented thing). To illustrate, the author mentions that thiazides are better & cheaper for hypertension than the newer calcium-channel blockers. The author et al. ran a simulation where they analysed 130,000 pharmacy claims and diagnoses of >65 patients and via a decision-making software, selectively replaced CCB prescriptions with thiazides where they thought it was warranted. The cost went down by tens-of-millions of dollars and with better health outcomes. Extrapolated to the US, that would result in savings of $1.2 billion, with an upgrade in health outcomes.
I've omitted a lot of points, but the theme ought to be clear.
posted by Gyan at 11:38 AM on December 5, 2004
Some key points stood out from that book:
1)All that's required for a drug to be FDA-approved is that clinical trials must show that the subject drug is better than a placebo. No comparision required against existing drugs in the same class. In other words, only relevant question = is the drug better than nothing?
2)The clinical trials the company must conduct, need not reflect the real-world market where the drug will be used. There are relatively very few elderly people in trials, and they tend to be healthier in general than the average, even if the intended core market are the elderly.
3)Companies are required by FDA to conduct postapproval studies to monitor drug performance/side-effects. Many companies don't.
4)After FDA-approval for so-and-so use, there is no mechanism to prevent/monitor how doctors prescribe that drug. They may prescribe it for another condition..etc.
5)Sales reps, and their promotional material, naturally don't include all info about a drug's performance in trials.
6)Many doctors are not aware of drug costs, thus crippled from prescribing cost-effectively (prescribing cheaper & equally effective drugs over the latest patented thing). To illustrate, the author mentions that thiazides are better & cheaper for hypertension than the newer calcium-channel blockers. The author et al. ran a simulation where they analysed 130,000 pharmacy claims and diagnoses of >65 patients and via a decision-making software, selectively replaced CCB prescriptions with thiazides where they thought it was warranted. The cost went down by tens-of-millions of dollars and with better health outcomes. Extrapolated to the US, that would result in savings of $1.2 billion, with an upgrade in health outcomes.
I've omitted a lot of points, but the theme ought to be clear.
posted by Gyan at 11:38 AM on December 5, 2004
Here's the pattern. It starts with drug-company sponsored meals in medical school. It feels like a perk: you're in medicine now, your time is so valuable that people bring lunch to you. You're important now, not just some student. You're sitting around with doctors, eating lunch at noon conference. Your future decisions on meds are so critical that attractive, educated, sharply-dressed drug reps are bringing, right to your very doorstep, the latest and greatest information from their hard-working, beneficent labs.
You eat your drug-company pizza. You nod sagely along with the real docs at the endless drug-company powerpoint spiels showing the 0.1% improvement in outcome for the 1200% more expensive drug. Must be great science, 'cause you never hear any adverse effects reported (you only find out about that part of the study after your Vioxx patients start dying).
You eat more pizza. The charming rep with the enhanced hair, the enhanced teeth, and the enhanced chest slides the fancy pen into your lab coat pocket, then pats it and gives you the enhanced wink. You're in now.
Then, as a resident, you start to get the free textbooks. It's all done with the best intentions, of course. We're giving you this $200 book because it's for your education....and oh, by the way, we sure appreciate all the prescriptions for Greedicillin you've been writing on your service. The drug reps are your old friends, now, of course. You want someplace nice for your next resident all-day retreat? How 'bout we send you all to wine country for the day? It's on us...and oh, by the way, we notice your department's orders for Avaracine has fallen off just a tad.
Then you're board-certified. Every notepad in your office is embossed with an advertisement for Pfizer. Mouse pads by Merck. Anatomical charts on the walls by Lilly. Your waiting room is filled with slick brochures for Viagra that the rep thoughtfully got your office manager to lay out among the magazines, in return for a few lunches.
The drug reps hang out in your back office, see you between patients. What a wonderful tie you have on today, doctor. It really sets off your eyes. And gee doctor....you say you need some continuing education credits for board recertification? What a coincidence. We sponsor an intense three-day conference on "The Latest Indications for Expensive Triple HIV Therapies That No Third World Country's Patients Will Be Able To Ever Fuckin' Afford." And oh, it just happens to be in Maui, and it's all on us, of course, airfare and hotel and, um, snorkeling lessons.
