I know there's a recession, but should I take this job?

tallaght01

I work half-time. I spend the other half of my week at uni.

It means I have very little cash until my course finishes in about a year.

A guy rang me yesterday. He heard I was doing some extra shifts in the hospital to augment my income. He's offering me a job helping out with the clinical side of some research.

Great.

Then I asked who was funding the research, and he told me it was "industry sponsored". So, a drug company is paying the bills.

I've spent the last few years not taking as much as a pen from drug companies. I won't go to their dinners, and I refuse to take drug rep visits.

Now, I'm in a poxy situation, where there's a crackdown on locuming at the hospital, coz of the recession. So, I might have to do this job to make ends meet

My consultant says there's very few of this particular type of trial happening without drug company money, and it's better to form my opinions on the inside.

I'm not asking for anyone to tell me what to do, as A) circumstances are likely to make the decision for me and It's a decision I have to make myself.

But, I just feel dirty about the whole thing :P And really just wanted to rant.

My dad says "You can't be pious when there's bills to be paid". I'm sure he's right.

PS: I know times are tough, and people who are struggling to get a job, or are worried about their job might read this. Apologies to anyone in that situation who might think I'm being a knob complaining about a job when so many people don't have one. It's just more an ethical issue, and I think it's important to raise these issues, even when the timing may seem a little inopportune.

road_2_damascus

keep your friends close and keep your enemys closer. If we brought ethics into everything that we consume, we would probably end up with very little. You may gain some further insights through your research, and who knows, you may someday be able to change drugs company's protocol on how they operate from within

mardybumbum

Take them down from the inside tallaght!

2Scoops

I'm sure the research itself is ethical; things just get gray when you consider the whole profit/business side of things. Give in to the Dark Side, Tallaght01!:eek:

Mucco

Just take the job, do the research and make sure the results are published. Drug companies fund and carry out a huge amount of research, as well as producing all those drugs that doctors prescribe. This research wouldn't be done otherwise. I don't see the ethical problem.

M

PS I work in the pharma industry.

Vorsprung

What kind of research is it? Could there be a clause that states that whatever the outcome of a trial, it must be put forward for publication?

BTW check your PMs!

injured365

Regardless of ethics, surely the experience would be worth having on a CV when your competing for jobs with your fellow graduates.
Everyone must dance with the devil at some stage

tallaght01

I don't think it's right to say I should take a job "regardless" of the ethics because it would be good on my CV.

I don't really know what the trial is about, to be honest. The guy running it wants to talk to me in person. ON the plus side, I know one of the consultants who's involved in it. He works his ass off for the kids, does no private work, comes in to see his patients most weekends. A guy of enormous integrity.

I don't think I'll have any power over what gets published etc. I'm just worried about how data that I collect will be used.

But, I'll chat to them and see what happens.

nesf

tallaght01 wrote: »

ON the plus side, I know one of the consultants who's involved in it. He works his ass off for the kids, does no private work, comes in to see his patients most weekends. A guy of enormous integrity

That's a huge plus.

sam34

tallaght01 wrote: »

I'm just worried about how data that I collect will be used.QUOTE]

well, you could look at it this way - if you dont take that job, someone else will. the data they want will be collected, if not by you, then by someone else. and ultimitely it will be used, or not used, as the big pharma dictates.

if you dont take the job, will it make a material difference to patients? - no.


if you dont take the job, will it make a material difference to you? - yes.

my two cents!

Nonoperational

Just be sure you can stand over your own actions ethcally and you'll never go far wrong.

SomeDose

gpf101 wrote: »

Just be sure you can stand over your own actions ethcally and you'll never go far wrong.

Agreed. As long as trust your own ethics and judgement, I don't really see the problem. In a similar vein, we get drug rep visits on average about every 2 weeks, and I have no qualms attending them from time to time since I apply the same principle as given above.

Also, is the research something that may be relevant to your current/future practice? Mightn't be a major factor in your decision but at least you could also gain some new knowledge or learn something that may be of benefit to you down the line somewhere.

hotspur

I don't wish to sound patronising but I would suggest having a long hard think about the nature of your ethical objection to drug companies and their research. Certainly there are things to find objectionable but you don't have to be so categorical in your thinking. You are obviously an intelligent person if you are doing this kind of study and work so drop the binary thinking of pharmaceutical industry = bad, you know full well that they also produce incalculable health benefits.

Private industry funded research is a fundamental fact of the modern health related research world, firms like Diageo fund problem drinking research, casino giants and online gambling sites fund problem gambling research etc. To be honest it is mostly the zealots and the naive who are implacably opposed to this kind of funding these days.

