pharma companies links with doctors

GER12

I've moved these posts to a new thread as we were derailing the pharmacy one. Sam34

jeepers wrote: »

You would end up with less letters if the lawyer didn't have a financial interest in them.

Correctly in Ireland, a GP cannot have a financial interest in prescribing.

This is not entirely true - the relationship between GP's, doctors and the pharmaceutical industry is very closely intertwined. In a hospital for example - the pharmaceutical industry can fund research, support lecture series within clinical dept's which includes provision of catering!

sam34

GER12 wrote: »

This is not entirely true - the relationship between GP's, doctors and the pharmaceutical industry is very closely intertwined. In a hospital for example - the pharmaceutical industry can fund research, support lecture series within clinical dept's which includes provision of catering!

true, the pharmaceutical industry supports SOME educational ventures. but they do not reward doctors financially for prescribing their products.

RobFowl

sam34 wrote: »

but they do not reward doctors financially for prescribing their products.

You've never got a freebee weekend trip to Madrid/Venice/Lisbon to hear a 1 hour "presentation" about an amazing new product then :rolleyes:
To be fair these seem to be dying out .........

sam34

RobFowl wrote: »

You've never got a freebee weekend trip to Madrid/Venice/Lisbon to hear a 1 hour "presentation" about an amazing new product then :rolleyes:
To be fair these seem to be dying out .........

well, what i was getting at was the insinuation that docs are directly financially rewarded for prescribing company X's product.

this was pointed out by jeepers, :

jeepers wrote: »

Correctly in Ireland, a GP cannot have a financial interest in prescribing.

but then ger came along and said that wasnt entirely true:

GER12 wrote: »

This is not entirely true - the relationship between GP's, doctors and the pharmaceutical industry is very closely intertwined. In a hospital for example - the pharmaceutical industry can fund research, support lecture series within clinical dept's which includes provision of catering!

now, whether or not individual doctors attend these educational events, be tehy conferences or lunchtime meetings, the events will still go ahead. likewise, docs will be asked to them irrespective of whether or not they prescribe drug x. ive never heard of a rep saying that dr y doesnt prescribe my drug, so im not going to ask him to talk z, likewise ive never heard a doc say that company x have "blacklisted " him because he doesnt prescribe drug y.

GER12

I was referring to secondary care ... but I am sure that primary care GP's attend conferences that are laid on by pharmaceutical firms.

And no the lectures that we attended would not have gone ahead irrespective - the lectures were specifically laid on by teh pharmaceutical company for us (one clinical department)... it was not open season in the hospital for attendance ... with what was laid on was seen by most as a perk .... and I am sure that this practice its replicated across other clinical fields.

sam34

GER12 wrote: »

I was referring to secondary care ... but I am sure that primary care GP's attend conferences that are laid on by pharmaceutical firms.

And no the lectures that we attended would not have gone ahead irrespective - the lectures were specifically laid on by teh pharmaceutical company for us (one clinical department)... it was not open season in the hospital for attendance ... with what was laid on was seen by most as a perk .... and I am sure that this practice its replicated across other clinical fields.

noone is disputing that the pharmaceutical industry host events.

my point is this: if I, or any other doctor, decide to attend one of these events, there is no obligation on me to prescribe that company's product.

similarly, if their product is one that i use, because of its effectiveness and tolerability, there is no way that the company can "reward" me for that prescribing by inviting me to more events etc.

likewise, if i choose not to prescribe a particular drug, again because of clinical reasons, the company will not begin to "punish" me for this by not inviting me to events.

a doctor can attend all the pharma sponsored events in the world without obligation to prescribe, and can prescribe at will without expecting rewasrds for that.

