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View Diary: Physician Payment and Drugs: a bit of clarity (22 comments)

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  •  They are not paid cash, but what about the (1+ / 0-)
    Recommended by:
    IARXPHD

    'conferences' in Hawaii's etc, sponsored by the drug companies? Are those tied to how many prescriptions for X that you've written?

    •  Funny thing about those conferences (3+ / 0-)
      Recommended by:
      icemilkcoffee, N in Seattle, FG

      I don't know how truly prevalent they were, or if they were always an urban myth.  I know a ton of Physicians and not a single one has ever been offered a trip to Hawaii.  I know we never have been offered one.

      In fact, a lot of medical practices won't allow drug, medical supply, etc.. reps to bring in lunch, freebies, etc... It is getting to be more and likely a rep won't get in the door.

      Some Physicians do meet with Reps but that is to get new information and samples.  I know a bunch of Physicians that give out the samples to people that don't have insurance or much money to help out.  

      •  My father (2+ / 0-)
        Recommended by:
        dogdad, Andrew F Cockburn

        was a physician for 40 years and he never got a free trip anywhere.  I've never heard of free trips for writing prescriptions.

        •  And I know physicians who made a living (2+ / 0-)
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          cynndara, Oh Mary Oh

          from attending sales meetings, educational conferences, and being on speaker's bureaus. Thought leader physicians were overwhelmed with invitations in the 90's and it hasn't really slacked off. Now docs are recruited to be in "post marketing trials" where they get paid to prescribe medications to be in studies where they might have to fill out a 2 question protocol.

          I was in a position to influence the formulary at a larger hospital in Florida for 15 yrs, and I was offered trips to Martha's Vineyard, the Masters tournament, and since we were close, more Disney junkets for my family than I could have taken vacation days off to cover. And the physicians on the committee had to be kept confidential to keep the sales reps from camping in their office waiting rooms to offer them the same incentives.

          Watch "Love and Other Drugs"...pretty accurate. It's an ADULT movie, don't watch with kids. Where there is money to be made, there are "adult activities" offered.

          WTF!?!?!?! When did I move to the Republic of Gilead?!

          by IARXPHD on Mon Dec 10, 2012 at 02:08:05 PM PST

          [ Parent ]

          •  This isn't being paid to prescribe. (3+ / 0-)
            Recommended by:
            susanala, dogdad, cynndara

            It is being paid to conduct a clinical trial. It is a different issue. This has been a very big problem- drug and device companies have flat-out bought some prominent researchers to shill their products.

            Most academic medical centers have cracked down hard on this over the last few years. IRBs require conflict of interest statements on both the protocol and on consent forms. Free meals, trips, and other give-aways have mostly disappeared.

            The other problem that you don't mention is the drug companies providing meals and swag to medical students. An MD making upwards of $200,000/year is not going to be impressed by free pizza. Medical students and residents who are piling up enormous debts are easier to influence. If they develop a habit of looking at a particular catalog early on it could pay enormous benefits to the drug company over their career. Therefore many medical schools have banned free meals.

            •  I don't want to get into a big arguement.... (0+ / 0-)

              But I know from my PhD research these are NOT true clinical trials, they are done in order to promote brand loyalty.

              They may go through IRB as ethical, but for the individual clinic or physicians office there may not be an IRB.

              Many of these trials are merely prescribing a medication for a patient, and having the patient report adverse effects at their next visit. There is no hypothesis being evaluated, these are drugs that are FDA approved, so there is not a pressing need for information to bring a medication to the market.

              They are, for all practical purposes, a sham. They give physicians an incentive to use and become used to using, newer and more expensive medications, often with no clinical benefit beyond the 10 other medications already available in a therapeutic class.