The devil is in the details, I would advise judging the project on its individual merits. I would also advise (if not for this decision then for the future) doing a little bit of study on the issue of ethics, not necessarily medical ethics but ethics in general. I mean why would you consider it unethical to take a pen from a drugs company?

2Scoops

hotspur wrote: »

I mean why would you consider it unethical to take a pen from a drugs company?

Big Pharma makes a pen. A doctor accepts it. A constant reminder of their product now resides in his office - no big deal, really... but that's not the full story.

Big Pharma learns that their pen marketing strategy was successful. More pens are made. Post-it notes are made. Free lunches are offered. A junket here or there is organized. Lots of money has now been diverted from R&D - real science that helps patients - to marketing. Millions. Millions of millions. All in the name of making money, not helping patients. It's a bigger deal than you imagine.

hotspur

2Scoops wrote: »

Millions of millions. All in the name of making money, not helping patients.

What exactly do you think the pharmaceutical industry is or should be? They are not philanthropic organisations, they are profit driven enterprises. They behave exactly as you would expect them to. Judging them by the standards of health professionals and their codes of ethics makes little sense. I'm not glibly dismissing all criticisms of big pharma, but I am suggesting to the OP that he deals pragmatically with the reality of them. They don't spend all of their time poisoning Nigerian children.

ZYX

To be honest here I have to agree with Hotspur here. I fail to see the problem. I do not see drug reps, go on drug company sponsored events or "accept a pen" as all this is advertising and is geared to encourage me to prescribe a particular product. I prefer to make up my own mind by doing my own reading on available products.
That having been said, I still prescribe drugs and know that were it not for drug company research we would be still using leeches.

ZYX

hotspur wrote: »

They don't spend all of their time poisoning Nigerian children.

Exactly. It's the oil companies who do that.

tallaght01

OK, they maybe shouldn't be judged by the same standards as the rest of us. But, to be honest, they should be judged against pretty high standards, as should anyone who makes their money from healthcare.

They send out drug reps who manipulate data all the time. They don't care if their drug isn't the best, as long as we prescribe it. Who cares that patients will suffer, as long as money is made.

I don't think that being a money making organisation exempts you from a moral framework.

They fight tooth and nail against companies that want to sell cheaper generic drugs to developing countries.

They have a history of selectively publishing data.

There is some evidence that merchandise/promotion has been shown to influence doctor prescribing.

But, essentially, I didn't want to be part of a study that would be manipulated if things didn't show what the company wanted. Vioxx was the classic example of this, though the FDA has helped stop the rot in the states recently.

Anyway, I went in and chatted to the guys today. I trust them. They say they have negotiated rights to publish the data, and will be publishing it regardless of what it shows.

AtomicHorror

tallaght01 wrote: »

Anyway, I went in and chatted to the guys today. I trust them. They say they have negotiated rights to publish the data, and will be publishing it regardless of what it shows.

Now that's integrity. Wish there were more trials conducted like that...

I say go for it. If it turns out to be the soul destroying experience you fear, then I guess you've learned something. But it actually sounds like there are good people involved in this thing.

Dr Galen

They send out drug reps who manipulate data all the time.

there not all like that

2Scoops

hotspur wrote: »

What exactly do you think the pharmaceutical industry is or should be? They are not philanthropic organisations, they are profit driven enterprises. They behave exactly as you would expect them to.

That's exactly my point. It may not be a big concern, but it is a concern - and I can understand why Tallaght01 or others would have initial qualms about working with them.

2Scoops

ZYX wrote: »

I prefer to make up my own mind by doing my own reading on available products.

If everyone were like you, then maybe the pharmaceutical companies would stop wasting their money on needless advertising and invest in R&D.

nesf

2Scoops wrote: »

If everyone were like you, then maybe the pharmaceutical companies would stop wasting their money on needless advertising and invest in R&D.

Which came first, doctors who don't keep up with the latest drug releases or advertising targeting exactly these doctors? Chicken and Egg etc.

ceegee

Personally, I dont have a problem taking pens etc from reps. It only poses an ethical problem if you allow it to: I know I'm not going to suddenly ignore published evidence just because of what my shiny new biro has written on it, and id imagine every poster here is the same.

ZYX

ceegee wrote: »

Personally, I dont have a problem taking pens etc from reps. It only poses an ethical problem if you allow it to: I know I'm not going to suddenly ignore published evidence just because of what my shiny new biro has written on it, and id imagine every poster here is the same.

