Is there a (crooked) doctor in the house?

[Phaycops]

Hi guys,
My purpose in writing today is to address what I think is a good question: Is there a vast conspiracy of pharmaceutical companies who are bribing doctors to prescribe their drugs? If not, why do so many people believe there is?

Here's what I think. A couple of recent articles have shown that research funded by pharmaceutical companies is often flawed and biased towards favorable results (i.e., results showing the funded drugs work the way they're supposed to). Also, people go into doctors' offices and see all the free goodies, like pens, coffee mugs, and calendars dropped off by drug company reps, and make certain conclusions. I've heard (on other message boards) additionally of some supposed widespread magazine or newspaper articles about doctors going to "funded" conferences and getting put up for free in nice hotels, etc. to present papers on the drugs from the drug companies, although I've never seen one of these alleged articles. Add to all this the treatment most people get from their doctors, which I'll freely admit is, in some cases, abominable, and you get this conspiracy theory.

So....is there anything to it? Can someone show me that doctors wildly prescribe drugs willy-nilly that aren't needed? Can someone show me that these doctors are taking bribes from these drug companies? I had one person tell me that "this sort of bribery does take place in all areas of the medical profession" including, aparently, oncology, endocrinology, and cardiology. If my endocrinologist is taking bribes from, um, the makers of the uh.....generic....drugs I take, well, I want...to....know....about it. Hmm.

I'll be honest, in that my gut instinct is that the doctors are trying their best to make people well under an imperfect system (in the US, I'm talking about here, we can deal with other health care systems as they come up), have gone through more schooling than most people can even conceive of, and know at least more than the average joe about medicine. I think, and again, this is my gut reaction, that the people claiming that the doctors are incompetent are full of s**t. But I don't know for sure. What do you guys think?

[rwald]

I'd concur with your gut reaction. Actually, my dad was a doctor for 25 years (now retired), so I'll think about asking him in the morning. If I remember...

[Denise]

I don't think most doctors prescribe drugs that are not needed. However, I think they often do prescribe drugs that they have free samples of.

I am a single parent without a lot of money. I've had doctors give me samples to see if I like a prescription, before I spend money on it. For instance, the doctor gave me free samples of Zoloft to see if it would work for me, before I forked out the money for a prescription.

I have confidence that most doctors are not swayed by calenders and pens. I know I wouldn't be.

Why are there conspiracy theories about pharmaceutical companies? I don't know, I think partially because they now have commercials on TV, and people think that they should be "above" that. Resulting from the commercials people seemed to realize that they are companies like every other company and do see the profit margin as something important. Partially, I think because it's the latest rage to dump on them.

[DrBenway]

Familiarity with a drug translates into a higher comfort level prescribing a drug. So, given two drugs of equal efficacy, a doctor is going to prescribe the one he or she is most familiar with.

The pens, calendars, and mugs, probably contribute to the sense of familiarity a little. Having some samples in the office also probably increases the chances a doc is going to prescribe that particular drug vs. another of equal advantage.

But there's no "kick-back" system, where a doctor gets money for prescribing more of one particular medicine. That would be unethical and illegal.

Sometimes I have to look up pill sizes in the PDR for drugs I don't use much. That step slows me down, and I think it probably makes patients feel less confidence in what I know. So familiarity definitely affects which meds I chose first, other factors being equal.

Whenever I've tried to trace back the conspiracy theories about doctors in kahoots with the big drug companies to over-medicate America, oddly enough, I've encountered the same apparently original source again and again: the Church of Scientology.

Hope the CoS link isn't my own delusional conspiracy theory. :)

[Skeptical Greg]

One of my pet peeves is the advertisements for Nexium, the 'purple pill'..

They implore people to " ask their Dr. about it ", without any hint of what it is supposed to treat.


I can't articulate why this seems devious to me, but it does.

[toddjh]

Originally posted by Diogenes
One of my pet peeves is the advertisements for Nexium, the 'purple pill'..

They implore people to " ask their Dr. about it ", without any hint of what it is supposed to treat.

I can't articulate why this seems devious to me, but it does.

My impression is that those prescription drug commercials are so vague because if they go into specifics about what it does, they also have to go into specifics about side effects. I remember, around 1996 or so, those Claritin commercials where all they'd say is that it makes things "clear."

