“My former internist, who has regrettably stopped practicing and is now solely teaching, wouldn’t let pharm reps pop in to visit nor give any freebies, food or otherwise, to his office and staff. To much undue influence.”
What pharma reps can give doctors is strictly regulated. The days of payola are long, long gone.
I’m not talking about the long gone payola but about more subtle forms of persuasion - the bagels, the meals, the goodies and gadgets, etc. THAT still goes on. The pharma companies wouldn’t engage in this stuff - nor have the foxy, young reps - if it didn’t have an impact.
http://fortune.com/2016/06/21/doctors-cheaper-drug-prescriptions/
@doschicos - the influence might be still there, but the impact is much, much smaller than in the old days of wine and dine deals.
Here is a good article for anyone interested in what is OK and what is not:
http://www.physicianspractice.com/blog/when-it-legally-acceptable-accept-gifts-your-medical-practice
Oh. Well, big whoops. How do you think I’d ever eat dinner if pharma reps didn’t bring my spouse’s office lunch so he can take leftovers home? Ha ha.
It does influence. See article linked. For the very same reason, my company would not allow us as employees to receive any gifts, meals, etc. from salespeople. We had a fiduciary duty to perform and one didn’t want to give even the impression that influence was being purchased.
All joking aside re: “free” meals (I like food as much as the next person probably more!), but all these expenses add to the consumers’ cost of drugs. It’s got to come from somewhere. Let’s not pretend its anything but what it is, an attempt to influence. Again, why else would they do it?
@marian:
I am not so certain of that, that fat paydays don’t influence what some researchers will say or do. There have been plenty of scientists who stuck to a position, not because they believed it, but because it was lucrative. Think about the doctors and supposed scientists who even after the surgeon generals report continued to claim that smoking was not harmful. The TV show cosmos had as one of its episodes the story of Clair Patterson, who discovered tangentially when trying to determine how old an meteor sample was (and the age of the earth), how much lead contamination there was from leaded gasoline.
His chief opponent was a doctor by the name of Keyhoe, who basically worked for the Ethyl corporation (that made the tetraethyl lead used in gasoline as an anti knock agent), and long after scientists were convinced lead was causing harm and most of it was from gasoline and industry, he kept on being the ‘proof’ it was safe (as early as the 1920’s, people in the plants making the stuff were getting sick and dying). As a result, lead was phased out in the 1970’s, decades after the harmful effects were known, and it was only phased out because of the catalytic converters being used for nitrate emission were fouled by lead (the EPA did not ban lead in motor fuel until 1981). And to make it even more interesting, the AMA supported Keyhoe in his claims lead was safe (gee, do you wonder why?) Keyhoe’s worse legacy was basically the claim that if lead is harmful, prove it, which later on would be used by the tobacco and absestos industry, rather than what it should have been, proving that tetraethyl lead was safe (with the former, the thing could be sold for decades, because it was easy to say “well, not everyone thinks lead is dangerous” and point to Keyhoe and yes, the AM, until it was ‘proven’ dangerous), rather than removing it and making them prove it was safe.
Sometimes people paid to do one thing do respect science enough to report the truth. A researched at Cal Berkeley, who was one of the chief climate change skeptics, funded by Charles Koch, several years ago issued a report where he said that he could no longer in honesty doubt that climate change was real and man made. That said, though, at the very least, when people are funded by people with a strong vested interest, the tendency is going to be to overlook things that are inconvenient and highlight those that fit your model; it isn’t lying per se, but it certainly is shading the truth.
nevermind. 
Public funding for nutritional research is great… But NIH/NSF grants are not given out blindly. Why do you think certain researchers get all sorts of funding and others can’t get a foot into the door even though their projects have been endorsed by independent reviewers?
And before someone says I think all researchers are somehow corrupted, they aren’t. First of all, I know people who are researchers in the pharm industry, and take it from me, they ain’t getting rich, friend of mine’s wife is an infectious disease specialist, she made really good money in private practice, was a whiz at it (she especially was unreal with treating AIDS patients, long before the cocktails they have now), and she went into research at one of the pharm companies because that was her love and passion and from what I can tell this is common. The problems I see with the pharm industry are in how the products are delivered and marketed, in being allowed to advertise the drugs (the US is one of only two countries who allow that)( and the cozy relationship between doctors and pharm reps that every study, including one by Harvard business school, have said heavily influence what doctor’s prescribe.
Likewise a lot of researchers do so looking for the truth, many of them suffer for it because they don’t choose the easy path. @bunsenburner is right, research dollars are skewed in the public sphere as well, for example, in nutrition research often those getting money are those whose work is more politically acceptable. For example, if your research is on the benefits of a grain based diet (ie the FDA infamous food recommendations) politically it is a lot easier to get funding, the farm state reps will be pleased, whereas if your work is questioning grains as the basis for our diet, or you are working on research let’s say about how bad factory farmed meat is for you versus grass fed beef, it is going to be a lot harder. In medical research, when it comes to cancer studies according to a friend’s brother (who is a top notch researcher and oncologist), if you are looking outside the box, looking at treatments that don’t involve the traditional chemo and radiation approaches, it can be hard to get funding, or if you have a radical idea you want to try and research.
Sometimes that isn’t necessarily a bad thing, for example with the debate about climate change, if we had to rely on the private sector it likely would be heavily skewed towards trying to show that climate change was not man made, etc, a lot of the climate research that has been done has come from the public sector, NOAA, NASA and so forth, as well as government financed research overseas, so bias in some cases can be a counterbalance to money, other times it is a victim of it.
I work with the darkest parts of US medical history. I study eugenics, forced segregation and sterilization, etc. Does anyone here know that eugenic sterilizations were justified using the same logic as forced vaccinations?
