Pharm Company Extras

[PrincessFiona]

I thought I'd throw this topic down here because it might end up being a discussion....

Does your spouse participate in all of the drug company extras?

DH just turned down....*gulp* $15,000 to do several talks for a particular drug.


When I practically had a heart attack on the spot he gave me a lecture about credibility, morality and his integrity. "People (other docs) trust that I am unbiased...I can't be bought"...blah, blah, blah.

I really *want* to be able to respect that .... and a small part of me does ...but wow...what is up with drug companies offering such sums of money for docs to just give a few talks about a certain drug????? And why can't my husband embrace recycling instead of this as his issue?

kris

[Flynn]

DH doesn't participate but we're fresh out of training and drug companies haven't approached him -- yet.

I think it really depends on the drug. If you use it to treat certain things anyway....I think it's probably okay. It depends on what you HAVE to do when you accept the money.

I applaude your DH's credibility.
Taking money to use a certain drug isn't inherently unethical but it does feel weird to me.

The money WOULD be nice though!

My DH has been approached to use a certain surgery tool that nobody uses here (meaning in about a 100 mile radius). It would help him do a procedure nobody does here. He'd have to speak a certain number of times to promote it. He's wary and needs to look into it more. The company is willing to offer him a SILLY amount of money to do this....we'll see. It's not a drug so it's different from Kris' origional post but it poses the same questions. Hmmm.

[Vanquisher]

I don't know. Part of me says, as long as you don't change the way you practice or the drugs that you prescribe for the money, you don't lie, etc., you can "talk" for the drug companies all you want. I don't think that is unethical.

However, I should note, that our current monetary level makes me about ready to sell dh's integrity and soul right down the river to the highest bidder.

Right now drug companies just take the department out to fancy dinners once a month for journal club. Whatever happened to schmoozing the spouses? Oh yeah, I can be bought. :>

[DCJenn]

The Army is extremely particular about the extra-curricular activities of it's physicians. (not that people don't moonlight, etc. but appearances really do count when you are a Federal employee)

I know that rather than deal with the limitations, most of the child neurologists we know just get out when they can and go into private practice. Once physician just started a primarily Botox clinic in DC. (for spasticity, not wrinkles although I have offered on numerous occasions to be a guinea pig if any of them need to practice)

Jenn

[migirl]

Drug reps are practically banned from DH's department, they very rarely have those fancy dinners for the residents anymore.

My dad (also a doc) just started doing talks for a drug company, they pay him for each talk and pay all of his expenses. He's a licensed pilot and likes to fly to some of the locations (several hours by car), they pay for all those expenses too.

A part of me agrees that it's money probably better spent somewhere else, but sadly a lot of these docs live in rural areas where their resources may be lacking and this may be one of their only outlets for continuing medical education.

[SuzySunshine]

Drug reps are banned here, they are not allowed on MC property. If they want to meet with staff/residents they can take them to LUNCH at a nearby restaurant but can not take them to a nice dinner or give them logo items (i.e pens and crap). Its actually rather nice because I don't have to worry about DH running off to drug rep dinners all the time.

As far as getting paid for talks, the staff here have been known to get paid and travel for conferences where they speak to equipment they use in the OR but I've never heard of that happening for a drug company.

[Grog]

There is a reason why drug companies do all those marketing things.

They work.

Even if individual physicians want to think that it does not influence them, it does. Having certain pharmaceutical companies logos in your field of vision all day will increase the chances that one will choose one drug over another similar drug when the time to prescribe comes. Drug reps - who have a job to do, it's not their individual 'fault' - create the impression that you have to give them back something. It's a prehistoric reflex: give something to someone and they'll want to give something back to you. As doctors are increasingly aware of this and, like your husband, unwilling to commit their credibility to the cause of big pharma, they have to increase the money they offer, and that reduces even more the credibility of those who accept... I think it's a smart decision for him.

Last night I overheard a conversation between my FIL-to-be (a dermatologist who does mostly cancers and public-insurance-covered work - we're in Canada) and his wife (who work in the office) about reps and colleagues who work for profit (common in dermatology with all the cosmetic procedures). It wasn't pretty. He's a super gentle guy so he has a hard time turning the reps away, but he gets them out of his office as fast as he can and refuses everything from them (except the Ivory soap which gets given to their son and myself!!).

I really hope their son - my partner - goes the same way when he starts to practice, and we often talk about this. Just like heidi said, we'll be making enough money between the two of us without having to take such risks,

[SuzySunshine]

More and more of the academic institutions are banning the drug reps, MC has done it and so has Stanford.

