drug companies

[Guest zipperzone]

>I never trusted those sneaky Canadians.

 

Me neither.

[Samai139]

I've enjoyed reading all the posts on this topic, but still would like others to respond to what I consider the most basic problem of drug companies advertising directly to consumers---that being the pressure badly informed consumers put on their physians to prescribe medications that may do no good, may be more expensive, or in fact may do harm---e.g. Vioxx

Can't drug companies get their message about new drugs out to those who really need to know about them, through professional journals, direct mailings to the medical community, sales personnel, etc., without bomnbarding an already suspectible American populace with advertisements for medications millions do NOT need but might be tempted to ask for??

BTW: Thanks to the poster who educated me that it was under the Clinton administration that the regulations changed. I wonder how much of that was due to campaign contributions/lobbyists who were "owed" by the Clintonians? Or is that naive?

[Guest Merlin]

But remember, those major companies in countries with socialized medicine largely depend on profits of sales of their drugs in the US. Their own countries have price controls while in the US they can set their prices to recover research and development. Those companies would develop few if any drugs without the inducment of sales in the US.

[Guest Merlin]

The advertisements serve the purpose of educating the public about new solutions to problems which may be available. They still need a prescription from the Doctor and we rely on the Doctor not to prescribe a drug which is not needed or which is harmful. We have seen ads for a drug for "restless leg syndrome". There are probably people bothered by it who never had a name for it and did not know there was a solution, and thought their Doctor would not have an answer. The ads are required to give the most important counter indications and possible side effects. NO system is perfect, but ours is not bad.

[+ purplekow]

Records are indeed kept of which physician's are writing which drugs. Pharmacies keep them and sell the information to date collection agencies which inform drug companies of the data. The drug representatives probably know more about a physician's prescribing patterns for their drugs than the doctors do. Though there would be no problem kicking back to doctors, the fact is that it happens rarely.

As far as big pharmaceutical companies go, they have so many ways of making their drugs profitable, it would be useless to try and list them. Merck Medco for example serves as a supplier of drugs by mailaway which has been marketed to insurance companies. Merck Medco put together a formulary of which drugs are given at discounted prices and which drugs are considered premium and have a higher co-pay. You don't find many drugs manufactured by Merck on the premium level at Merck Medco.

As for needing a prescription for medication. How many men on this site get Viagra on line? Cialis? Levitra? Well if you want anything from Accutane to Zithromax you can get it online without a doctor intervening.

[Guest]

>Do you really think the pharmacy keeps a

>record of which doctor prescribes which drugs and reports that

>info back to the drug maker so as the doctor can collect a few

>bucks? Get real!

>

The very surprising answer is that they actually do (except the part about the pharmaceutical company paying money to the doctors)! I must say that I was very surprised myself to learn that most pharmacies actually sell the drug companies data as to which physicians, nurse practitioners, and PA's are prescribing what. While it used to be the case that favors given to doctors were generous to the point of being questionable ethically (such as flying the doctor and his wife or partner to a lecture series in a tropical resort), current guidelines limit each pharmaceutical representative to $100/doctor/month, generally spent on dinner lectures, medical software or books, etc (they must have at least some educational value--and spouses and partners are no longer allowed at these dinner meetings).

I would say that it doesn't affect my prescribing decisions except in the very rare situation in which (1) two competing drugs are completely equivalent, AND (2) they cost exactly the same to the patient. The only two meds I can think of in this category are Novolog and Humalog, which you could ask 1000 diabetes specialists (who are not on the payroll for either Novo-Nordisk nor Ely Lilly), and they will all tell you that these two are completely equivalent.

Before the current pharmaceutical guidelines went into effect, while I was still a resident physician, I can remember the most unethical gift I ever received, and am almost ashamed to admit it (although it was quite legal at the time): 100 lottery scratchers! What makes me feel not so bad about it was that the dinner was promoting Tagamet, which I have never prescribed except when required to do so by insurance companies. Even as a naive resident, it was always clear that Zantac, and later Pepcid and Axid (and much, much later Prilosec) were superior drugs.

