Today a lady who promotes Lantus insulin for Sanofi-Aventis drug company came to my office. She brought a dietician with her, and brought lunch for me and my office staff as well as the two of them. They were there partly to promote a diabetic education program they have, which I think is free to the patients, in exchange for me just listening to their promotion of their fairly new, very long acting insulin.
October 5, 2006
Sanofi and Aventis are merging; they may not even have finished the deal. Aventis used to be known as Aventis-Pasteur, and they were the company from which my office has been buying our flu shots (directly) for years -- until last year.
Last flu season Aventis was the company that DIDN'T have trouble producing flu vaccine. The only other company in the US market last year had production problems, so there was a shortage. This spring my office manager tried, as usual, to 'pre-book' our order with Aventis. Their phone was busy most of the day, and their web site was down. By the time we got through, they said they were sold out. I tried to speak to someone 'higher up' but the highest up lady who'd talk to me on the phone told me basically that I -- and my patients -- were s--- out of luck. Eventually we managed to place an order through a medicine wholesaler, that said we'd be getting flu shots produced by Aventis (!) when they were available. Apparently the wholesaler's phone call to Aventis got through, or they got to 'pre-book' before the process was opened up to small fry customers like my office.
Today, as has happened most office days for the last month, I told a patient the flu shots hadn't come in yet, and that I didn't think anybody has them. Then I heard that some of the walk-in clinics in town were advertising flu shots. (This seems to be incorrect, the clinics in question have the inhalable flu immunization, which isn't approved for elderly patients. Most of my practice is elderly.) On checking farther, it seems at least one doctor in town, whose office (a large office with four internists) put in orders for flu shots from FIVE different sources, has gotten a partial fill of one order -- three bottles, or thirty doses at most.
Then the unfortunate lady from Sanofi walked in. I told her I was upset that her company had stiffed me for flu shots, being unable to take my order last spring. She tried to beg off, saying Aventis was a whole other division, and she didn't even think they'd finished merging, and she had no control over what they did on the other side, and she didn't even know anybody at Aventis, and so on. I wasn't buying any of it. I told her to call her boss -- "There's a phone," -- and tell him to keep going up the corporate ladder until he finally did get to someone who could move things at Aventis.
I said I didn't want to hear about her insulin until my patients could get their flu shots. I then finished one taco, and walked out of the room where we have lunch. A little later my receptionist showed her into my office. Round two.
I pointed out that the flu shots are the second wisest thing I get to do for my patients. "Not, smart, but wise. It doesn't take a lot of smarts to say, 'Gee Ms. Patient, you're over sixty (or diabetic, or have a chronic disease, or a lot of other things that make a patient high risk for pneumonia and even death complicating the flu), so you should have the flu shot.' A good ninety percent of my patients are high risk for one reason or another and ought to get high priority for getting the flu shot. Giving those folks the flu shot doesn't require smarts, but it is WISE. Not giving those patients a flu shot would be very unwise. The only reason I call flu shots the second wisest thing I do is that flu shots are only good for a year. The pneumonia shot (immunizing against Pneumococcus) is good for ten years or more, and the protection -- against a different though similar threat -- is at least roughly comparable to what the flu shot gives you for just one year."
"The difference between your company's Lantus insulin," I continued, "and other types of insulin is like icing on the cake. The flu shots are the damn cake! Don't come in here trying to sell me on your insulin until your own company gets my patients their flu shots."
In retrospect, I feel a little bad about jumping all over this detail lady over something that's at least way off her usual path. (I'm going to give her a copy of this, for her boss's boss's boss's boss's boss, or however many layers her company has.) But I'll feel a whole lot more than 'a little bad' if the flu comes early this year and some of my patients end up in the hospital with pneumonia.
Full disclosure: I don't directly own stock in any drug company that makes flu shots. Most of my patients are on Medicare, and I'll make maybe $5 for each flu shot I give to Medicare patients if I'm lucky. I'll do a bit better on patients who pay cash and maybe on patients with private insurance, but I'm not making any great money on flu shots.