I'd much rather know what a drug does, including side effects, than be left in the dark. But even then, I doubt I'd "ask my doctor" about it -- he's the one who went to med school; I'll tell him any health concerns I have and trust him to suggest a prescription if he thinks it would be helpful.

Still, the requirement to list side effects in a commercial seems a bit silly. A person will have to get a prescription from a doctor before they can start taking the drug anyway; that's the appropriate time to discuss side effects, in my opinion. If they order the drug from overseas or otherwise obtain it illegally, they deserve what they get if they don't do their homework.

Jeremy

[rwald]

I'm pretty sure that you're both right; if a commercial mentions what the drug does, it must also mention the side-effects. So, the drug companies make both commercials which discuss the uses (and side-effects) of the drugs, and ones which only mention the name. The idea (I think) is that when you see the "name-only" commercials, you might remember what the drug did, but not the side-effects, effectively circumventing the system.

An even funnier way of avoiding the laws is the one used by Nexium. There's nothing that says they can't mention the disease if they don't mention the name, so they have some commercials which talk about acid reflux, but don't mention the word "Nexium." They just talk about the "Purple Pill." Pretty sneaky, I think.

[boooeee]

I remember, around 1996 or so, those Claritin commercials where all they'd say is that it makes things "clear."


Yeah, I remember Rogaine did something similar at about the same time as well. They never said what their product did, but the ads featured lots of middle aged men wearing baseball caps.

[a_unique_person]

There are numerous stories of companies using devious means to push their drugs. You just have to look at all the freebies that land up on their desks. They can also get cheap trips to 'conferences'.



$200M 'BRIBE' TO LURE OUR DOCTORS
Author: Shelley Dempsey
Date: 17/08/1991
Words: 2192
Publication: The Sun Herald
Section: News and Features
Page: 38

DRUG companies spend a massive $200 million every year in Australia on marketing their products. To emphasise the extraordinary size of that figure consider these facts:
* That represents almost $10,000 a year spent attempting to woo each of Australia's 21,000 "actively prescribing" GPs, according to Dr Ken Harvey from La Trobe University;

* It amounts to roughly 15 per cent of total annual drug sales in Australia or, if you like, 50pc more than allowed by law in Britain for marketing.

That $200 million ensures doctors not only receive every conceivable gift from the drug companies, but their messages are followed up by a mountain of promotional material mailed to doctors every day; by glossy advertising in medical journals; and by personal visits from an average five drug company sales staff each week.

As a result, industry critics say, it's no wonder a major new report from the Trade Practices Commission reveals that Australians spend up to $37 million a year needlessly on expensive drugs.

The report highlights the power wielded by big-budget drug marketers on how prescriptions are written by Australian doctors.

In the report, the Federal Department of Health and Community Services is"very critical of advertising which gives rise to prescribing practices that result in the use of expensive drugs when cheaper efficient alternatives are available".

Dr Harvey, senior lecturer in health education at La Trobe University, confirmed to The Sun-Herald that his surveys of prescribing practices by Victorian GPs in the last five years show 40pc opted for newer, more expensive drugs when older, cheaper drugs would work just as well.

[Kilted_Canuck]

In canada, the laws forbid perscription drugs to be advertised with both the name and what the drug treats. They aren't allowed on tv, so you see these huge billboards saying:

ZANTEC
ask your doctor

why must they say that!! I've heard some doctors getting really pissed off when patients walk in and ask them if they need this certain drug, but don't even know what its for, let alone if they require it!

[spoonhandler]

I initially found it difficult to believe that a GP would choose one drug over another based on whether a sales rep had provided him/her with a pen. Unfortunately, the recent story about COX-2 inhibitors suggests pharmaceutical marketing strategies, including paying for lunches, providing chocolate bars and stationary supplies and sponsoring conferences, do work.

It could be said to be an example of non-critical thinking. The packaging is nice, the brochure is slick, the pen is cool, the rep brings cake = the company is professional = the research findings are sound = the drug is the better one to use.

[DrBenway]

Originally posted by spoonhandler
I initially found it difficult to believe that a GP would choose one drug over another based on whether a sales rep had provided him/her with a pen.

I'm a doc and I don't think the pen (I have a thousand pens) or the mug (no mas!) or the crappy plastic clocks, or the pads (I yell at drug reps who try to give me any more dead trees) or the lunches (my time is limited, so I only bother to go to one if I can get CMEs or if I want to chat with colleagues) make much of a difference.