ZYX

sam34 wrote: »

noone is disputing that the pharmaceutical industry host events.

my point is this: if I, or any other doctor, decide to attend one of these events, there is no obligation on me to prescribe that company's product.

similarly, if their product is one that i use, because of its effectiveness and tolerability, there is no way that the company can "reward" me for that prescribing by inviting me to more events etc.

likewise, if i choose not to prescribe a particular drug, again because of clinical reasons, the company will not begin to "punish" me for this by not inviting me to events.

a doctor can attend all the pharma sponsored events in the world without obligation to prescribe, and can prescribe at will without expecting rewasrds for that.

To be honest though, the only reason drug companies run these eevents is to influence prescribing.

sam34

ZYX wrote: »

To be honest though, the only reason drug companies run these eevents is to influence prescribing.

oh sure, thats why they're running them.

but there seems to be a perception out there that they are in cahoots with doctors "prescribe X twenty times a week and we'll bring you to whereever/give you whatever/pay you whatever", which is way off teh mark.

The_Conductor

sam34 wrote: »

oh sure, thats why they're running them.

but there seems to be a perception out there that they are in cahoots with doctors "prescribe X twenty times a week and we'll bring you to whereever/give you whatever/pay you whatever", which is way off teh mark.

It may be wildly off the mark now- but in bygone days it was common practise to have a seperate marketing budget specifically for wining and dining GPs and other medical personnel. In a former job (nearly 15 years ago at this stage), I was involved in organising a number of these events.

These days a few blocks of post-it notes, and funky pens are about the extent of it (and for the GPs- don't forget those branded torch pens- perfect for checking pupil dilation etc). What I'd love to see is a little hammer with branding on it- I have a few non-medical ideas of what to do with it, but lets not go there.......

ZYX- I genuinely don't think that a practise prescribing large quantities of morphine would necessarily ring any alarm bells. It really depends on the profile of the patients in the practice, and the patient profiles in different practices can be startlingly different. A GP in a working class area for example (say Dublin 15 as an example) will statistically prescribe up to 140% more antidepressants, than a similar sized practice in an upper class area. This does not mean that they are handing out antidepressants like smarties- simply- that antidepressants may be the sole recourse for the average person in that area- while alternate treatments may be available to those in other areas. Similarly a GP with a number of nursing homes nearby- may have a genuine need for large amounts of morphine for paliative treatments.

sam34

smccarrick wrote: »

It may be wildly off the mark now- but in bygone days it was common practise to have a seperate marketing budget specifically for wining and dining GPs and other medical personnel. In a former job (nearly 15 years ago at this stage), I was involved in organising a number of these events.

These days a few blocks of post-it notes, and funky pens are about the extent of it

again, im not disputing that the pharma companies have these budgets for marketing events.

however, my point is that doctors are not rewarded financially, or via invitations to meetings in exotic places, for prescribing particular drugs.

i get invitations to meetings the whole time. i dont go to them, for a variety of reasons. but i get them from all the drug companies, the ones whose drugs i use a lot and the ones whose drugs i use occasionally and teh ones whose drugs i rarely/never use.

it has never been said, implicitly or explicitly, that i'm being invited because i prescribe a lot of drug X, or that invitations are being witheld because i dont prescribe, or that they'll invite me if i agree to prescribe etc etc etc.

while, undoubtably, the companies are hoping the meetings will raise awareness of their drug etc, doctors are generally not naive enough to believe everything a drug rep tells them at a promotional meeting. and there is no obligation with these events.

tallaght01

I have pretty extreme views on this issue. As far as I'm concerned the pharma companies are only there to get you ti prescribe their meds, regardless of whether it's in the patient's best interests or not.

Doctors are there to make sure we prescribe only what's in the best interests of the patients.

I pretty much see us as being on opposite sides of the battle against disease.

I work for a clinical trials group, that runs large research projects, and industry sponsored clinical trials. The only way I can justify doing this is by making sure my own input is of unquestionable integrity, which it is. My colleagues are also super, and we work entirely independently of pharma reps. We let a mionitor from the companies come in and examine the data periodically. But other than that, I have never met anyone from the drug companies.