Doctors are influenced by reps. Why else did Augmentin become so popular in this country?Why did nexium become so popular despite the fact that for most patients it is no better than other PPIs (just a lot dearer) Why are statins prescribed so frequently in this country despite little evidence for their benefit in low CHD risk patients? These things did not happen to the same extent in UK where a much more cynical attitude to drug reps exists. If you are not influenced by drug reps why see them?

Vorsprung

If you prescribe generically it should be less of an issue

sam34

ZYX wrote: »

If you are not influenced by drug reps why see them?

because sometimes (actually, often) they're very hot and it brightens up my day

maxheadroom

ZYX wrote: »

Why did nexium become so popular despite the fact that for most patients it is no better than other PPIs (just a lot dearer)

Because the company that makes it provides it for free to Irish hospitals. As a result, it is widely prescribed in hospital and most people who are discharged on a PPI are discharged on the one they were on as an inpatient. Unfortunately, it happens to be the one of the most expensive PPIs in the community.
That's clever marketing. More than a little evil, but clever nonetheless

sam34

maxheadroom wrote: »

Because the company that makes it provides it for free to Irish hospitals.

what? is that correct?
i never heard that before.

and it certainly wasnt something i was aware of when working in general med/surgery, and it was never touted as a factor when choosing which PPI to prescribe

nesf

maxheadroom wrote: »

Because the company that makes it provides it for free to Irish hospitals. As a result, it is widely prescribed in hospital and most people who are discharged on a PPI are discharged on the one they were on as an inpatient. Unfortunately, it happens to be the one of the most expensive PPIs in the community.
That's clever marketing. More than a little evil, but clever nonetheless

If true that's cold.. I vaguely remember some "ranting" about the drug itself in Scientific American a few years back about the "sleight of hand" aspect to the original patent running out.

sendic

OP, Unless you are the PI or senior scientist/postdoc i don't see how you can feel that you have any ethical responsibility for the work carried out. No offence, but you can't blame the guy who pumps the petrol for the oil spill in the ocean. Would you be an author on any papers published as a result of this work? If not then its really not your problem.

maxheadroom

sam34 wrote: »

what? is that correct?
i never heard that before.

and it certainly wasnt something i was aware of when working in general med/surgery, and it was never touted as a factor when choosing which PPI to prescribe

nesf wrote: »

If true that's cold.. I vaguely remember some "ranting" about the drug itself in Scientific American a few years back about the "sleight of hand" aspect to the original patent running out.

I don't have anything to back it up with, but its certainly what I've heard in work. There doesnt seem to be much about it on the net

ceegee

maxheadroom wrote: »

Because the company that makes it provides it for free to Irish hospitals. As a result, it is widely prescribed in hospital and most people who are discharged on a PPI are discharged on the one they were on as an inpatient. Unfortunately, it happens to be the one of the most expensive PPIs in the community.
That's clever marketing. More than a little evil, but clever nonetheless

Is that the case nationwide? I was under the impression that was only the case in a few of the larger hospitals. From the drug companys view its pure genius marketing and nothing overtly wrong with it. The problem lies with the insular view of those who control the purse strings: If the hospital uses a different drug thats cheaper from a pharmacy (and thus costs the hse less in the long term) it'll take a bigger chunk out of the hospital pharmacys budget and they'll be in trouble for "wasting resources" - the HSE arent exactly renowned for spotting the bigger picture

ZYX

maxheadroom wrote: »

I don't have anything to back it up with, but its certainly what I've heard in work. There doesnt seem to be much about it on the net

It is true certainly in Dublin that it was sold very cheaply to the hospitals. I heard about it, rang the pharmacy in one of the hospitals and the chief pharmacist confirmed it. I then e-mailed Liz McManus who was labours health spokesperson but she didn't seem to understand the situation. She asked a question about it in the Dail but was fobbed off with some remark about lack of generic alternatives to Nexium.

SomeDose

ZYX wrote: »

Doctors are influenced by reps. Why else did Augmentin become so popular in this country?Why did nexium become so popular despite the fact that for most patients it is no better than other PPIs (just a lot dearer) Why are statins prescribed so frequently in this country despite little evidence for their benefit in low CHD risk patients? These things did not happen to the same extent in UK where a much more cynical attitude to drug reps exists. If you are not influenced by drug reps why see them?