[+ bigjoey]

the drug companies getting the information had an interesting result in one case. in kansas city, the local salesman for a cancer drug could not reconcile the number of prescriptions the doctors said they were writing and the amount of the drug the pharmacies were ordering. it turns out a major local pharmacy was deluding the drug. the pharmacist made millions and murdered dozens of people who could have been saved by the drug. curently, the pharmist is doing life in prison.

 

he only got caught because the drug company salesman started questioning the amounts being prescribed and sold. a friend of mine was on the drug that was working and then suddenly stopped working when she got the deluded drug and died.

[Jlelland]

>> By golly; do you think

>>that these could be sales people?? from drug companies??

>>Cheerfully leaving samples of their newest products, along

>>with the rebate (kickback) schedule for your MD.

>

>Just to set the record straight. Yes, these people are

>pharmaceutical company sales people, and no they do not give

>kickbacks to MDs, if by that you mean money. The most they

>can do is to offer medical textbooks or software, or invite

>the physician to a promotional dinner lecture at a nice

>restaurant (admittedly of dubious educational value). I

>remember a nurse practitioner once asking me if she could

>obtain continuing education credits for attending these

>lectures. I told her that should be thankful they don't

>remove her existing educational credits for attending these

>lectures!

>

>Just to make you feel better, physicians are also under

>pressure to keep costs down (from insurance companies, of

>course), as well as the other way around from the

>pharmaceutical industry. Hopefully, your physician is smart

>enough to do the right thing for his patients (admittedly very

>difficult if not impossible for a patient to tell).

 

I never thought the kickback would come in the form of a check direct from Merck or some other company; nor would it be highlighted on the P&L statement at the annual shareholders meeting. But I do believe that there is room in that little sample case all of those rightous parmaceutical sales people carry for a small brown bag of cash.

Now my question...

what did Santa bring you this year?

you getting ready for the easter Bunny??

[Jlelland]

>>I never thought that I had to bring a new drug to the

>>attention of my MD.

>

>I never said I would bring the DRUG to the attention of my MD.

>I meant that if I thought I had a sympton that could possibly

>indicate a problem, I would mention the SYMPTON to him. Big

>differance there.

>

>As I sit in the waiting room I notice a

>>constant stream of people in suits, pulling little suitcases

>>on wheels in and out of my MD's office. By golly; do you

>think

>>that these could be sales people?? from drug companies??

>>Cheerfully leaving samples of their newest products, along

>>with the rebate (kickback) schedule for your MD.

>

>Another conspiracy theory? The MD only prescribes, it's the

>pharmacy that sells. Do you really think the pharmacy keeps a

>record of which doctor prescribes which drugs and reports that

>info back to the drug maker so as the doctor can collect a few

>bucks? Get real!

 

Not a conspiracy theory; a human greed theory.

and what did Santa bring you??

>

[Jlelland]

>But remember, those major companies in countries with

>socialized medicine largely depend on profits of sales of

>their drugs in the US. Their own countries have price controls

>while in the US they can set their prices to recover research

>and development. Those companies would develop few if any

>drugs without the inducment of sales in the US.

 

Who says???

[Damascene]

The sad fact the commercials are used to create a demand among patients, who, if their doctor won't prescribe the drug, bounce to another doctor - even, if what they are on now, is cheaper or better.

[Guest]

>The sad fact the commercials are used to create a demand

>among patients, who, if their doctor won't prescribe the drug,

>bounce to another doctor - even, if what they are on now, is

>cheaper or better.

>

It's actually quite unusual for a patient to insist that he knows more than me, after I explain the situation. On those rare occasions they do, however, I'm more than happy to show them the Out door. Any patient like that is Trouble. I have more than enough trouble being able to secure appointments for all of the patients who want to see me and who value my advice.

Most of the doctors who will prescribe anything a patient requests without discussing alternatives (and there are quite a number of them, unfortunately) tend to be rather shady characters. I wouldn't want to be known as the walking-talking drug dispensing machine! But in all seriousness, I actually wonder whether direct-to-consumer marketing is all that effective (other than for things like Viagra, Levitra, and Cialis). They're probably more effective at bringing in a patient to the doctor to discuss a condition than to twist the doctor's arm into prescribing something.