When they put on lunch for us, I don't go. I don't take their pens etc. If they're sponsoring a presentation, I bring me own lunch.

Virtually any presentation that's only put on because a drug company is putting it on is a waste of your time, as far as I'm concerned. They feed you nice food and crap, manipulated data.

I don't see reps. But lots of docs and pharmacists do. Worryingly, the pharma companies are sending their drug reps to see the nurse practitioners now a LOT. NPs don't have much in the way of statistics training, and seem to be quite susceptible to being fed data that's statistically questionable.

But let's face it. There's lots of studies suggesting we're all susceptible to this kind of marketing. They wouldn't devote such huge amounts of money to it if it didn't work.

One of the great achievements of the pharma industry has been the failure of the rest of us to convince doctors and pharmacists that we're actually altering what we give out because of marketing.

sam34

tallaght01 wrote: »

Virtually any presentation that's only put on because a drug company is putting it on is a waste of your time, as far as I'm concerned. They feed you nice food and crap, manipulated data.QUOTE]

i totally agree with you here. but that doesnt mean i wont eat the nice food!

i'd be surprised if most medics are naive or gullible enough to take what the reps say at face value.

tallaght01

sam34 wrote: »

tallaght01 wrote: »

Virtually any presentation that's only put on because a drug company is putting it on is a waste of your time, as far as I'm concerned. They feed you nice food and crap, manipulated data.QUOTE]

i totally agree with you here. but that doesnt mean i wont eat the nice food!

i'd be surprised if most medics are naive or gullible enough to take what the reps say at face value.

Problem is, sam34, that not everyone is particularly good at intertpreting trial results. Just look on this forum for the number of times the conclusion is the only thing presented as evidence.

Plus it's all about brand recognition. There are so many drugs that are referred to by their trade names in conversations in hospitals, which was the first thing that alerted me to the effectiveness of this type of marketing. Like I said, they're only doing it because it works.

boardswalker

I've posted this already on another thread but its just as relevant here.

In 2007, the Institute of Medicine (IOM) in the US appointed the Committee on Conflict of Interest in Medical Research, Education, and Practice to examine conflicts of interest in medicine and to recommend steps to identify, limit, and manage conflicts of interest without negatively affecting constructive collaborations.

Here are relevant excerpts from the report which was published in April 2009.

The introduction to the report states (my emphasis)

Financial conflicts of interest pose many challenges to health care professionals. They raise concerns about the objectivity and trustworthiness of research conduct and publications, the prudent management of scientific investigations and other activities in the public interest, and the commitment of health care professionals to the best interests of patients. In recent years the media has highlighted failures of individuals and institutions to disclose and appropriately manage financial ties with industry (including pharmaceutical, medical device, medical supply, and insurance companies). These failures contribute to questions about whether industry has undue influence in research and other activities.

As medical research, professional education, health care, and institutional management have become vastly more complex and expensive, the task of managing conflicts of interest has become more challenging. Industry is now the leading funder of medical research, and much research is conducted in nonacademic settings. Industry also is involved in funding the development of evidence reviews and practice guidelines that are intended to help translate research findings into practice. Such guidelines may shape clinical choices and may even be used to evaluate professional or institutional performance.

Other very relevant sections of the report.

“The Financial relationships with industry are extensive in medical education.
To reduce the risk for bias within the learning environment, academic medical centers and teaching hospitals should prohibit faculty from accepting gifts, making presentations that are controlled by industry, claiming authorship for ghost-written publications, and entering into consulting arrangements that are not governed by written contracts for expert services to be paid for at fair market value. Medical centers also should restrict visits by industry sales people and limit use of drug samples to patients who lack financial access to medications.

Many providers of accredited continuing medical education—a usual requirement for relicensure of physicians—receive the majority of their funding from industry.
The report recommends a broad-based consensus process to develop a new system for funding high-quality accredited continuing medical education that is free of industry influence. The committee recognizes that such a system may involve higher costs for physicians and require cost-cutting steps by education providers. Because current policies are highly variable and sometimes confus¬ing, the commit¬tee recommends standardizing the content, format, and procedures for disclosing finan¬cial relationships physicians and researchers have with industry.