And yeah, the drug reps are often such physically attractive people. They laugh at your lame jokes, maybe flirt a bit, maybe do a bit more. See how important you are? You're a doc...you deserve all this.
There is a shared understanding: you scratch my slimy back, I'll scratch yours. The cost to the patient (and often the health of the patient), or the cost to society through higher health and insurance costs, doesn't often enter into this oh so cozy picture. After all, patients don't bring the free lunches and don't (very often) wear the expensive suits....the tight skirts and sweaters.
But hey, that's American business, right? We're just doing business, ok? Ain't that what American medicine (and America herself, goddamnit) is all about as well? Health care consumers? Health care providers? Enormous profits for those doing business? What could possibly be better for America?
Horseshit.
There is absolutely no need for drug reps to have contact with physicians. All that docs need to know about a medicine can be found in the literature (where, of course, the next problem is to determine how much of a drug's "effects" are merely drug company hype, since so many of the "studies" are funded by the pharmaceutical companies themselves).
Accepting gifts, meals, texts, pens, junkets, fellatio, whatever....from these glorified peddlers is unethical. Accepting anything from a drug rep is unethical. Period.
posted by fold_and_mutilate at 12:05 PM on December 5, 2004
You eat your drug-company pizza. You nod sagely along with the real docs at the endless drug-company powerpoint spiels showing the 0.1% improvement in outcome for the 1200% more expensive drug. Must be great science, 'cause you never hear any adverse effects reported (you only find out about that part of the study after your Vioxx patients start dying).
You eat more pizza. The charming rep with the enhanced hair, the enhanced teeth, and the enhanced chest slides the fancy pen into your lab coat pocket, then pats it and gives you the enhanced wink. You're in now.
Then, as a resident, you start to get the free textbooks. It's all done with the best intentions, of course. We're giving you this $200 book because it's for your education....and oh, by the way, we sure appreciate all the prescriptions for Greedicillin you've been writing on your service. The drug reps are your old friends, now, of course. You want someplace nice for your next resident all-day retreat? How 'bout we send you all to wine country for the day? It's on us...and oh, by the way, we notice your department's orders for Avaracine has fallen off just a tad.
Then you're board-certified. Every notepad in your office is embossed with an advertisement for Pfizer. Mouse pads by Merck. Anatomical charts on the walls by Lilly. Your waiting room is filled with slick brochures for Viagra that the rep thoughtfully got your office manager to lay out among the magazines, in return for a few lunches.
The drug reps hang out in your back office, see you between patients. What a wonderful tie you have on today, doctor. It really sets off your eyes. And gee doctor....you say you need some continuing education credits for board recertification? What a coincidence. We sponsor an intense three-day conference on "The Latest Indications for Expensive Triple HIV Therapies That No Third World Country's Patients Will Be Able To Ever Fuckin' Afford." And oh, it just happens to be in Maui, and it's all on us, of course, airfare and hotel and, um, snorkeling lessons.
And yeah, the drug reps are often such physically attractive people. They laugh at your lame jokes, maybe flirt a bit, maybe do a bit more. See how important you are? You're a doc...you deserve all this.
There is a shared understanding: you scratch my slimy back, I'll scratch yours. The cost to the patient (and often the health of the patient), or the cost to society through higher health and insurance costs, doesn't often enter into this oh so cozy picture. After all, patients don't bring the free lunches and don't (very often) wear the expensive suits....the tight skirts and sweaters.
But hey, that's American business, right? We're just doing business, ok? Ain't that what American medicine (and America herself, goddamnit) is all about as well? Health care consumers? Health care providers? Enormous profits for those doing business? What could possibly be better for America?
Horseshit.
There is absolutely no need for drug reps to have contact with physicians. All that docs need to know about a medicine can be found in the literature (where, of course, the next problem is to determine how much of a drug's "effects" are merely drug company hype, since so many of the "studies" are funded by the pharmaceutical companies themselves).
