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"I said, 'why is it I'm ordering one drug and a totally different drug is being given?'" LaCorte said. "And I was told 'therapeutic interchange.'"

Therapeutic interchange meant the hospital was switching virtually all antacid prescriptions to Pepcid. And it wasn't a meaningless change.

Merck ended up paying $650 million a year to make that drop in the bucket problem whistleblower go away.  

The fight took 12 long years, but Merck recently agreed to pay back taxpayers $650 million for deals to get hospitals nationwide to favor not only Pepcid, but also Merck drugs Zocor and Vioxx.

Then it's back to business as usual: an utterly corrupt medical community that's married to an utterly corrupt pharmaceutical industry continues destroying what's left of America's public health system.

The relationship between drugs companies and physicians is also vulnerable to corruption. Doctors may be offered commissions for prescribing a particular drug or a drug from a particular company. Because this practice is illegal in most countries, companies may employ underhand methods to disguise such kickbacks. The aggressive promotion of medicines, the sheer volume of information that is received in its many forms by prescribers and the use of patient groups through which to generate demand for prescription drugs, all contribute to the inappropriate prescription of medicines. In the United States some US$ 16 billion is spent annually by pharmaceutical, device and biotechnology industries on marketing to physicians.

One day all the crooks who are enabled by corrupt Washington DC pols will ALL face their day of reckoning.  One day.

Originally posted to a gnostic on Fri Mar 07, 2008 at 05:58 PM PST.

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Comment Preferences

  •  Ouch!! (11+ / 0-)

    I'll try not to take this personally - but I used to get lots of pressure from drug reps when I was in private practice to prescribe their drugs.  I had heard of the Neurontin "speakers' fee" scandals, and found them pretty awful.
     Now that I work in an urgent care clinic, the only drug reps who come around are pushing rarely used allergy meds and pediatric meds that are now prescription, rather than OTC - and I never hand those samples out, much less prescribe them.
     It seems that the pressure and the reps go where the money is -
     Please don't tar all of us physicians with the same brush.

    In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by drchelo on Fri Mar 07, 2008 at 06:01:49 PM PST

    •  you have to admit (3+ / 0-)
      Recommended by:
      Marie, navajo, AmericanRiverCanyon

      doctors haven't done much... at ALL... to stop a totally corrupted system.

      in a way, all doctors are to blame.  you folks need to organize with each other to save your reputations.  where' the AMA?  why aren't there stiffer sanctions to corrupt doctors?

      that coming, thanks for being one of the "good guys."

      •  The AMA spent decades fighting against (4+ / 0-)
        Recommended by:
        tmo, debedb, AmericanRiverCanyon, Pinecone

        universal health care.  That was a good way to control the supply of health care providers and therefore, maintain high incomes for physicians.  Worked great for specialists. Primary care physicians, not so much.  But the lightbulbs are beginning to go on for physicians as they spend more and more time on paperwork and fighting with insurers.

        In a rational world, the coalition of physicians, big industry and a solid majority of Americans would be enough to switch to universal coverage.  Too bad those invested in and doing very well within the current system are strong and ruthless enough that they can keep this nation from even having the discussion.

        What FDR giveth; GWB taketh away.

        by Marie on Fri Mar 07, 2008 at 06:14:48 PM PST

        [ Parent ]

        •  The AMA controls the number of doctors (3+ / 0-)
          Recommended by:
          Marie, debedb, AmericanRiverCanyon

          by using its sub-organization, the Association of American Medical Colleges. Through the AAMC, it controls enrollments and curricula. It's not a pretty picture, but there are plenty of doctors who want to provide good care. The AMA and the MBAs have corrupted the whole process.


          "This chamber reeks of blood." -- Sen George McGovern, 1970

          by cotterperson on Fri Mar 07, 2008 at 06:19:00 PM PST

          [ Parent ]

          •  Not really true. (4+ / 0-)
            Recommended by:
            cotterperson, BlueGoo, drchelo, Pinecone

            It's not the AMA. The Association of American Medical Colleges has essentially nothing to do with the AMA. The physician supply has more to do with the willingness of states and health insurers to subsidize the (very expensive) education of medical students, and especially the grotesque mal-distribution of physicians among specialties.

