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WNYC reporter Ailsa Chang talks about ProPublica's Dollars for Docs investigation and what some New York City doctors earn from the pharmaceutical industry.
I've been suspicious of this whole practice since reading this article 3 years ago:
I am a non-practicing RN and an attorney. I also have a friend who once was a drug rep. As an RN it was my responsibility to know know everything about a drug before I administered it. If I wasn't familiar with it I had to look it up in the PDR (Physicians Desk Reference - a compendium of all medications). The fact that it was prescribed by a physician was not enough. Physicians do make mistakes & the nurse was responsible for the patients safety.While new drugs constantly come on the market the law constantly changes too. That includes case law, regulations, statutes and executive branch opinions. No one comes to us to give us a tutorial on the changes. Attorneys do not get invited to free lunches where changes in the law are discussed. Every time a client comes to you with an issue that you haven't dealt with recently you need to research the law concerning the issue before proceeding. Continuing education education courses are offered by the NJ Bar Assoc. The attorney must travel to usually one of 2 or 3 locations and they pay for the courses.There is no reason why physicians can't do their own drug research & in fact many, especially the most competent, do. Pharma reps & paid MD's are not essential for educational purposes. As far as I know rep.'s are not required to have experience in health care. Their only purpose is to sell the drugs. They can be very aggressive. Physicians should be prohibited from receiving any form of benefit from Pharma. Not exotic trips, not lunches, not money for giving a presentation. If the physician really cared about the best interests of patients, they would offer a free presentation on a drug that they had positive experience with, at a hospital or medical society meeting. Remember lobbyists have often said that their purpose is to educate lawmakers on legislation before them and the public doesn't seem to think that they are very ethical people. But it's still better than what does. The lawmakers also hear from lobbyists on the other side of the issue. Physicians only hear from one side. Companies that have a competitive drug will give the MD a different opinion, i.e their drug is better but the point is that drugs are always being pushed which I believe has led to an overuse of drug which are not always in the best interests of the patient.
I feel the guest did not accurately portray all sides of this. Firstly, the guest mentioned that doctors are confined to the slide decks prepared by the pharma companies. While this may be true (as it's an FDA requirement for companies to provide fair-balanced approved content), she failed to comment that physicans have a choice in their participation in these programs! If they do not feel comfortable with the content, they should not be participating. Secondly, additional benefits can be gained for physicians participating in these programs. Yes, they are exposed to new drugs/treatment options from the supported company, but these events also provide a forum for other discussion on new & existing treatments, particular challenging cases, etc.
I edit a lot of those PowerPoint presentations sposored by pharmaceutical co's., & I always see data comparing the drug w/competing drugs in them. But these are usually for seminars or conferences, not standalone presentations at restaurants. Maybe the latter are more blatant about promoting whichever drug the co. is trying to sell.
The reporter confuses promotional dinner meetings on a particular drug (speaker paid by company) with certified continuing medical education courses (theoretically covering the full gamut). The promotional speakers MUST by law speak only from the FDA-approved label. Pharma companies are no longer allowed to sponsor CME courses, so it makes no sense to criticize the companies for not presenting pure educational meetings.
I think it's human nature to want to reciprocate. If a pharmaceutical company is paying for a doctor to speak about a drug or to hear about a drug, I think it'd be natural for the doctor to at least give it extra consideration when writing out a prescription.
Could your guest address how doctors learn about drugs in the first place. I was under the impression that doctors read peer-reviewed scientific journals to keep up on research. I wouldn't expect pharmaceutical companies--whose primary purpose is to make money--to "educate" doctors on their options.
Brian, you should do an expose on the FDA. It approves so many drugs that have terrible side affects. Doctors seem to be prescribing more and more drugs to relieve symptoms but not cure anything and the side affects are sometimes worse than the disease, such as prednisone for example. What ever happened to "First do no harm"? The pharmaceutical companies are pulling the wool over everyones eyes. If doctors are on the pharma payroll it is unethical.
Please, do you think that doctors are that corruptible when sitting down to listen to a lecture? We know who is sponsoring a particular activity
I am a pharma rep in the NYC area. I am ambivalent about the usefulness of these educational programs. We certainly appreciate tue additional time that a dinner educational program affords us to interact with our physicians. Pharma companies are only allowed to discuss slides an info approved by the FDA. Literally every thing I say all day has been approved by the FDA. If doctors want a full picture of a disease state with all drugs in a class, theycan attend physician Continuing Medical Education seminars that are run by the AMA and Rhee physician groups or theycan attend specialized congresses.
Why didn't Brian or Alisa ask the previous caller whether he worked for a pharmaceutical or marketing company?
Aren't doctors who speak just taking advantage of a loophole to allow the pharm co to pay the doctor a "speaking fee" because they banned gifts to doctors?
Doctors selling drugs or acting as the agent and representative of big pharma is abusing the trust that we all have for the medical professionals that abide by the Hippocratic oath, rather than free market principals.Yes, it's unethical.
This is a slippery slope, and is similar to the revolving door between lobbyists and government.
Heard the report this morning. So long as the dinner guests know that the pharma company is paying the doctor, and wrote the script, I did not detect a hint of wrongdoing.
For a moment it sounded like the story was going to be that the pharma companies were targeting the list of doctors who had been reprimanded or suspended. But then you said that was just 1% of the total.
If this is a story about the number of greedy incompetents that obtain medical degrees, and how that effects the public, then might I suggest looking into how AETNA, CIGNA and others select the arguably bottom-of-the-barrel professionals in their "networks." I expect many NYC-area adults and/or parents already understand that finding a satisfactory doctor (competent, efficient, plus with enough time and interest to listen, think and learn) is not normal. To me your story was a slight connection to that theme.
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