Friday, July 28, 2006

Drug Lunches

It's Friday. Lunch is served. But I'm not professional or ethical - so says a New York Times article today. Well, I beg to differ.

The pharmaceutical industry deals in drugs, and doctors dispense drugs. The pharmaceutical industry wants doctors to use their drugs. So they market. This is America - we do this. Look at Starbucks, Panera offering WiFi, McDonalds giving away Disney Toys, Nike, Apple. They all have products, and they market these products to the average American who often can't afford higher prices for their products. Yet these companies spend zillions of dollars marketing their products. Their shareholders demand it, revenues rely on it. And guess what.... people buy their products. Can you believe? Yep, doctors might actually be influenced by a drug company buying them lunch! And companies might profit!

But in the case of marketing to doctors, well that's not okay, because they're rich! They are single-handedly increasing the cost of health care! Look at those drug lunches! Look at all that fat! See? I told you! And those free pills they get - those are driving up the cost of health care to American's, I tell you! See how unethical and unprofessional they are? I'm sure that's why the cost of healthcare is spinning out of control! It's the doctors having lunch! And free lunch at that!
But I would remind the casual reader that there are few professions that have sustained a negative reimbursement rate for services rendered like the medical profession. The July-August issue of Physicians Practice published a survey of internists, family practice doctors, and pediatricians salaries by Merritt, Hawkins and Associates. The average generalists' salary was $150,000 per year, over half of the doctors were "dissapointed" with their income relative to their work effort, and 28.6% of doctors stated that in retrospect, they would not choose to go into medicine again at all. All this with an aging and growing population that needs these guys more than ever.

Look, what the drug companies feel is useful or not is up to them. It's a great country and this is the American Way. The free market has permitted our health care system to be the best in the world. Certainly, I can elect not to attend drug lunches. My employer can elect to stop permitting drug lunches. But will this self-virtuous act change the cost or quality of healthcare?

I know there are colleagues who are emphatic about this issue: that we, the doctors, should live a puritanican lifestyle and not interface in any way with peddlers of products that might influence our decisions. Especially medical decisions. But we interface with these products every day. Nearly every major medical profession I can think of receives a significant portion of its operating budget from the pharmaceutical or medical device industries. Look at any "Scientific Session" or "professional society" in medicine. Even the AMA peddles our prescribing habits to the drug industry to receive funds.

Certainly physicians should take a lead in reducing the costs of healthcare for our patients. But we should not be disingenuous about our dealings with these companies either. I'd like to think I'm capable of independent thought on the subject of drug marketing. Believe me, as the article suggests, enticements were much more prevalent before 2002 and yet here we are, with a healthcare system that is emulated by many and yet with higher costs than ever before. Was this from doctor's lunches? Will we stop deluding ourselves to thinking that stopping this practice will influence the cost of medications? Newsflash: it won't. The days of the $10 pill are here. And drug lunches didn't start this.

--Wes

2 comments:

Daniel Haszard said...

Eli Lilly is a big drug company that puts profits over patients.

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Anonymous said...

You Have Now Been Sampled (Drug Reps, Part 2)

While the pharmaceutical industry’s image and reputation has suffered, and has been complicated with their declining profits due to a few reasons, these companies still apparently insist on keeping most of their gift- givers on board. Known presently as simply drug reps today, this job has become a vocation void of a sense of accomplishment, which will be described below.

So they may be named at times in different ways, these promoters will be referred to as drug reps, which number close to 100,000 in the U.S. presently, it is believed. The cost to the pharmaceutical industry of these employees is around 5 billion dollars a year. Income for each rep grosses close to or above 100,000 grand a year on average, along with great benefits and a company car, as well as stock options as they gladly work from their homes.

The main function these days of drug reps, I believe, is primarily to offer doctors various types of inducements of a certain value. The drug sampling of doctors may be considered an inducement, and a rather valuable one for the drug rep, as many believe that these samples are what ultimately influence the doctor’s prescribing habits over anything else, including statements from drug reps. This may be why the drug industry spends around 20 billion every year on samples.

While historically drug reps have used their persuasive abilities to influence the prescribing habits of doctors in an honest and ethical manner. However presently, most health care providers now simply refuse to speak with them, or have banned all drug reps permanently from their practices for a number of reasons, including the recommendations from their colleagues. It is possible that this may be due to the following reasons:

1. The doctors lose money. Doctors are normally busy, so their time is valuable. As a drug rep, you are a waste of their time. Yet they will accept your samples still. The credibility you possibly have as a rep is not considered anymore to be present in your vocation due to various controversies associated with the pharmaceutical industry, it is speculated.

