Program to Inform Doctors about Drugs at Risk
The pharmaceutical industry spends millions every year to inform doctors about their products. An innovative program begun here in Massachusetts, at the Harvard Medical School, has tried to give medical professionals independent information about treatment options, but it’s now threatened by state budget cuts.
Tags: doctors, pharmaceudical
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I am a physician assistant in the Boston area and am visited at least twice weekly by Rx reps. All of them are attractive, a few of the women routinely wear high heels, short hems, and low necklines. Most are professional but when pressed for more specific answers are unable to answer our queries re: the drug/studies etc. None of them have a medical, biochemistry or biology degree. Next week I am instructing the front desk staff that I am too busy to see reps.
Having worked with Pharmacy Benefit Managers and insurers, I know that unless an MD prescribes a med “dispense as written” – which is rare indeed – an insurers formulary dictates what drug is dispensed and whether a generic is substituted.
As a thankfully retired physician, this is what I can say.
I am thankful for the drugs that the industry has provided. We have now many treatments that were just not available when I graduated from medical school class of 58, (let alone compared to what was available when my grandfather graduated in 1901).
However, I am aware of how much my prescribing had been manipulated by the pharmaceutical industry. Like most physicians, the greatest part of my Continued Medical Education credit had been courtesy of pharmaceutical companies.
The majority of research on therapies is conducted by drug companies; and why should they fund research that holds no promise of benefit to the company? This funding bias affects what evidence is available in the best peer reviewed journals. Therefore, this bias is present when we follow “evidence based therapy”.
Let us not blame the pharmaceutical industry. The blame is in our society, we do not adequately fund independent research and education in a short sighted effort to “save money in the budget”.
I found Dr. Stossel’s final comments on this show both shocking and plainly wrong. First, he dismissed the entire field of social science (studying the effects of advertising and gifts) as “absurd”. Ouch. Second, he essentially argued that billions of dollars of advertising and gifts have no effect. I’m sorry, but *no* industry spends that kind of money if it isn’t working. The scope of his expertise is medicine, and does not admit the arrogant dismissal of other areas of science.
Sam: What if those drugs are being used because they are effective and help pts. Perhaps the reps help spread the word about the best drugs. Any drug that is ineffective or has side effects ends up being weeded out by the market on its own. There are thousands of lawyers waiting for the smallest side affects so they can sue the deep pockets of the pharma companies. I know I would want to know of the latest info if a loved one was ill and at that point cost would not be an issue.
Tim: I agree — it’s important and completely legitimate for drug companies to spend money informing doctors about their products. I was mainly reacting to Stossel’s comments. But I would also argue that there is a significant difference between dispassionately informing a doctor — scientist to scientist — about new drugs, and taking doctors out to dinners or on a vacations. I am a scientist, and maybe I’m just jealous, but fancy dinners are not necessary for the dissemination of medical information. Given how much more they cost, I’m fairly certain there’s a reason drug companies do this.
Also, I think the Magic of the Market argument doesn’t hold much water — in medicine, there are just too many historical counter-examples; plus, knowledge is highly asymmetric, and demand is totally inelastic (how much would you pay to stay alive?)
Does anyone really believe that drug companies do anything other than attempt to maximize their profits? They are always going to choose to pursue a product that maximizes their profits and they will attempt to minimize any adverse scientific information. There are innumeral instances of those companies witholding info and spininng not so good data to appear to support drugs where the data does not really do so. In fact, most drug companies force their researchers to sign non-disclosure agreements that prohibit the scientist from releasing any information that would cast doubt on the drug product.
I am a family doc practicing in MA. I do not see any reps at my practice for years. We doctors are supposed to be life-long learners and we have plenty of resources to learn new things from – journals such as New England Journal of Medicine, Journal of the AMA, the Medical Letter, Prescriber’s Letter, many unbiased continuing medical education courses to take all over world and now on the internet. Many lay publications such as the Harvard Health Letter, Tufts U. Health and Nutrition Letter, Public Citizen’s Good Drugs /Bad Drugs, and Andrew Weil’s Self Health, and many many more …etc all provide great info as long as one keeps in mind the underlying bias of each publication. So the question you pose for the program is kind of mute. The “innovative program begun here in Massachusetts” is only one of thousands and thousans of great resources around.
More on Acre and Dr. Stossel and his group ACRE on Boston Health News.com
http://tinkerready.wordpress.com/2009/07/24/bhn-exclusive-mass-gift-ban-takes-a-beating-pt-1/
The topic of today’s show is highly relevant to modern medical practice and cost, and as Sam noted, big pharma doesn’t spend billions on detail reps. without expecting a return. However, drug companies spend far more on direct to consumer advertising, a practice that is legal only in the US and in New Zealand. The television ads in particular are ubiquitous, extremely annoying and very costly with the consumer ultimately footing the bill. This form of advertising should not be allowed in the US. Europeans get medical care comparable to ours without it.
Sam: I agree with you about Dr. Stossel’s comments. On the one hand he notes that promotional schwag is a normal sight across all businesses and asks why healthcare should be made exceptional. On the other, he exceptionalizes doctors when he indicates that it’s absurd to think that the type of marketing that is shown to influence everyone could possibly influence doctors. His arrogance was disheartening.
It is interesting that this focused on the alleged problem of drugs being pushed to docs and patients with little regard for AEs. I find it curious that in MA, as well as other states, advertise procedures on billboards. While driving down the highway and reading the newspaper you can find advertisements of complicated invasive procedures which have little balance with regards to negative outcomes or side affects. Examples include robotic surgery for prostate issues, vascular stenting, and spinal surgery. Many of these procedures are “pushed” because the institution made a large capital investment in the equipment necessary for these procedures. They may be helpful to patients but I suspect they are supremely profitable to hospitals.
It is interesting that there were a few attractive woman drugs sales reps that called into the show and said how offensive the notion that the drug sales rep is a beautiful woman is to them because it makes them look stupid. And that in fact they are very smart and knowledgeable. I am sure they are smart and knowledgeable and believe in the business they practice. But other people weren’t mentioning these sales reps to make them look stupid – if anything, they were trying to make the drug companies look “stupid.”
These reps need to stop and think why the drug companies seem to prefer hiring these professionals in high heels to sell their drugs to doctors. I am sure there are many qualified sales reps around to take the job and that these pharmaceutical companies have a lot of similarly qualified candidates to choose from when they hire, but they pick the beautiful women anyway. So why do these sorts of sales reps become so common among the pharmaceutical sales rep industry? They aren’t hired mainly for their drug knowledge, and few of them probably even have a related degree such as one in a medical field or in biochemistry. They are hired because they are attractive, have good sales skills, and are generally persuasive and charming.
And I’m sorry, but if I were a doctor and asked a high-heeled rep who came to sell a drug things such as: What are the most common side effects to the drug and their prevalence in the FDA study? How long does the intended effect takes when one starts the regimen and among those who participated in the FDA study, what percentage of them does the intended effect not take place at all or to a negligible extent? If I asked those and other specific questions and she doesn’t know the answer, then it certainly doesn’t cast the rep or the company she is working for in a good light, does it? These reps need to think about these things and perhaps at least study the drug they’re selling a little better, at the very least. Perhaps more of them should actually have a medical background, but apparently the drug companies aren’t hiring for that qualification.