In 2009 the Pharmaceutical Research and Manufacturers of America, with the approval of the FDA, laid out a revised code on interactions with physicians. The two most publicized parts of this agreement discussed the free hand-outs and free meals; there was going to be no more free pens for doctors and although doctors could still be taken to dinner they would have to listen to an expert speaker discuss a medical topic. On paper it seemed that the FDA struck a good deal: no more free pens and doctors would have to listen to a top speaker on a medical topic if they attended one of those free dinners. But of course, as you all know by now, big business always out smarts big government.
I don't believe anyone is stupid enough to believe that a ten-cent pen is really going to make a huge difference when it comes to bribing a doctor to write one script over an other but that was one of the most publicized parts of the agreement. Although, in my attempt at the darkest kind of humor, I enjoyed showing my collection of pens for Baycol, Seldane, Encainide,and Trovan over the years since all those drugs were pulled off the market after they killed scores of patients.
The most significant change was of course the newest dinner arrangements. Ironically,we would have been better off if they allowed doctors, just like every other profession, to be taken to dinner by a rep without the lecture; as long as it was a dinner of reasonable cost and not a strip club. That's right, we all would have been better off if they just let doctors go out and drink and have fun on the expense of a drug company. How could that be?
The money, the action, the scripts, the person who big Pharma really wants to have in their pocket is not the internist who is sitting around the dinner table fattening himself up,it's the guy who is getting paid at least a thousand dollars to give that dinner talk that lasts for about an hour. And the talk is not about a random and important topic but more likely how great the drug is that the company who just paid for your dinner markets.
Dr. J is a member of a large group of physicians and he is yearning for a few extra bucks - actually as much as a hundred grand a year if he gives a one hour talk twice a week. In order to show his thanks to the big Pharma, and to encourage that company to use him often, he begins writing that company's drug like a madman. He also writes the script on his partner's patients when they are away and encourages all his friends and associates to do so. Dr. J has a teaching position at a hospital and lets the students , who are graded by Dr. J, know that he likes that drug. As I have mentioned repeatedly in my book and past articles ,big Pharma knows who writes their drug and how often they do, and Dr. J, of course , knows this as well. The more scripts Dr. J writes the more talks he will do for big Pharma and that , of course, is just a scam to pay-off the doc. And Dr. J enjoys the pat on the back he gets from the Pharma reps especially the young women. Sometimes I find myself laughing at this scenario but the reality is is that the reps who work for big Pharma know how to encourage doctors to write scripts and money and flattery , in that order of course, are the best impetus.
If the pharmaceutical industry were allowed to do what every other big business does, take clients out to dinner, then Dr. J would not have that incentive to write the drug. Many doctors, like Dr. J do actually prepare a talk, often with biased material supported by the Pharma company, and do spend a few minutes, often between courses, discussing the benefits for using the drug but there are too many circumstances where this simple talk is not even given. There are too many instances, especially with the smaller pharmaceutical companies, were dinner is eaten and someone also ends up with a thousand dollar check.
My review of some of the local physicians, some who were paid more than $50,000 dollars last year by big Pharma, shows that a few of these doctors, who lectured about a specialty drug, were far from experts and not even board certified in that specialty or even general medicine. Again, this just makes my point , that having doctors talk for drug companies is a tricky way of saying thank you to doctors, whether qualified or not, for writing lots and lots of their drug.
Pharma did not, apparently, reach and agreement about what to do with those free lunches brought to doctor's offices. Just about every day a rep has to be at a doctor's office with a full catered lunch for the doctor and all his staff. And , for the most part, there isn't an expert there to discuss much of anything; just a lot of food for all to have and a way to get in the good graces of the doctor's staff so the rep can get into the office, even when there are patients waiting, to talk to the doctor.