            The truth is that America has enough doctors already. We do! We have more per-capita than most European nations. The problem is that we have far, far more subspecialists, surgeons and proceduralists than we rationally need, and far, far too few family physicians and general internists. This disparity has been cemented in place by gross underpayment of primary care docs, and gross overpayment of thoracic surgeons and radiologists.

            The paradoxical result is that we have a dwindling force of grossly overworked primary care docs getting paid peanuts, and mushrooming ranks of procedural specialists chasing the well-insured and inventing new procedures to keep themselves busy and well-paid. This grotesque distortion of the physician workforce creates the illusion of a shortage.

            •  Well, no offense, but you guys have to figure out (1+ / 0-)
              Recommended by:

              ... a way to change this if you don't like any of our layperson's suggestions. Because the "system" cannot continue to function like this.

              While we're on the topic of medications, somebody needs to get real motor- vated to start figuring out how to pressure the FDA into forcing pharmaceutical companies to be more careful with their ingredients, because the Chinese are now supplying so much of our binders and fillings and raw ingredients but are not being real careful about what really is IN them.  It is only a matter of time before we have an even bigger problem than tainted heparin killing a few heart/dialysis patients and sickening hundreds more.

              There is a huge problem going on right now with mystery ingredients in otc and prescribed drugs, such as the major allergens not being called out on the labels.  When the companies are contacted, there is then a lot of CYA vague statements about how they can't confirm or deny what was used in that batch. Or the batches switch from lot to lot, and what was corn sourced last time could now be from wheat or rice or who knows what.  This may not be a big deal to most people, but if you have allergies or intolerances it is a HUGE deal, esp. if the pharmacy you are using wants you to confirm the status yourself because they cannot get an answer.  If a pill has white powder filler in it, should we not be able to expect to know what it is ?

            •  I can't find a link, so you must be right. (0+ / 0-)

              I know the rest of what you say is true. Sorry for passing bad information.

              I watched the super-subspecialization of internal medicine happen, and saw surgeons, internists, and pediatricians compete for position in the then-new  subspecialty of critical care. The reimbursement in that area is great for hospitals and physicians as well.

              Money shouldn't be deciding these things, imho.

              Thank you for the thoughtful, knowledgeable response.

              "This chamber reeks of blood." -- Sen George McGovern, 1970

              by cotterperson on Fri Mar 07, 2008 at 08:03:20 PM PST

              [ Parent ]

              •  Sadly, money always decides these things. (3+ / 0-)
                Recommended by:
                cotterperson, BlueGoo, drchelo

                The average medical student graduating today carries (depends on the study) between $100,000 and $150,000 in educational debt. Thanks to BushCo's absurd "free market" ideology, programs for loan forgiveness and subsidies like the National Health Service Corps have been obliterated. Interest begins compounding while students are still in school. Most doctors are about 30 years old by the time they finish residency training and start their careers; many if not most are married and already have a few kids. Consequently the pressure to earn a lot of money quickly is overwhelming, and the vast majority feel compelled to choose a subspecialty that pays very well. This problem is greatly exacerbated by the "culture" of academic medical centers, which exalts the God-like procedural subspecialist and treats primary care doctors like slightly retarded door-mats. I shit you not, the withering contempt directed toward primary care by the "gurus" is mind-boggling.

                So until we start paying primary care docs a bit more, and interventional radiologists a hell of a lot less, this crisis will only deepen.