2. Most drug reps in the U.S. are hired for their looks and their personality. As a result, many are somewhat ignorant in regards to anything that is clinically relevant to a medical practice, so doctors seem to know this and have responded in such ways. Most drug reps have college degrees that do not correlate with their profession as a drug rep, which is to say that the clinical training of drug reps is limited. In fact, many consider this of such a serious nature that an Act is presently being considered called the SafeRx Act that would certify pharmaceutical reps, and this would be mandatory. One main reason would be to ensure personal accountability for their tactics and statements, I believe, which may improve the quality and safety of their function in the medical community.

3. Many drug reps, it is believed, are void of any ethical considerations due to ignorance of what they are coerced to do or say to prescribers by their employer, and this allows them to embellish the benefits of their promoted products at times in addition to offering inducements to doctors. This is usually due to the rep being unaware of the consequences of their actions at times, yet at other times what reps say is with premeditated intent for potential financial gain for such a drug rep. Worse yet, due to pressure to keep their high-paying jobs, they always are anxious to please their superiors, who require them to offer various types of inducements to physicians that are designated targets of a particular drug company. Such tactics are especially true with the larger drug companies. These reps are in fact coerced to spend these individual promotional budgets assigned to them by their employer. While legally risky, the drug companies continue to dispense to their reps these large budgets reps have been forced to be responsible for dispensing, and are required to spend these budgets. In fact, so much emphasis is placed on this promotional spending, there seems to be an association between the money a rep spends and the progression that occurs with their career working for their pharmaceutical employer. Disclosure laws are being considered presently to mandate the release of all funds dispensed from pharmaceutical companies, which is to say to allow others to see where their money goes and who it goes to, as it is presently very secretive, overall. It is not unusual for a big drug rep to spend 50 thousand dollars a year for clinic lunches alone. In addition, drug reps hire doctors as speakers for certain disease states, and they find many other ways to spend this money they are required to spend.

4. Another issue is what is referred to as data mining. The American Medical Association sells this prescribing data on individual doctors to pharmaceutical companies, which allows them to track the scripts a doctor writes, and the data is free of the patient names. Yet the names the products prescribed are well illustrated and available to the drug reps. This allows reps to tailor their tactical approach with any given doctor, if they see the doctor at all during an office visit. Worse yet, doctors who greatly support the promoted products determined by this data allow reps to reward those doctors who favor the rep’s products that they promote, and this could be considered a form of quid pro quo. Laws are being considered presently to prevent this practice of allowing reps to have this data. Doctors are opposed to the data the reps have as well about them for privacy and deceptive reasons, so they say.

5. Overall, reps can be best described as far as their function goes with their profession is to, whenever possible, manipulate doctors with remuneration or other forms of inducements, as they also continue to sample such doctors along with others their promoted meds. Also, frequent lunches are in fact bought often for doctors’ offices and their staff as a method of access, primarily, as stated earlier with the money reps spend earlier for this type of function. Essentially, because of the income and benefits the drug reps receive that they would likely not be able to obtain with any other job, they are compelled to do such unethical if not illegal tactics mentioned earlier that they perhaps normally would not do in another setting. Usually these drug reps rarely refuse to implement such tactics encouraged to them by their employers.

6. Samples keep the prescriber from selecting what may be their preferred choice of med due to cost savings from samples left with a medical office by a drug rep. In addition, doctors are now being paid by prescription providers, which are called pharmacy benefit managers (PBMs) that are typically owned by a managed care company to have a doctor switch their patients to generic substitutes, if they exist, and this is often not disclosed to such patients. Apparently, these PBM companies are doing this in response to the activities of the branded drug companies, as they continue pay doctors often for various reasons, which are questionable in themselves.

It is likely that most drug reps are good and intelligent people who unfortunately are coerced to do things that may be considered corruptive to others in order to maintain their employment, ultimately. It seems that external regulation is necessary to prevent the drug companies from allowing the autonomy of drug reps that exists, with their encouragement, which forces the reps to do the wrong thing for the medical community, possibly. Clearly, greed has replaced ethics with this element of the health care system, which is the pharmaceutical industry, as illustrated with what occurs within these companies. However, reversing this misguided focus of drug companies is not impossible if the right action is taken for the benefit of public health. Likely, if there are no drug reps, there is no one to employ such tactics mentioned earlier. Because authentically educating doctors does not appear to be the reason for their vocation. This is far from being the responsibility of a pharmaceutical sales representative.

“What you don’t do can be a destructive force.” --- Eleanor Roosevelt

Dan Abshear