[+ purplekow]

>while I was still a resident physician, I can remember the

>most unethical gift I ever received, and am almost ashamed to

>admit it (although it was quite legal at the time): 100

>lottery scratchers! What makes me feel not so bad about it

>was that the dinner was promoting Tagamet, which I have never

>prescribed except when required to do so by insurance

>companies. Even as a naive resident, it was always clear that

>Zantac, and later Pepcid and Axid (and much, much later

>Prilosec) were superior drugs.

>

>You are not required to prescribe any drug and certainly are not required to do so by an insurance company. What is true is that you driven by unfair tiering of drug copays which makes certain selections of similar drugs more expensive or by the desire to avoid time consuming and basically unnecessary insurance company approval requirements to write for drugs in their formulary. One hits the patient in the pocketbook and the other hits the physician in the wristwatch. Both are effective in getting the insurance companies what they want but to state that any drug might be required by an insurance company is overstating the case just a little bit. The difference is between illegal coersion and legal "guidance".

 

An interesting item in this vein. The status of many cough and cold medications containing Guaiafenesin is being changed. Many of these will no longer be available by prescription and because of the heavy government cost for bring these medications to over the counter status, some will cease being made. While the value of these drugs is certainly questionable, what is interesting is a letter sent by the FDA to manufacturers of these drugs about their concerns that these drugs would no longer be covered by insurance policies. Paraphrasing, the FDA stated that though insurance companies might benefit from decrease expenditure as they no longer paid for these drugs, but that the manufacturers sales would probably stay steady as people would take the copay they would use to go to the doctor to purchase the medicine instead of seeing the doctor. So, insurance companies save money, drug manufacturers break even, with the insurance company money being picked up by the patients and doctors copays. Less doctor visits, more insurance company savings. It is also true that most visits for colds and such to doctors are not needed, but they do represent for many patients, the only opportunity for a doctor to see the patient and get him routine care he may need.

[Guest]

Insurance companies are not required to pay a penny for any medication. The purpose of Prior Authorizations are not to give the doctors a choice between prescribing something quickly or wasting time. If the pharmacy tells you that a drug requires a Prior Authorization (PA), it doesn't mean that the doctor just needs to do paperwork. What it means is that the patient MUST try a formulary medication first, or the insurance won't pay squat. If drugs A and B both perform similar functions, and A is on formulary and B requires a PA, the patient MUST try A first. The PA form MUST state "patient was unable to take drug A because of X." It cannot simply state "patient wants to try drug B and doesn't feel like trying drug A."

Of course, if the patient just wants to pay cash, the doctor can simply write for B, and the patient could pay cash. This is not personally an option for most of my patients, especially for chronic medications. So effectively, if A is on the formulary and B is not, I always HAVE to write for A first.

[+ purplekow]

The patient does not have to have tried a formulary drug, someone from your office has to tell the checklist checker on the other end of the phone that they did. Its called lying to get what you want rather than capitulation. Choices can be ugly but they are still choices.

 

I have never seen a purplekow;

I never hope to see one;

I can tell you anyhow;

I'd rather see than be one

 

Help there is a purplekow in my mirror

[+ Lucky]

RE: Zetia

 

I didn't see anything in this thread about the fact that the drug companies hid information that the cholesterol drug Zetia really wasn't effective. For two years they made billions on this drug, knowing the results of studies didn't support their claims. It got me so depressed that I thought about taking an antidepressant, until I read this:

http://www.nytimes.com/2008/01/17/health/17depress.html

[Guest]

The doctor usually has to sign the forms. If you want to go to a doctor who's a liar, so much the better for you. If the staff member does it, it's not better. In any case, sometimes the insurance companies check medical records for documentation of reactions. Yes, it's certainly possible to falsify medical records as well. I wouldn't go to a doctor who's sleazy enough to do that kind of shit, and I definitely don't need any patient who would ask me to pull that kind of shit. It's totally unnecessary in any case. There's no reason not to at least try drug A before drug B, even if Madison Avenue has convinced the patient that B is better for some reason.