Comments on: Hey Doc, It Hurts When I Do This….

By: mui

mui — Fri, 10 Aug 2007 15:56:04 +0000

Doing a very quick driveby. Pharma companies are like lobbyists to the doctors. I know a few doctors who are clean, and others who are not so clean. Marcia Angell nails it on the head in her book, The truth about drug companies. There is fake research and conferences that tell doctors that prescribing an epilepsy drug is good for bipolars, & etc. (Even doctors can be credulous). When in fact it was not, nor FDA approved. Forget the name of the drug. But what a fiasco. HMO pushes for lower amounts of visits and aids and abets the drug companies by pretending a patient can go for months without visits, since drugs are supposed to be so great, particularly in the Mental Health area. It kills the Mental Health profession really for HMOs to pretend that mental health is nothing but a prescription thing. Doctor Freud would be appalled I think.
Incidentally, I was picking up a prescription at a chain pharmacy and the coversation went like this: Pharmacy clerk says that she lost her pen. I say, but the pharm reps always provide enough pens for you don’t they? Pharmacy clerk, says oh yeah and lots of other stuff as well, last week our rep brought us pizza, & etc.
Pizza?!?

By: G in INdiana

G in INdiana — Fri, 10 Aug 2007 13:32:22 +0000

If you look back in the history of health care reform in the USA, it is the AMA that has been out front AGAINST any sort of universal or national health care. They are the number one enemy of making sure all people get covered because they won’t be able to snag those perks like Mr. Kain mentioned.
They claim to hate the system but it is the one under which they profit the most. A lot of them are deluded into thinking it is a free market system, but most of them wouldn’t know one if it came up and bit them on the rear end.
Just mention to your physician that his “union” is one of the main reasons health care in this country is in a mess. It has been since it started…

By: James Kain

James Kain — Fri, 10 Aug 2007 12:09:54 +0000

Sadly, I am a pharma rep. It is, however, my last week, so I feel I can freely share my thoughts here at FDL.

The little good that reps do is to provide clinical evidence about a particular drug’s efficacy, mainly through published studies. Doctors can’t keep track of all the information that is out there; they are physicians and not pharmacists, and so there is generally a small need for reps to answer questions and provide genuine knowledge about a drug’s application.

However, that is not how the system works. The system is broken. Most doctors, which I would pin down at 75% from my experience, cater themselves to the pharmaceutical industry and will pimp themselves out to the highest bidder. This is done through speaker programs, for which doctors are paid an honorarium, as well as office lunches, expensive dinners, and small gifts. Actually, spending on doctors has been severely curbed; ten years ago it was not uncommon for doctors to be given expensive vactations or season tickets for sporting events.

Not only is this horrible medicine- this is money that could be spent on research for new cures or that could be put back in the pocket of the customer so they could actually afford medication. Again, most doctors will cater (write prescriptions) to the company that rewards them the most, which means that, for each class of medication, they have four or five reps each spending thousands of dollars per year on a single doctor. There are hundreds of classes of medications that exist.

The best doctors don’t play this game- and only spend time with reps discussing clinical data by going over peer-reviewed published journals. This is what medicine is supposed to be, and sadly, what we have in the US is far from it.

By: gorobei

gorobei — Fri, 10 Aug 2007 05:30:21 +0000

I worked for one of those data mining companies until recently. Ours was a little different. Better or worse is hard to say. We matched anonymized doctor office visit data against the prescription data as well. So we could show over time how a doctor was diagnosing, treating and prescribing. But this really was at the “market research” level. Just showing trends and differences in the uptake of new drugs. We seldom detailed to the physician level. It happened more on procedures.

Over all it was a bit creepy, but not as sinister as the folks who actually track prescriptions by doctor.

More often than not, it was information that helped a company decide whether investing in a new drug in a market made financial sense. If it can be accused of anything it would be of providing more evidence to drug companies for why they should develop or not develop a drug for an orphan illness.

Sure, ideally every condition would be funded to the nines with research on treatment. But thats not the system today.

By: Moesie from Boston

Moesie from Boston — Fri, 10 Aug 2007 04:12:51 +0000

Jane..wonderful and interesting article.
Before I even left FDL, I had written a letter
to my Rep., John Tierney, and hopefully he will
take some action. He is a good guy when it comes to working for the people. I sent it to his new secretary and told her to either give it to him
or email it to him. He is home locally I think and he should be ready in September. I agree with the assumption that the PA or nurses write more generic scripts as I see it all the time.
Both Mr. M and I take a lot of stuff and they are aware of that. Now and then because of his transplant, he MUST take a brand name, but over time if he reacts ok, then the might switch to the lower priced brand.

Will be putting this one into the save folder.