All the reps for competing products do the same thing. No rep offers a clearly better mug, plastic desk clock, calendar, or type of sticky notes. It's laughable, thinking that this junk serves as some sort of "bribe." At most, it induces a sense of familiarity with the product, which probably contributes to a physician's comfort level in prescribing the product.

Sometimes the brochures have garbage science in them. The last (insert popular med X here) brochure had "pooled data" from 3 studies on one page, then "pooled data" from 5 studies on the next page. Hmm.

Occasionally I learn something useful from my conversations with drug reps. But usually, these guys aren't a joy to have around. Why waste 15 minutes of my time with a hyper-cheerful over-dressed guy I hardly know, when I could make good money spending that same 15 minutes with a patient?

I wouldn't even let the drug reps in my office, except for the fact that the few samples and coupons they drop off can be a big help. If a patient is really poor, he or she can get Medicaid which covers meds 100%. But many jobs offer no health coverage or a plan with limited outpatient coverage. For certain illnesses, the newer meds are clearly superior in efficacy and have a much better side effect profile, when compared to older meds that have cheaper generics available. But some of the newer meds cost hundreds of dollars a month to take. By loading up a few of my poorer patients with a couple of months of samples, I can make sure they get the treatment they need.

If docs out there are getting thousand dollar vacations or other major perks, then I'm totally getting screwed.

[edthedoc]

I'm a doc too.

I find the common conception that we under somehow in league with pharmaceutic companies deeply insulting.

My knowledge and prescribing habits has developed over the year in response to my trainers/teachers, peer-published studies and information, journals and other 'official' publications, and yes, a lot of day-to-day anecdotal evidence as well.

I don't give the time of day to pharmaceutical companies. They're a necessary evil (someone has to develop the drugs) but I detest their brochures/advertisements as much if not more than the rest of the junk mail I get. I don't see drug reps if I can help it, never get involved in drug trials and have never received any inducements to prescribe one drug over another.

So please, don't tar us all with the same brush, particularly us doctors who don't work in the US.

There, I feel much better having said that ;)

[DrBenway]

Originally posted by edthedoc

I find the common conception that we under somehow in league with pharmaceutic companies deeply insulting.

Undergrad: 5 years (two majors)
Med school: 4 years
Internship: 1 year
Residency: 3 years
Fellowship: 2 years

How do you put an dollar amount on an investment like that? How big does the bribe have to be, to balance the risk of losing one's professional reputation?

The accusation of taking bribes from drug companies is insulting on two counts: it says, in effect, that I'm unethical, and also that I'm stupid.


My knowledge and prescribing habits has developed over the year in response to my trainers/teachers, peer-published studies and information, journals and other 'official' publications, and yes, a lot of day-to-day anecdotal evidence as well.


Yeah, none of my supervisors ever said, "Drug X is preferable in this situation, because drug X comes with a cool refrigerator magnet."

I have a thought at the back of my mind as I work, that the patient will one day move on to another doc, and the other doc will look at the decisions I've made. I don't want a colleague thinking I'm irrational.


So please, don't tar us all with the same brush, particularly us doctors who don't work in the US.


Hey, give us in the US a break.

[Denise]

Well said, DrBenway!

[edthedoc]

I wasn't implying that US-based doctors are in league with pharmaceutical companies - so apologies if you thought this - I was just making the point that there are plenty of doctors outside the US and the thread started with what seemed to be a largely US slant.

I was also a bit peeved at the 'crooked' doctors suggestion and general accusation that we are being bribed.

I'm sitting here doing a six hour continuous surgery trying my best to make the right decisions etc., extremely tired and read this thread a few minutes ago.

There's a lot of difference between countries in terms of rules regarding pill-pushing companies and doctors and the UK has as far as I'm aware very strict rules. I think the maximum monetary value of any gift to a doctor from a drug company is £5 - hardly sufficient to change anyone's prescribing habits.

Hope this clears up any confusion.

[toddjh]

Since there are a couple doctors reading this thread, I'm wondering whether any of you could say how many patients actually ask about the drugs in those mystery commercials. I hope the number is small, but you never know...

Jeremy

[DrBenway]

Originally posted by edthedoc

I'm sitting here doing a six hour continuous surgery trying my best to make the right decisions etc., extremely tired and read this thread a few minutes ago.