Acceptance of meals and gifts and other relationships with industry are also common among physicians who practice outside medical centers. Data suggest that these relationships may influence physicians to prescribe a company’s medicines even when evidence indicates another drug would be more beneficial.
Therefore, the committee recommends eliminating these problematic relationships between physicians and industry. In addition, the committee recommends that community physicians should also follow the restrictions described previously regarding gifts, including meals, from companies; presentations or articles whose content is controlled by industry; meetings with sales representatives; and use of drug samples. Professional societies and health care facilities should adopt policies that reinforce this recommendation.

Clinical practice guidelines influence physician practice, quality measures, and insurance coverage decisions. Given this influence, clinical practice guidelines need to be developed with greater transparency and accountability.
The committee recommends that professional societies and other groups that develop practice guidelines not accept direct industry funding for guideline development and generally exclude individuals with conflicts of interest from the panels that draft the guidelines. In addition, these groups should make public their conflict of interest policies, their funding sources, and any financial relationships panel members have with industry.”
Full report available at http://www.nap.edu/catalog.php?record_id=12598#toc

Remember, this is the output from a 2 year examination commissioned by the US Institute of Medicine not just someone with an axe to grind.

ZYX

sam34 wrote: »

i totally agree with you here. but that doesnt mean i wont eat the nice food!

i'd be surprised if most medics are naive or gullible enough to take what the reps say at face value.

I'd be surprised if the most flogged drugs were not the most prescribed. In other words I believe the drug reps and drug companies who spend most on "education" have the highest sales. Marketing influences everyone. To suggest doctors are different does not make sense. Drug companies spend billions worldwide on advertising and marketing. This marketing works.

Indeed you could argue they are so effective you haven't even noticed.

tallaght01

ZYX wrote: »

Indeed you could argue they are so effective you haven't even noticed.

I genuinely believe this is the crux of the issue. Not every doctor is influenced by marketing. But enough are to justify the spending. I bet if you polled a drug company's execs and asked "does marketing work?" you'd get most of them answering yes. If you asked the same question of docs, they'd say no.

Those that aren't affected by marketing are affected by the abstracts they publish. They get patients like that, too. Just look at ads in america for drugs. People put pressure on their doc to prescribe what they see on the TV.

Now THAT is smart. I've said it before and I'll say it again...just look around you on this forum. Just look at the crap some people with no science training come up with, because they've read an abstract. It's not their fault. But we've all seen it.

boardswalker

There was an interesting article in last Tuesday's New York Times - Aug 18.

By NATASHA SINGER
Published: August 18, 2009

A growing body of evidence suggests that doctors at some of the nation’s top medical schools have been attaching their names and lending their reputations to scientific papers that were drafted by ghostwriters working for drug companies — articles that were carefully calibrated to help the manufacturers sell more products.

Experts in medical ethics condemn this practice as a breach of the public trust. Yet many universities have been slow to recognize the extent of the problem, to adopt new ethical rules or to hold faculty members to account.

Those universities may not have much longer to get their houses in order before they find themselves in trouble with Washington.

With a letter last week, a senator who helps oversee public funding for medical research signaled that he was running out of patience with the practice of ghostwriting. Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice."

Full story here - http://www.nytimes.com/2009/08/19/health/research/19ethics.html?pagewanted=1&_r=1&ref=health

I don't know how much science training Senator Grassley has had.

DublinWriter

It's more insidious than you think.

I worked for several major pharmas in the late 90's. There's no out-and-out bribing, but it's junket central for GPs. From golf-weekends thinly disguised as seminars, right down to providing most of the consumables for GPs' offices.

Next time you visit your GP, check out the branded biros, calenders and other paraphernalia.