Drug Reps

[fluffhead]

Yeah, I suppose I've got a problem with it, but not necessarily more of a problem than, say, lobbyists. And doctors are, after all, still in the private sector, so who's to say what's kosher or not in terms of getting them to use drugs?
And I doubt many doctors out there are actually reading any literature, so if this is what it takes to get them to try something new, maybe it's ok?
dunno.
In any case, we're drowning in post-it notes and pens. I always have to make sure not to bring the viagra pens to school - I'd never live it down with the high school kids.

[mommax3]

We are somewhat protected by this because of being in the military, but we ate at our share of drug rep dinners during residency. Now that we are out and in a much smaller city, he gets a lunch every once in a while, but not often.

In principle, I agree with you, Kris, but pratically speaking, I guess the companies are entitled to spend money advertising their product, and spending it directly on the docs is probably a more efficient use of their money than flooding magazines or the airwaves with ads. (Although I see more and more ads for drugs in magazines, but they are directed more at the patients than the doctors....) My husband can only prescribe what the military will pay for, so I don't think he has really had a chance to compromise his integrity so far. He can't keep or pass out any samples, either.

Fluffhead, I can't tell you how many times I have written notes to teachers on paper that I later realized was for some drug that relates to a "female problem". Oh well. If they noticed, maybe they thought I had some serious disorders and cut me some slack at some point.

Sally

In any case, we're drowning in post-it notes and pens. I always have to make sure not to bring the viagra pens to school - I'd never live it down with the high school kids.

The thing that really, really gets me pissed off is the ads for drugs on TV, etc. The spending on television advertisement vastly exceeds what a drug rep spends on doctors. Recent studies have shown that the TV ads are a significant driving factor for the drug costs of several Medicaid programs. Of course, there are other factors contributing to rising drug costs as well but the role of TV ads is significant. When Eric was in a primary care clinic it would drive him bonkers when patients would ask for that "cholesterol drug I saw on TV, you know the one?" Nine times out of ten, it was one of the most expensive drugs and not always the best choice for the patient. And the only reason they wanted it was because they saw it on TV -- I guess the drug companies call that "patient education." So, if there was one thing I could change, that would be it.

I think that most doctors are savvy enough to see through the drug rep bs and I don't think they prescribe something just because the drug rep dropped by. But I do think the drug rep could bring their attention to something and a doctor may use their drug preferentially but I don't think it would lead to bad clinical choices. Eric said he thinks that the reps sometimes are good about disseminating new information about a drug (usually in the drug's favor, of course, but still things he wants to know). And the free samples are really, really useful for the patients who have few means for getting them otherwise....

By the way, did you know that some pharmacies (a lot) sell prescribing information to drug companies and drug reps? A friend of ours who is an allergist had a drug rep ask him, "I noticed you prescribe zyrtec 10 more frequently than claritin. Do you have concerns about claritin? I have these articles for you....blah, blah, blah...". Boy, was he mad! I don't know if that drug rep even comes to his office any more. (btw, this may have changed with HIPAA, but all the data are aggregated and de-indentified, so may not.)

[fluffhead]

Well in the case that two drugs are identical, I can see the freebies swaying the doc toward the one side.
Case in point (purely hypothetical of course )
We may have gotten lots of free similac from the sales rep. The enfamil folks may have refused because we weren't peds residents. So you can guess what my wife might be more apt to recommend for new moms.
Not that I condone this behavior, of course.

[PrincessFiona]

Well, I think that one of the reasons that Thomas has a lot of concern about it is because he sits on the hospital committee that oversees these things...he has a lot of drug reps make appts. with him when prescriptions of their drugs go down,etc...and he gets all of the prescribing stats. Docs are just human, and I guess name recognition does play a role in their prescribing habits....he just has a problem with the fact that often times drugs are prescribed after a dinner/event with an increased frequency and at times they are the more expensive option for the patient and aren't necessarily more effective.

Of course...he has a whole other issue with drug affordability in this country, as do I...and I won't even start that discussion. 8)

kris

[SueC]

Well, I'm biased becasue BOTH of my sisters are drug reps. But, with all the new drugs coming out, I don't see how doctors could possibly keep themselves informed on all of them. I certainly don't want my husband coming home every night reading journals when he could be spending time with us. Let me offer the other perspective--one of my sisters often gets up as early as 5 in the morning to get a breakfast ready to take to her doctors (and their staff) so that they can maybe half listen to her for two minutes while she is giving her pitch. Often they don't even do that and don't seem remotely appreciative that she fed their whole office staff. Not to mention they keep the doctor supplied with samples that can be distributed out to patients. And I'm just guessing that they must be giving somewhat useful information at their programs. Do you really think the doctors would go just to hear the information without being enticed by a nice restaurant or tickets to a football game. Bribery works!