Accepting gifts, meals, texts, pens, junkets, fellatio, whatever....from these glorified peddlers is unethical. Accepting anything from a drug rep is unethical. Period.
posted by fold_and_mutilate at 12:05 PM on December 5, 2004
I've been curious to see when this story breaks. One of my friends is a doctor and it's been amazing to to hear his stories of all the things that he can get for free: concert tickets, dinners, office supplies and even trips to Hawaii if he pushed. The only catch is that anything he does will involve being in the company of the drug rep. Although he tries to stay above the marketing and sales, he does admit that there is a great deal of pressure to "pay back" the nice person who has done so much for you. The fact that you are "paying back" at no immediate cost to yourself doesn't help matters either. Particularly if you are dealing with a patient who is an asshole anyways.
Another one of my friends was a drug rep who had finished a college degree and was just starting her career with her company. She'd worked as a stripper before and she joked that being a dancer was the preferred path into pharmaceutical sales. I don't know how accurate that is - but there's enough truth to it to be humorous.
posted by rks404 at 12:16 PM on December 5, 2004
Another one of my friends was a drug rep who had finished a college degree and was just starting her career with her company. She'd worked as a stripper before and she joked that being a dancer was the preferred path into pharmaceutical sales. I don't know how accurate that is - but there's enough truth to it to be humorous.
posted by rks404 at 12:16 PM on December 5, 2004
Accepting gifts, meals, texts, pens, junkets, fellatio, whatever....from these glorified peddlers is unethical. Accepting anything from a drug rep is unethical. Period.
While I agree with you your conclusion, I have to wonder if all the vitriol, drama, righteous indignation, half-truths, and exaggerations were necessary.
Also, as a rule, I never turn down fellatio, especially from strippers dressed in business suits.
posted by drpynchon at 1:28 PM on December 5, 2004
While I agree with you your conclusion, I have to wonder if all the vitriol, drama, righteous indignation, half-truths, and exaggerations were necessary.
Also, as a rule, I never turn down fellatio, especially from strippers dressed in business suits.
posted by drpynchon at 1:28 PM on December 5, 2004
here's another wrinkle, I've heard that the AMA prohibits its members from discussing alternative treatments with their patients. such as I use a white vinegar wash to treat my facial Rosacea. works as well for me as the expensive prescription.
Is it true that the AMA prohibits members from discussing alternative treatments? I sat in the hosp room as a doc suggested to my friend that they remove his right lung and lymph nodes for cancer treatment. My friend declined and went to Mexico for alternative treatments. one year later an MIR showed him cancer free and he kept his lung. Is it true that if I get cancer my AMA doctor can't inform me about alternative treatments?
posted by BigRoof at 2:02 PM on December 5, 2004
Is it true that the AMA prohibits members from discussing alternative treatments? I sat in the hosp room as a doc suggested to my friend that they remove his right lung and lymph nodes for cancer treatment. My friend declined and went to Mexico for alternative treatments. one year later an MIR showed him cancer free and he kept his lung. Is it true that if I get cancer my AMA doctor can't inform me about alternative treatments?
posted by BigRoof at 2:02 PM on December 5, 2004
The whole health care system has this sort of attitude where "If people are not dying left and right....it's ok" They'll get better somehow, someway. I'm in the medical field and it can be astonishing to see how even things like hypertension is treated so differently and through using different drugs and how individual doctors prescribe different things.
It can be trial and error, yes, but lots of times I fear a doctor might be one to many times to please a drug rep. and then go onto the thing they know works. And, as has been mentioned, it's not just pens. It's dinners and vacations too. That stuff -- I can't blame doctors. I routinely see my friends in law in business get great seats to games, expense fancy lunches, get the "corporate rate" on lots of things -- when I'd get squat -- despite having a similar educational background -- and, I'd say, even tougher. Drug reps and their goodies are really the only way for these "professionals" into that world......so, you, can't blame the doctors necessarily. They're people and often unappreciated, underpaid people at that (for the amount of work that goes into our careers before they "possibly" (if the HMOs won't remove it) see money).