Maureen

By: Sheila Condit

Sheila Condit — Fri, 10 Aug 2007 03:57:48 +0000

Accurate and revealing post!
The big ticket script peddlers do get the lions share of attention by reps, but phamas don’t entirely neglect potential clients by a long shot.
Money rains down on this big business even if all of the doc’s staffs aren’t getting lunch brought in every day by a rep.

By: kkmd

kkmd — Thu, 09 Aug 2007 23:52:50 +0000

Like Teresa said, it only takes a minute to fill out the AMA opt-out. The non-profit physician group I work for has an on-site sample pharmacy– the reps drop the samples off there, and leave us alone in the clinic. It takes effort to not be influenced- but it is worth it.

By: InfoNut

InfoNut — Thu, 09 Aug 2007 22:17:15 +0000

kirk murphy @ 90

InfoNut @ 84

This is no longer correct.
Due to new legislation, there is a very real cap on the amount of money a rep or pharma company is allowed to spend on a particular doctor. It’s to the point where they count the pens and notepads they drop off to make sure they don’t go over the limit.

To say that “Doctors prostitute themselves to pharma reps.” is quite funny. Pharma reps are almost universally reviled, and have to resort to ambushing doctors as they walk down the hall to get any of their time.
I found this sentence in the original post to be overstated as well : “Make no mistake about it: the purpose of prescribing data is to assist industry to influence physicians to prescribe the most expensive drugs.”
IMS data is not used to influence a physician to prescribe more expensive drugs.
It is used by a rep to target which drugs he should talk to a doctor about. If the doctor writes prescription for a competitors drug more than mine, then I know I need to talk up the benefits of my drug vs. the competitor’s. Yes, it’s all about sales. Reps are salesmen, their job is to influence doctors.

Also, doctors can opt out of the IMS system, and many do. Their data is still collected, but not sold to the pharma companies with any personally identifying data.

Full disclosure: I work in the pharma industry… developing software to help pharma companies better utilize IMS data. :-)

I may not be the most un-biased source, but I do know a touch about the topic.

InfoNut

InfoNut, I do not agree about the IMS data not being used to push MD’s to RX more expensive drugs.

However, I’d be delighted to opt out of the IMS system - and help my academic colleagues to do so en masse.

How do docs “sign up” to opt out?

Teresa @ 91 covered opt-out nicely.

Thanks Teresa

By: Teresa

Teresa — Thu, 09 Aug 2007 22:13:19 +0000

The AMA offers on its web site an option for doctors to deny access to their prescribing patterns to drug companies. However, they warn that this may cause a decrease in the number of free samples provided.

I do notice that I don’t get as many free samples as I used to before I filled out the request to deny access to my prescribing data, although I get lots of free prenatal vitamins which I use to give the pregnant women who are waiting for their Medicaid applications to go through so they can get prescriptions filled.

Yes, these are the expensive vitamins but I figure the Medicaid population often especially needs the good vitamins anyway. Mostly they use more easily absorbed and tolerated forms of iron.

By the way, I don’t belong to the AMA for political reasons and never have.

By: kirk murphy

kirk murphy — Thu, 09 Aug 2007 22:09:35 +0000

InfoNut @ 84

hackworth @ 19

…snip…

Doctors prostitute themselves to pharma reps. Reps take them to the Daytona 500. They see the race from a suite with all complimentary amenities. Its a perk that would cost a thousand dollars per person if available.

Reminds me of convicted Republican lobbyist Jack Abramoff.

I used to know a big pharma rep. He became a trainer at the home office. He shared this info with me.
…snip….

This is no longer correct.
Due to new legislation, there is a very real cap on the amount of money a rep or pharma company is allowed to spend on a particular doctor. It’s to the point where they count the pens and notepads they drop off to make sure they don’t go over the limit.

To say that “Doctors prostitute themselves to pharma reps.” is quite funny. Pharma reps are almost universally reviled, and have to resort to ambushing doctors as they walk down the hall to get any of their time.
I found this sentence in the original post to be overstated as well : “Make no mistake about it: the purpose of prescribing data is to assist industry to influence physicians to prescribe the most expensive drugs.”
IMS data is not used to influence a physician to prescribe more expensive drugs.
It is used by a rep to target which drugs he should talk to a doctor about. If the doctor writes prescription for a competitors drug more than mine, then I know I need to talk up the benefits of my drug vs. the competitor’s. Yes, it’s all about sales. Reps are salesmen, their job is to influence doctors.

Also, doctors can opt out of the IMS system, and many do. Their data is still collected, but not sold to the pharma companies with any personally identifying data.

Full disclosure: I work in the pharma industry… developing software to help pharma companies better utilize IMS data. :-)

I may not be the most un-biased source, but I do know a touch about the topic.

InfoNut

InfoNut, I do not agree about the IMS data not being used to push MD’s to RX more expensive drugs.

However, I’d be delighted to opt out of the IMS system - and help my academic colleagues to do so en masse.

How do docs “sign up” to opt out?