[DCJenn]

I definitely think the TV and print media ads are the greater of the evils. I also have some relatives and some acquaintances who are drug reps and they do bust their butts. Sales is hard- no doubt about it. As Sally mentioned, the military is somewhat cushioned by the fact that they have specific meds they can prescribe- period- and if you want something else- too bad.

What steams my husband (or did, when he actually got to see kids!) were the parents insisting on name brand ADHD meds- with no evidence of ADHD in the first place. (which is a whole 'nother topic that pisses me off, too) Also, the insistence on antibiotics, although that has dimished somewhat over the past three years as they get the word out. I even heard a commerical from Blue Cross today reminding parents that antibiotics don't cure common kid illnesses. I thought it was great, especially here in DC where there's such a mixture of cultures and backgrounds.

I love the ads you see in magazines that don't even tell you what the medication is FOR. What the heck is that all about?

Jenn

[SueC]

I do think all the commercials and magazine ads have gotten out of hand. I'm sure it drives the doctors crazy to have patients convinced that they need this or that medication based on some commercial they saw!

I love the ads you see in magazines that don't even tell you what the medication is FOR. What the heck is that all about?

Jenn

Yeah, those kind of stump me too. I figure that I have a little advantage over the general viewing public with having a medical spouse....how is anyone else supposed to get it?

My absolute favorites are the ones (typically diet drugs) that warn of --- really, really undesirable GI side effects like "oily discharge" and excessive flatulence, etc. And the voice-over guy says it in this super-cool matter of fact voice. Those are actually worth seeing.

I do think all the commercials and magazine ads have gotten out of hand. I'm sure it drives the doctors crazy to have patients convinced that they need this or that medication based on some commercial they saw!

Oh yeah. Mike says it's about as bad as all the online medical sites where people go to diagnose themselves--often wrongly, which can have disastrous results.

Kris,

I do agree with you 100%. The hosp. my dh is at does not do drug samples at all. They are not allowed anywhere on the premises. My dh says it's because doctors tend to use the samples just because it's there instead of possibly doing a little more research and prescribing a different drug. I hate to say this but my dh tends to go to these lunches just for the good lunch not because he is interested or even paying attention to what a rep has to say about a drug. Our hospital has only had this rule in place for a few years I think but I can see why they rid themselves of reps and samples on the premises. I am also however drowning in all sorts of cool drug pens and note pads.

[twinsmom]

Wow -
So many fun times ahead for us . I love that your dh stood up to the drug reps and didn't pull any plugs in his speach. My dad is a FP, and he absolutely detests drug reps. Once my mom was at the office and she was talking to the rep when my dad came out, so he started talking to the rep. When he went back in to the next patient, the rep asked my mom to come back every time he came because that was the nicest my dad had ever been to him .

Jen B.

I agree with Kris,

Pharmaceutical companies spend big bucks on marketing strategies. Despite the lack of direct pressure, post it, pens etc increase brand awareness.

I think that there are huge ethical issues associated with dinners, conferences, symposia etc. You simply do not need to fly Sydney -> London first class for a clinical trial start up meeting that goes for 2 days! Coersion perhaps?

Things are a little different here because by law you can't advertise precription theraputic goods at all, ever on any medium. You don't see as many people asking for a drug by name because they have seen it advertised.

I am very wary of BigPharma and the rest of the industry. I have been involved in trials where the results are bogus and the design is just crappy.

Or maybe I am just envious because I have never got to go anywhere good at BigPharma's expense.

There really is no such thing as a free lunch.

<<to answer question, no I don't feel as though they intrude on 'our' time. It seems no one wins both clinicians and drug reps work long hours away from their families. Besides, you can always take the ethical stance and stay at home>>

[PrincessFiona]

Tegan,

I'm curious...Is there a lot of effort put out by the drug companies in Australia? We didn't see a lot of it in the UK or Germany......but that was also many years ago.

kris

Kris,

not really. Australia only represents 1% of worldwide drug sales. My experience with the local pharmacuetical industry is quite positive. Where clinical trials are concerned we seem to be fighting a losing battle. Many of these drugs will not be make avalible in Australia due to prohibitive cost and the hoops that the Theraputic Goods Administration puts in place.

The Pharmaceutical Benefits Scheme subsideses medication for all Australians. To make health care more affordable and accessable most clinicians prefer to prescribe from the PBS list. It is very difficult to get new drugs on this list. A sponsor will only make a big effort if they think that a new drug will go on the PBS. Other wise, they may conduct phase I, II, and II trials but pull out once the data has been collected. There are usually problems securing the drug for ongoing use if a patient has shown a positive response. Countries outside the US and Western Europe are starting to scream 'ethical imperialism'! Australia sites are sometimes not included in clinical trials unless as last resort because there are some FDA requirements (CRF's??) that many sites cannot or will not meet.

Another example of exploitation by BigPharma, Declaration of Helsinki my ****