If you're a surgeon: I know you guys are god-like with your hands, but how do you see what you're doing with a keyboard in your sterile field?

If you're an anesthesiologist: I realize your job is boring, but isn't it a bit risky, eyeing the O2 sats and surfing the 'net at the same time?

:)

[edthedoc]

Yeah, sounds amazing, but unfortunately more mundane. I'm a GP doing a six hour "surgery" as in "clinic" so have PC on my desk which means I can browse the forums during brief breaks from the hoards of patients outside! (am seeing patients at the rate of 1 every 7.5 minutes which is virtually impossible to keep up with, wasn't my idea etc. etc., bl**dy NHS, blame Tony Blair moan moan).

6.20 pm, 3 patients to go then home to kick the cat (:) ) and pour myself a large G+T. Same again tomorrow though.

[spoonhandler]

As with any profession, medical practitioners come in all shapes and sizes. That is, many are not influenced by the cheap gimmicks drug companies offer, whilst others may be. I would not in any way tar all clinicians/surgeons with same brush, but they are human and therefore subject to the same population variations. Some are impressed by the strategies drug companies use to get their product across. Not all scientists are good scientists, not all teachers are good teachers and not all doctors are good doctors.

We could all name an instance where we made a decision based on advertising and later realised our decision was flawed.

As an apology to any health care provider I may have unjustly accused of non-critical thinking, I'd like to point out that in my experience, most doctors use the drug company gifts to the best advantage of their patients and themselves without ever allowing their treatment choices to be influenced. If instances where a drug has become popular without having the track-record to back it up, the fault probably lies in less than complete or even deceptive documentation from the marketing rather than a proliferation of mugs and fridge magnets.

It's a cautionary tale for everyone. :)

[DogB]

The marketing departments of these companies must have done some research on the effectiveness of these tactics.

Surely they wouldn't keep outlaying the money if there was no effect??

[a_unique_person]

they don't advertise because it has no effect. I know that we are all susceptible to subtle pressures, and some more than others.

The 10,000 per doctor/year doesn't go to all the doctors, but eh marketing, salesmen, lobbyists etc. And they do work. We wouldn't have 'free' tv if ads didn't work. I am sure companies could find better things to do with their money.

[BillyJoe]

Originally posted by Phaycops
Is there a vast conspiracy of pharmaceutical companies who are bribing doctors to prescribe their drugs? No.

Originally posted by Phaycops
If not, why do so many people believe there is? Read my signature below.....

[edthedoc]

Is there greater pressure in the US on doctors from drug companies compared to the UK?

In the UK all we get is crappy full page ads in our journals that are easy to ignore and post-it notes/pens/rulers etc. for our clinic rooms. Gone are the days of sponsored "conferences" in far flung parts of the world.

Best free gift from a drug company I found on another doctor's desk was one of those "stress-relieving" soft balls that you're supposed to squeeze to destress. His had been completely worn out, poor sod.

[Phaycops]

Thanks for the input, especially from the doctors. I guess my initial gut instinct was correct, thank goodness :)

So, this person on a different forum who inspired this topic is also concerned with the percieved "over-percribing" of anti-depressants, especially the new Serafim for PMS (basically, aparently, low-dosage Prozac). To what extent do you doctor folks think Prozac et. al. are over-perscribed? Is it really as bad as some people think, i.e., they go in feeling depressed and before they even stop talking the doctor's written them out a script for the stuff?

Does anyone know if the QuackWatch website might have info on this? I've looked a bit, but didn't find anything. Are there any on-line resources I can point this person to proving that she's full of it? Thanks!

[edthedoc]

Very difficult question to answer:

There is a huge variation in prescribing habits for antidepressants between doctors (own expertise, knowledge, workload), large cultural differences between countries, societies, ethnic groups, religions for both patient and doctor.

Some doctors do overprescribe (but what is 'overprescribing'), some patients demand them inappropriately. There are pressure of time issues in the consultation, lack of other treatments (therapy, counselling) that affect the decision to prescribe.

Personally I don't usually prescribe at the first consultation: I'll listen, discuss options, review in the near future and then consider prescribing but will try to involve the patient as the more they know about the drug the better.

There is a maxim for antibiotics that could be loosely applied to antidepressants and it goes something like this:

60% of patients will get prescribed the drug
but only 40% want the drug
and only 20% need/would benefit from the drug

Slightly tongue-in-cheek but I do like it.