So do I get the hesitancy from some? Yes. Does that mean I accept people’s paranoid delusions? Nope. I draw my line at whether or not someone is hurting or at risk of hurting the community. Don’t want to trust chemo to cure your cancer? Fine, as long as you are an adult. Don’t trust vaccines? Too bad, they’re one of the costs of living in a society.
I’m especially bitter because I’m on a round of antibiotics because I was exposed to an unvaccinated child with whooping cough. I’m on antibiotics all the time because of a compromised immune system which leads to infections. I don’t need preventative antibiotics on top of that.
With that said, I still trust studies that are more recent and that have multiple studies backing them up. I do not trust studies from the 70s. I do not trust studies that study 6 people. For the most part, studies by reputable scholars and institutions are very good.
Spinning off of another discussion upthread: I do not think there will be a cure, or even an effective treatment, for lupus and the multiple other autoimmune/connective tissue diseases that I have. Could that have something to do with the fact that my meds cost over 20k a month? Maybe, but unlikely. More likely is the fact that it’s a weird disease that no one really even understands, let alone can figure out how to cure it.
ETA: Oh, and in general, I don’t trust diet studies. They just (on a whole) do a poor job of controlling for lifestyle factors and whatnot. Plus it’s very difficult to do RCTs with diet.
Good point.
For example, it’s entirely possible that obesity would have increased in the United States in recent years no matter what we ate. The key factor may be the screens that we now sit in front of so much of the time. People used to move around more, even in office jobs. Now we send e-mails to colleagues who are sitting 50 feet away from us.
It may often be that it is not the studies that are the problem, but the unwarranted extrapolation of the study results. A treatment may be effective for some subgroup of people, but the treatment might then be prescribed for a much larger group of people. Some will still benefit, but for many the treatment might be inappropriate. For instance limiting salt intake is really important for some people, but of negligible benefit for many others. But we are all told to limit salt, because that’s easier than sorting out who really needs to.
The idea persists that pharma pays doctors to prescribe. That is illegal. Now, if THAT is going on behind the scenes somewhere, it really would be the story of the decade.
I don’t think anyone here is claiming that pharma pays doctors outright in cash. However, they do try to influence through ‘freebies’. It still goes on, the lunches and such.
I see it in debates about drug abuse. People are convinced the drug companies are paying the docs to write for painn meds.
I was a hospital pharmacist. We used to get lunch for no reason a LOT before they clamped down. Then it was lunch if and only if they provided an educational seminar with it and that was the only time we got free pens and note pads. Back in the day, the reps used to just drop by and leave dozens of pens and note pads and there were always staplers and clipboards from the drug companies around. Nope. No more. Strictly associated only with providing education as well and the reps document it, we sign it, etc. There are still lots of continuing ed dinners hosted by drug companies at very nice restaurants, those are always nice.
Are those dinners really informative or are they “continuing ed dinners” and an excuse to be treated to a nice dinner in an expensive restaurant? Could the same info be imparted without the dinner?
As a med student my H was given a ruler by Valium. “The anxiolytic by which all others are measured”, lol.
I have attended a few pharmaceutical dinners. Some medical centers do NOT allow ANY of their physicians to attend these dinners any more or allow the reps on their campuses. The reps are supposed to cultivate relationships with the physicians and their staffs and have regular contact with them. I’m sure the companies believe it is worth their while for their employees to cultivate and maintain these relationships.
One MD responded immediately to a text from a pharmaceutical company about helping with an event I was having until it didn’t appear the pharmaceutical company would be paying him and then he didn’t both to call me back. I was underwhelmed by that MD and gave up trying to contact him, despite them saying great things about him.
Trying to get MDs and other healthcare professionals to attend continuing education events is challenging, especially when they are in private practice and don’t get compensated for taking time out of their busy schedules to attend. I know several MDs who choose what events to attend based on the quality and type of food that will be served, honestly. I have hosted several continuing ed events and have had very low turnout–it is an ongoing challenge. Our state does NOT require continuing ed in the field that the MD or healthcare professional is practicing–any continuing ed is OK in ANY field.
“Are those dinners really informative or are they “continuing ed dinners” and an excuse to be treated to a nice dinner in an expensive restaurant? Could the same info be imparted without the dinner?”
But thy won’t listen / read the info unless the carrot (ha ha) of the dinner is dangled. Anyway, this has all decreased dramatically in the last few years - few doctors / office staff are willing to now spend 2 hours at a restaurant when they could be home with their families. My H used to be a speaker for several pharma companies - and that business has almost completely dried up. And he’s an entertaining, high energy speaker.
There are many medications where the choice of A vs B is six of one, half a dozen of the other. There’s no incentive for a doctor to choose a worse-performing medication, but if two meds are interchangeable, I don’t see the big deal if the doctor chooses A because he likes the drug reps better and gets samples and better service. It’s like choosing between Office Max and Office Depot for your staples and file folders. No harm if you make one choice over the other even for “superficial” reasons.
There is a bank in our area trying to court us. So far this year, they have invited us to a nice museum exhibit/reception complete with dinner and cocktails and valet parking; they just invited us to a Cubs game in their box; and the last time they pitched to us, they came over to our house and brought hors d’oeuvres. I’m still going to make the decision where I put my money based on what’s best for me, and not be swayed by a Cubs game.
Now the drug companies just advertise to potential patients, telling them to “talk to your doctor about [advertised drug, or condition that can be treated with advertised drug]”.
Sometimes, there may be significant cost differences between A and B choices (not necessarily just with drugs, but with other medical care choices, such as different kinds of colon cancer screening). Since the prescribing physician is not the one paying (directly or indirectly through insurance), effective marketing to physicians by companies offering the more expensive choices may be helping to drive up medical care costs generally. The same can apply to direct marketing to patients who have insurance paying for their medical care.