              WTF!?!?!?! When did I move to the Republic of Gilead?!

              by IARXPHD on Mon Dec 10, 2012 at 03:07:51 PM PST

              [ Parent ]

    •  The FDA (I think it's the FDA) has really clamped (4+ / 0-)

      down on all those"freebies" right down to the free pens, cups, post-it notes, and notepads.  My doctor's nurse was complaining she doesn't get all the pens and whatnot like she used to, and she was going to have to actually buy it for the first time.  

      Where I am temping now, there are very strict policies in place and that is not allowed.  This is not to say there are unethical doctors and sales reps, who may have figured out a way to get around this.  However, my BIL who used to practice, would laugh, and they could give him all the free stuff they wanted, but he would only prescribe their product if that was the best way to treat his patient.  He was a good doctor, but left because he got tired of fighting with the insurance companies.

      •  That is exactly right (2+ / 0-)
        Recommended by:
        Andrew F Cockburn, VClib

        My wife was the same way.  The samples are great to give to people that otherwise couldn't afford the drugs.  I know a ton of docs that do that.

        •  And it makes them even MORE expensive (0+ / 0-)

          to everyone else.
          It makes insurance premiums increase for everyone else. And it creates a false reliance on new under-tested and much more expensive medications rather than tried and true and often inexpensive generic medications. I mean come on, most areas have pharmacies with a long list of $4 a month medications that work.

          It also is a health hazard as these samples are not entered into pharmacy computer systems for interaction and duplication checks.

          Never rely on a drug sales rep...all they do is SELL their companies stuff. They don't give a shit about patients and they laugh behind physicians backs about how they are fooled by the reps.

          WTF!?!?!?! When did I move to the Republic of Gilead?!

          by IARXPHD on Mon Dec 10, 2012 at 02:01:38 PM PST

          [ Parent ]

      •  Nope....all voluntary, no FDA involvement at all. (1+ / 0-)
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        cynndara

        They now do it all through the backdoor. There is no force of law behind any limits on behavior.
        And any money not spent there is rolled in DTC advertising and other edutainment focused on prescribers.

        And any physician who thinks all the gifts do not effect their prescribing failure is just deluding themselves. There is a good size body of research about gift theory and how gifts effect prescribing. I  should know, I read every since article published on the subject before 2008 as a part of my dissertation literature review.

        WTF!?!?!?! When did I move to the Republic of Gilead?!

        by IARXPHD on Mon Dec 10, 2012 at 01:56:48 PM PST

        [ Parent ]

    •  Nope (2+ / 0-)
      Recommended by:
      IARXPHD, Andrew F Cockburn

      They are actually geared toward physicians who may not be prescribing the company's product.

      The idea is that when the doctor thinks Condition A, they will automatically prescribe Drug B. That's what the pens and note pads and clipboards are all about: Keeping the company's drug the default drug of choice.  

      "Life is too important to be taken seriously" Oscar Wilde

      by Annie B on Mon Dec 10, 2012 at 11:25:33 AM PST

      [ Parent ]

      •  It is basic marketing (1+ / 0-)
        Recommended by:
        Andrew F Cockburn

        Keep the drug name in front of the Doc, Nurse, Nurse Practionner, etc...  

        •  But unfortunately, those actually PAYING (1+ / 0-)
          Recommended by:
          cynndara

          for the docs choices are not in the "basic marketing" equation like they are for any other purchases they would make.

          Just think, if only doctors could decide who could have what  kind of car, there would be nothing but Mercedes, Cadillacs, and Porsches on the roads today. If you don't have to pay for it, you don't have the usual economics of scarcity to take into effect.

          WTF!?!?!?! When did I move to the Republic of Gilead?!

          by IARXPHD on Mon Dec 10, 2012 at 02:11:40 PM PST

          [ Parent ]

    •  icemilkcoffee - those types of incentives (1+ / 0-)
      Recommended by:
      nextstep

      were outlawed by Congress more than ten, maybe twenty, years ago. There are very severe restrictions about what a drug rep can do for a physician or office staff.

      "let's talk about that"

      by VClib on Tue Dec 11, 2012 at 01:19:13 AM PST

      [ Parent ]

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