That said, any hope of changing this stuff is sort of ridiculous. The public could care less and the Republicans and Dr. Frist control a lot of stuff. Their really is no reason to even have drug commercials on TV -- but they're there do to BIGDRUG's lobbying (which I want to say happened under Bush).
That said, you guys might want to look at the American Medical Student Association (http://www.amsa.org/) It's sort of what would happen if the Nation went to medical school but it's basically a great force for Progressive change in health care reform.
posted by narebuc at 2:46 PM on December 5, 2004
It can be trial and error, yes, but lots of times I fear a doctor might be one to many times to please a drug rep. and then go onto the thing they know works. And, as has been mentioned, it's not just pens. It's dinners and vacations too. That stuff -- I can't blame doctors. I routinely see my friends in law in business get great seats to games, expense fancy lunches, get the "corporate rate" on lots of things -- when I'd get squat -- despite having a similar educational background -- and, I'd say, even tougher. Drug reps and their goodies are really the only way for these "professionals" into that world......so, you, can't blame the doctors necessarily. They're people and often unappreciated, underpaid people at that (for the amount of work that goes into our careers before they "possibly" (if the HMOs won't remove it) see money).
That said, any hope of changing this stuff is sort of ridiculous. The public could care less and the Republicans and Dr. Frist control a lot of stuff. Their really is no reason to even have drug commercials on TV -- but they're there do to BIGDRUG's lobbying (which I want to say happened under Bush).
That said, you guys might want to look at the American Medical Student Association (http://www.amsa.org/) It's sort of what would happen if the Nation went to medical school but it's basically a great force for Progressive change in health care reform.
posted by narebuc at 2:46 PM on December 5, 2004
I've been curious to see when this story breaks. One of my friends is a doctor and it's been amazing to to hear his stories of all the things that he can get for free: concert tickets, dinners, office supplies and even trips to Hawaii if he pushed skyrocketing malpractice premiums, OB/GYNs not able to practice their love, and trail lawyers...never forget those trial lawyers.
Whose needs the truth when lies are so much more effective.
And the story has already broke, but it was just swept into the trash and replaced by rhetoric from whores in suits.
posted by MikeKD at 3:01 PM on December 5, 2004
Whose needs the truth when lies are so much more effective.
And the story has already broke, but it was just swept into the trash and replaced by rhetoric from whores in suits.
posted by MikeKD at 3:01 PM on December 5, 2004
Both of my mothers (step and normal) are practicing nurses, and I've heard lots of interesting anecdotes. My step-mother works in a high-paying private cancer practice, and she basically never needs to pay for lunch. Meals at $40 restaurants happen monthly. It seems very clear that drug companies are spending an exhorbinant amount on these "perks". What's more unclear is if it's working
One area where it is definitely working is well documented: formula. My mom works labor and delivery, and they are litereally inundated with free formula samples. No women leaves the hospital without a week's supply of formula. Many doctors no longer advocate breast feeding, simply becuase it's more effort for them. My mom is a very strong breastfeeding advocate and works hard to fight against the formula hegemony, but, there's not much she can do when the doctors are too lazy and overworked to make breastfeeding a priority. The formula people have already won.
posted by JZig at 4:00 PM on December 5, 2004
One area where it is definitely working is well documented: formula. My mom works labor and delivery, and they are litereally inundated with free formula samples. No women leaves the hospital without a week's supply of formula. Many doctors no longer advocate breast feeding, simply becuase it's more effort for them. My mom is a very strong breastfeeding advocate and works hard to fight against the formula hegemony, but, there's not much she can do when the doctors are too lazy and overworked to make breastfeeding a priority. The formula people have already won.
posted by JZig at 4:00 PM on December 5, 2004
I would like to think that I am not susceptible to the marketing by the drug companies. I don't take anything that the drug reps tell me into consideration when I am writing a prescription. However, I guess that if it did not work they would have stopped a long times ago.
The drug reps that come to the hospital often come off looking pretty ignorant about the nuts and bolts of the medications that they are trying to push. Their pens suck and most of the other crap I would not want to be seen with.