But not very long ago, I received a call from a friend telling me that his former professor and a chief of Medicine at a large academic center was in his office, hawking a drug known as Bystolic, with the rep and the free lunch they were expecting. My friend, also a cardiologist, told me how awkward it was to see him at his office since it's very unusual for anyone to show for a free lunch, other than the rep, and shocking to hear that your former chief of medicine, a person responsible for training students and residents and the doctor responsible for all the physicians that practice medicine at the institution was schlepping around with the drug rep to help sell a drug. I can't tell you why he was there, although he must have been paid very well, or how he could help sell an expensive drug that many feel is not a top choice for the treatment of hypertension and, remarkably, as much as ten times expensive than many other drugs used to treat high blood pressure. But I can tell you that it is disgraceful for someone of this stature to lower himself to this for a few bucks; likely around $2,000 bucks if I had to guess.
There is something that physicians can do which will prevent companies from knowing what prescriptions your doctor writes. As I mentioned for the past eight years, and in my book, " What Your Doctor Won't (or Can't) Tell You, businesses best known as prescription data- mining companies like IMS Health , for a fee, give the reps a list of doctors in their territory that tells them how many prescriptions the doctor wrote for their drug and their competitors.
The state of Vermont enacted a law that prohibited the sale of this information but In June of this year the the pharmaceutical industry won a major victory when the U.S. Supreme Court struck down this Vermont law ruling in their decision that the law violated the industry's First Amendment free speech rights.
However, doctors can sign up with a site at the American Medical Association, even if they are not a member, and for no cost, and block the companies from knowing what drugs they write. I encourage every doctor to do this and I would encourage patients to tell their doctors that they want them to do so.
Without this information, drug companies will have a tough time knowing which physicians are writing their scripts and perhaps this quid pro quo game - more prescriptions written gets more paid talks for the doctor- will be stopped.
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Comments
I stopped giving pharma-sponsored lectures about 10 years ago, even though I never used their "preferred" research studies in my lectures. I just increasingly felt that I was prostituting myself, and that I was rubbing up against my own personal ethical boundaries, and so I stopped doing it.
The Pharma industry spends, literally, many billions of dollars per year on both physician "outreach" and direct-to-patient marketing activities. They do not spend these vast sums of money carelessly, as their own marketing research clearly shows that they are able to significantly change physician prescribing patterns with these outreach activities (including logo pens and other cheap trinkets).
My next book will offer a sobering and disturbing look at how a Pharma company that has been the dominant purveyor of hormone replacement therapy (HRT) since 1945 marketed their HRT drugs over a 50-year span, and how they disparaged solid science, and employed junk science and paid physicians, to persuade both patients and physicians to take their products. In the end, tens of thousands of women subsequently died of breast cancers (and other diseases) that have been incontrovertibly linked to chronic HRT use....
I certainly agree with you!
Robert A. Wascher, MD, FACS
Author, "A Cancer Prevention Guide for the Human Race"
http://www.npr.org/templates/story/story.php?storyId=130730104
It's all about the money. The mansions in Connecticut surrounding the Pfizer don't come cheap. I think the public would be shocked to know that most all pharmaceutical reps are no different from any other salesman. We assume, at our peril, that drug companies are all about making us well, improving our health, helping us lead better lives.
That's nonsense. No matter what their fancy Mission Statement is, all pharmaceutical companies are no different from car companies or pogo stick companies; the mission is to return an ever growing profit to the investor, regardless of anything else.
There is a good side to this, as their greed for growth pushes them to come up with better drugs and better applications, but unbalanced by moral regulations, this same greed pushes corporations to do whatever it takes, even breaking the law over and over again, if it nets a profit.
As Gordon Gekko said, greed is good. However, greed, like any human behavior, must be kept in check by other human behaviors such as altruism, love, empathy, and charity.
There should be no doubt that regulation by a government of the people, people not directly connected to the pharmaceutical industry is the only remedy to this problem.
Sure, accuse me of supporting Big Government or Big Brother all you want. The truth is that without a govenment strong enough to restrain the greed of Big Pharma, most of us will continue to suffer its results.
Before getting out of the buiness I owned pizza restaurants. I actively marketed to the drug reps because they would send lunch to the doctors offices and their American Express cards fabulous.