As for why they do it, I get that. I'm in marketing - I've interviewed for drug rep jobs, my FIL is a pharmacist at the mail order special order drug level. So I understand all of it.

I'm just glad we don't have to worry about it here.

[Sheherezade]

It's obscene. I have had many conversations on this topic at the holiday parties. There was a front page article here recently that skewered an orthopod at the C. Clinic for his investment in a company that promotes a particular surgical procedure. He uses the procedure - in fact he invented the procedure if the folks I"ve talked with can be believed. None the less, the Plain Dealer devoted front page and two full interior pages to the "investigation" of his questionable ethics. The clinic is backing him and most docs say his position is not unusual. I'm not sure if he deserved to be vilified that way. I guess I tell this story as a warning: be careful. I think the climate is turning solidly against docs+pharma combos.

I think that there is a grey area in which docs can promote a drug they believe in - but I'd not risk it now. From what I've heard recently, a lot of academic docs *double* there salaries from associations with drug companies - and some pharma companies have even endowed chairs with the stipulation that the department promotes their product. That's wrong. Not gray at all. I'm not sure what will happen in the future, but I think the ethical tide is turning and things will be changing in the next decade.

[SuzySunshine]

Drug companies can, and do, do many good things. The problem is their image and what they do with their profits.

They are seen charging hundreds of dollars per pill for a drug that a cancer patient can't live without. Now is that pill worth that much on the open market because no one else could develop it? Maybe. Would they have to charge so much if they didn't spend millions of dollars marketing to the consumer (TV)? No!

My final project when I got my MBA was on the pharmaceutical industry. I don't remember the numbers off of the top of my head but the amount of money they spend on consumer marketing is insane! If they saved that money or put it back into R&D there would be more drugs for the diseases that still aren't cured and the drugs people really need wouldn't have to cost so much.

[Sheherezade]

Oh....Lily......I come by my pharma hate honestly as a former biomedical academic research person. It's drilled in to our heads that pharma's number one cause is making money - often on the hard won research findings of starving professors (or more likely post docs and grad students). Remember that lots of those advances came from NIH funded results in university settings - not from pharma R and D labs.

Nothing was more vilified in the lab hallways than someone "selling out" to go make money at a drug company. I still can't stomach the idea - even though I'could probably get the work hours I need in that setting. I don't think I'd have the academic freedom though - and I think research decisions would be made on a basis beyond science. That was my experience in the brief time that I worked for a drug company.

Do you have experience working for pharma that gives you a different impression?

[Grog]

I'm afraid to say the cause of 'big pharma' (shortcut for 'top-15 major pharmaceutical corporations') is not and cannot be "improved health for all". They are corporations, and corporations are there for, and only there for, shareholder profits. If they made decisions that were good for people's health and bad for profits, shareholders would be fully justified to fire their administrators... and they would. The rest is PR and marketing.

Now, the great thing is that for some companies it's becoming a source of profits to have (really) ethical behaviour, because consumer-behaviour is changing. So decisions that happen to be good for the planet, or people's health or whatever can be made. But it's still about profits. It cannot be otherwise.

I don't think that being 'about profits' is morally good or bad in itself. But we have to be realistic about what is going on in the industry.

[Vishenka69]

Reps don't target anesthesia for some reason, the most I've seen in the past 3 years were pens. I think there might have been an occassional lunch or dinner but definitely not as much as DH saw while in his prelim year. Back in those days I got half a porterhouse or lobster for dinner at least once a week.

I think he also did a few online surveys for textbooks. I don't know how I'd feel about the loss of all that money either. Ethics are great and all but the bills don't pay themselves. :!

SO used to go to pharm company dinners and events here in Ireland, heck I have too, at them the sales rep would do their speech on it etc, It would never make either of us choose one drug over another to use because we've been paid extra to push or use this drug more.

When prescribing a meds (I had a very limited strict guidelines to prescribe in the uk) both SO and I agree we right the generic rather than brand names of the drug that is best for our patients and that way the patient will get that drug at which ever company is selling it at the cheapest on the market at the moment. Not sure what the story is where SO is working at the moment.

[Rapunzel]

Radiologists don't get hassled by pharm reps as a rule. So, this doesn't really affect me one way or another in that manner.

I will say, however, that when I was a kid and my parents had lousy medical insurance coverage (or none at all) our family physician giving us the "freebies" he got from the drug reps was a profound blessing. Let's not forget that in many instances these drug reps are allowing physicians to charitably give medications to patients that might not normally be able to afford them. If a practice refuses to even let the drug reps in the door then that practice is potentially denying free medications to its working-poor patients (which is a large percentage of the population).

Just a thought.