I don't know if the UK necessarily has a more cynical attitude to reps, rather there's more policies and protocols in place which makes it much tougher for drug companies to get non-evidence based drugs prescribed. They also seem to have figured out that using generic drugs is A Good Thing. The fact that GSK managed to get Augmentin "Duo" into such wide circulation in Ireland is...well, it should never be possible for this to happen in the first place. Many regions in the UK have established joint formularies between the main hospital and the local primary care trust i.e. only a set list of drugs may be used within a hospital, and this same set of drugs is available for the local GPs to prescribe. This means the reps would need to make submissions to both hospital and primary care trust just to get a drug included on the formulary, and would also eliminate the nexium-type shenanigans alluded to here. Drug use in the UK is also heavily influenced by national guidance bodies such as NICE, SIGN etc and also local trust guidelines...I'm not sure if this is the case in Ireland or not.

Vorsprung

sam34 wrote: »

because sometimes (actually, often) they're very hot and it brightens up my day

I knew there was something good about Psych!

Vorsprung

SomeDose wrote: »

I don't know if the UK necessarily has a more cynical attitude to reps, rather there's more policies and protocols in place which makes it much tougher for drug companies to get non-evidence based drugs prescribed. They also seem to have figured out that using generic drugs is A Good Thing. The fact that GSK managed to get Augmentin "Duo" into such wide circulation in Ireland is...well, it should never be possible for this to happen in the first place. Many regions in the UK have established joint formularies between the main hospital and the local primary care trust i.e. only a set list of drugs may be used within a hospital, and this same set of drugs is available for the local GPs to prescribe. This means the reps would need to make submissions to both hospital and primary care trust just to get a drug included on the formulary, and would also eliminate the nexium-type shenanigans alluded to here. Drug use in the UK is also heavily influenced by national guidance bodies such as NICE, SIGN etc and also local trust guidelines...I'm not sure if this is the case in Ireland or not.

I believe that in the UK, when a generic is prescribed (pretty much 100% of the time), the dispensing pharmacy HAS TO give the patient the cheapest version available.

No such law here. Could save a lot of money, and a lot of doctors in my hospital have made a point of prescribing generically lately where possible, and for the most part I do the same (I make an exception for anti-epileptics, not too comfortable messing around with those).

sam34

bigjimthefirst wrote: »

I knew there was something good about Psych!

you better believe it! :D:D

nesf

bigjimthefirst wrote: »

I make an exception for anti-epileptics, not too comfortable messing around with those

Or psychiatric drugs, I think the total cost of my meds is over 450 euro per month again. All those brand names make me particularly appreciative of the DPS scheme.

tallaght01

ceegee wrote: »

Personally, I dont have a problem taking pens etc from reps. It only poses an ethical problem if you allow it to: I know I'm not going to suddenly ignore published evidence just because of what my shiny new biro has written on it, and id imagine every poster here is the same.

Well, why do you think the drug companies do it? There's data showing association between drug rep freebies, and prescribing habits. It's tough to prove causation, though. But it certainly raises questions.

I would argue that so much cash is spent on silly things like pens and staplers and alarm clocks, that they wouldn't be doing it if it didn't work.

bigjimthefirst wrote: »

If you prescribe generically it should be less of an issue

I always prescribe generically. That's what the UK experience does to you. Same with Oz.

sendic wrote: »

OP, Unless you are the PI or senior scientist/postdoc i don't see how you can feel that you have any ethical responsibility for the work carried out. No offence, but you can't blame the guy who pumps the petrol for the oil spill in the ocean. Would you be an author on any papers published as a result of this work? If not then its really not your problem.

I don't think that's fair. I think, if you knowingly take part in the data collection of safety or efficacy data when you know it may not get published if the results are "wrong", then you're complicit.

nesf

tallaght01 wrote: »

Well, why do you think the drug companies do it? There's data showing association between drug rep freebies, and prescribing habits. It's tough to prove causation, though. But it certainly raises questions.

I imagine the causation works similarly to advertising elsewhere. Freebies with company/product logos on them are not unique to pharmaceuticals. Especially when there are multiple options of similar quality/effectiveness and there's no clear "first choice" among them.

tallaght01 wrote: »

I would argue that so much cash is sent on silly things like pens and staplers and alarm clocks, that they wouldn't be doing it if it didn't work.

You'd be shocked how much advertising happens "just cause the other guys are doing it".

sam34

tallaght, what did you decide to do?

tallaght01

I sold my soul. Start friday!!!

I'm pretty satisfied that the results will be published. And I'll walk away if things get dodgy. But, knowing the guys who are involved, I'd be amazed if there was any bogeyness involved.

sam34

good luck.
hope it works out well for you

Dr Galen

good luck dude. keep us posted etc.

do you have any good links for data relating to freebies and doctors prescribing decisions btw?