There is one freebie that I have kept. It is actually from my grandfather who is also a doc. It is a glass red blood cell with the name of the drug hovering in the glass. I hope he got it along time ago, because it is an ashtray.
For me the most frustrating thing to deal with is patients who come in and want to be put on some drug that they saw on an ad and they don't even really know what it is used for.
The most disturbing trend that I see in medicine though is this. There is a great deal of research going on and a great deal of pressure to make it profitable whether it is drugs, devices or procedures. What I see happening is the creation of a lot of problems to use these things for rather than the other way around
posted by gonadostat at 4:15 PM on December 5, 2004
The drug reps that come to the hospital often come off looking pretty ignorant about the nuts and bolts of the medications that they are trying to push. Their pens suck and most of the other crap I would not want to be seen with.
There is one freebie that I have kept. It is actually from my grandfather who is also a doc. It is a glass red blood cell with the name of the drug hovering in the glass. I hope he got it along time ago, because it is an ashtray.
For me the most frustrating thing to deal with is patients who come in and want to be put on some drug that they saw on an ad and they don't even really know what it is used for.
The most disturbing trend that I see in medicine though is this. There is a great deal of research going on and a great deal of pressure to make it profitable whether it is drugs, devices or procedures. What I see happening is the creation of a lot of problems to use these things for rather than the other way around
posted by gonadostat at 4:15 PM on December 5, 2004
Their pens suck and most of the other crap I would not want to be seen with.
I work at a peds office, and the pens and other free crap is almost fought over. Some of the pens suck, some are far better than the average pen.
I tend to hoard the good ones, and the free lunches? Mmmmmm....
posted by justgary at 6:07 PM on December 5, 2004
I work at a peds office, and the pens and other free crap is almost fought over. Some of the pens suck, some are far better than the average pen.
I tend to hoard the good ones, and the free lunches? Mmmmmm....
posted by justgary at 6:07 PM on December 5, 2004
Tickets to the ballgame??? Trips to Hawaii?#?#? FELLATIO?#!?#!?
I write a LOT of prescriptions and all I've got to show for it is a bunch of these damn pens! Oh,...and some tablets too. And, well, to be perfectly honest, I have a couple of water bottles as well.
Jeez, maybe it's the specialists who are reaping the windfall of all this drug company largess. Maybe us primary care guys are just getting overlooked? Do you think some drug company would be willing to ship me and my 20 year old pickup truck over to Europe for one of these fantastic junkets? (Not that I'm bitter or anything.)
posted by FredFeral at 6:49 PM on December 5, 2004
I write a LOT of prescriptions and all I've got to show for it is a bunch of these damn pens! Oh,...and some tablets too. And, well, to be perfectly honest, I have a couple of water bottles as well.
Jeez, maybe it's the specialists who are reaping the windfall of all this drug company largess. Maybe us primary care guys are just getting overlooked? Do you think some drug company would be willing to ship me and my 20 year old pickup truck over to Europe for one of these fantastic junkets? (Not that I'm bitter or anything.)
posted by FredFeral at 6:49 PM on December 5, 2004
I work at a company that builds sites and web-products for a large pharmaceutical company... so I see all this "promotional" stuff for consumers and Healthcare professionals all the time. I absolutely hate it and the pharmaceutical (and most, really) in question.
I'm not high-up enough to know the full plans and goals, but... some of the stuff seems kinda shady. I think they want to make a database of all HCPs and identify the ones "favourable" to the companies' products. So they could reward the shills, no less.
Anyway, it's all moot as I quit this job today.
posted by mkn at 10:24 AM on December 20, 2004
I'm not high-up enough to know the full plans and goals, but... some of the stuff seems kinda shady. I think they want to make a database of all HCPs and identify the ones "favourable" to the companies' products. So they could reward the shills, no less.
Anyway, it's all moot as I quit this job today.
posted by mkn at 10:24 AM on December 20, 2004
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posted by Gyan at 10:04 PM on December 4, 2004