      •  Hey, don't slander us all. (10+ / 0-)
        1. I don't accept trinkets or gifts of any kind. I never meet with pharmaceutical representatives. I do let them in the office to drop off samples, because for many of my uninsured patients these are the only medications they will ever get. But the instant one of the "detailers" tries to pitch me in the hallway, he's out on his ear. We've come to an understanding.
        1. I never—ever—accept literature from drug companies. Anything left behind is immediately shit-canned. I depend on independent, peer-reviewed, skeptical sources like the Medical Letter for drug information. So do most of my colleagues, at least in my little town.
        1. The AMA is essentially a club of conservative Midwestern physicians that heavily over-represents surgeons and proceduralists compared to primary care physicians. It has been a major hindrance to serious discussion of genuine national health insurance for more than 50 years. It is in bed with BigPharma, to the extent that a past president of the AMA sold out the organization's name to endorse a line of "health care products" from Sunbeam. He was shortly thereafter forced to resign because of the embarassment, but the AMA's default position when encountering BigPharma is to bend over.
    •  I'm a hospital doc (10+ / 0-)

      No drug reps, no drug dinners. I even bring my own pens. Some of us are trying to do the right thing. I suspect a lot of us are.

      I would appreciate the same thing as drchelo- to not be tarred by the same sweeping brush.

      Bye Bye Blackwell!

      by BlueGoo on Fri Mar 07, 2008 at 06:10:09 PM PST

      [ Parent ]

    •  I know what you say is true, (3+ / 0-)
      Recommended by:
      BlueGoo, AmericanRiverCanyon, drchelo

      though I am not a physician. I worked at a medical school for 20 years, and saw a lot of drug reps on the make. They'd sponsor speakers and bring colorful pamphlets.

      The second chairman of medicine I worked for put a stop to it. Drug reps could only bring reprints of articles in medical journals! He got a mixed reception from the residents and faculty, but he stuck to it.

      I suspect it's gotten much worse since I left 12 years ago. This sounds like hospitals overriding doctors -- NOT a good plan!

      "This chamber reeks of blood." -- Sen George McGovern, 1970

      by cotterperson on Fri Mar 07, 2008 at 06:16:19 PM PST

      [ Parent ]

    •  drchelo . . . (8+ / 0-)

      how are you doing?

      How are you feeling, any better?

      Let us know. Thinking of you.

      •  I'm half-way through.. (4+ / 0-) chemo, nyceve - I'll be finished with this damn cancer treatment on May Day!
         I'm feeling pretty good.  Able to work for a week and a half in between treatments.
         And yes, I'm pissed at Big Pharma for charging me $6K a pop for oxaliplatin and making my hands into pincushions.  
         I suppose my $ go to pay for the woolly gloves the drug company "gave" me before I started treatment.

        In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

        by drchelo on Fri Mar 07, 2008 at 06:24:31 PM PST

        [ Parent ]

  •  duh (3+ / 0-)

    and thanks.

    "We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly," MLK

    by educonfidential on Fri Mar 07, 2008 at 06:05:05 PM PST

  •  Ethical physicians should (4+ / 0-)

    refuse to take so much a pen from a drug rep.  And many do just that.  Unfortunately far more take whatever gelt is being handed to them.  

    There are many reasons why health care consumes a larger share of GDP in the US than in other industrialized companies even though a large percentage of Americans are denied any care at all.  
    The graft and corruption is one of the reasons.

    What FDR giveth; GWB taketh away.

    by Marie on Fri Mar 07, 2008 at 06:08:51 PM PST

  •  My shrink did to to me. (4+ / 0-)

    Now I trust noone and take nothing.

    "Injustice anywhere is a threat to justice everywhere." ~ Dr. Martin Luther King, Jr.

    by godislove on Fri Mar 07, 2008 at 06:09:20 PM PST

  •  I'm on Lexapro (1+ / 0-)
    Recommended by:

    It's expensive.  I notice that they give out lots of free clocks, notepads, pens, and various stuff at my clinic.  Furthermore, they give out lots of free stuff to non-psychiatric clinics.  

    I'm ambivalent.  I have had three psychiatrists tell me that Lexapro is absolutely the best anti-depressant, because it gives one extra energy.  It certainly seems to increase testosterone levels.  

    I get my Lexapro for free, under its manufacturer's program for low-income patients.  

    That's one drug.

    Mostly, big pHarma drug-shilling is fraud.  Many doctors use free samples to help out low-income patients.  Sometimes, this is a very good thing.

    The whole system is in need of reform.  Too bad John Edwards dropped out.

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