Doctors who take pharma industry freebies prescribe more of their benefactors' drugs

This cuts both ways as a patient. I’m a type 1 diabetic. My insurance discontinued support this year for the insulin and other medication that works best for me. The Dr is loaded with both of these meds, as well as the latest insulins for me to experiment with. Scrounging till the new year and a new insurance co that should cover the better stuff.

I was in my doctor’s waiting room the other day. She is an excellent glaucoma surgeon and I have a long history with her as I came down with drug-untreatable glaucoma at the age of 40, several years ago. 99% of the people I see in the waiting room in the dozens of time I’ve been there are over the age of 60. This day. I saw a very attractive, well-dressed twenty-something sitting in the waiting room with me. My first thought was: could she possible be here for high ocular pressure (a symptom of early glaucoma)? I immediately dismissed that thought and went with the conclusion that she was a nice young woman escorting her grandparent to the doctor’s office.

When I re-emerged from my battery of tests 2 hours later, she was still in the waiting room, doing something on her laptop, waiting to be seen. That is when I realized, she’s a Pharma rep. Duh. I turned to the receptionist, nodded at the woman and asked “Pharma sales?”. The receptionist nodded and rolled her eyes.

These pharma folks constantly nag doctors in their offices. As someone who vigorously researched and discussed new drugs and surgical techniques with my doctor before treatment, I appreciate that there are people aggressively educating very busy doctors with the latest in medical science. Yet, I doubt she was there with the latest in revolutionary approaches. She was just selling one more drug that was incrementally different from the last, or more likely, one that had been around for a while already.

I like that my surgeon had her sitting in the waiting room for hours, while she treated actual patients first. I know my surgeon isn’t going to buy their product unless she is sure it has a reasonable chance of working better.

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" doesn’t take into account the financial outcomes for individual patients, and the healthcare system as a whole, of doctors prescribing expensive drugs under the influence of pharma reps."

I did address that partially. Sometimes, a prescription drug can be less expensive to a patient - for example, generic Zantac so the patient doesn’t have to buy OTC.Is it possible that a doc might prescribe a more expensive drug for a patient when a less expensive expensive equivalent, or a better covered equivalent would cost a patient less? Sure. But that sort of thing happens all the time regardless of what reps say, or whether the doc sees reps at all. Most docs don’t bother learning - or do not have the time to check formulary coverages for the drugs they prescribe. That was one of the things I did as a rep - remind them of the formulary coverage of my drugs on the major plans used by the major corporations in the area.

And remember also - the substitution of generic drugs if possible is mandatory at pharmacies. A doc might write “Zantac”, but the patient will get generic ranitidine unless the doc writes “Dispense as written”. That almost never happens unless there is good reason. And a good reason might be for a patient on an anticoagulant.

And what this study does not show - and for which you have no proof - is the idea that the number of docs prescribing expensive drugs to patients are unnecessarily having a financial impact on the health care system.

The first time I went to my current Gyno, he refused to prescribe the generic birth control pills I’d been successfully using for years. He said he didn’t prescribe generics, so he gave me a script for something else. Well, I didn’t like the difference, and called the nurse line. She happily changed the script to the one I liked, and no harm was done, just one crummy month.

But, it irritated me that his rule was no generics. I assumed it had to do with Pharma Reps, but that’s pure speculation.

Right. And yet, as I said, when I was told of prescribing errors by docs, it was invariably the docs who would not see reps. And it wasn’t just dosing errors - I would see drugs and drug/combos written in contraindication. Sometimes in black box contraindication. I talked to docs about antibiotics who didn’t know the bactericidal spectrum of the different agents, who didn’t know what an antibiogram or an LD50 was.

Plenty of idiocy going around. On the other hand, I have got to say I don’t know if I would see reps, or at least most reps, if I was a doc. When I started in the industry, drug reps had some actual qualifications - they were former pharmacists, had science degrees. We are also allowed to talk about on-going clinical research and utility of products outside of strict indications. When the marketing guys took over the industry, what was most important, it seemed to HR was youth, physical attractiveness, and blind zeal.

And some companies had marketing departments and legal departments that didn’t care very much about truth and accuracy. I almost got into a fistfight with a competing rep who was handing out official brochures with deliberate misrepresentations of the indications of my drugs. His excuse? “It never would have made it past legal if it wasn’t true”. At least half of the new reps in my district had zero science background.

Good for you for writing them! But you don’t even need to write for them, because generic substitution is mandatory. And guess what - they ain’t so cheap anymore. I just shopped for Medicare D plans. I have about 6 prescriptions. all of them generic. Some official Medicare plans estimated my coverage would cost $12,000 a year, just for part D.(!) I called around, and discovered I could buy out of pocket for less than any of the plans. For me, the killer script was pyridostigmine. They were all charging more than retail price for it.

As I said - no one would really give a crap about evil Pharma if the insurance programs were forced to cover our outpatient drugs at 100%. Let them hammer out the discounts.

Not sure what you are referring to here.

I refer to your claim that docs who do not host reps make more drug errors. If there were any evidence of this, reps would be using it to push into offices or slam those who refuse. As far as cheaper generics go, it is true that in recent years the cost of generics has skyrocketed, which just backs the whole “evil pharma” meme. Within my memory, I would have defended the pharma companies as R&D beasts, but those days are gone. It’s all “me too” because actual innovation is too risky.

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