Shocking news! Posted by schnro at 01/28/06 08:07 PM

It seems like a no-brainer that the system we rely on for educating doctors about drugs is really messed up: the company providing our doctors supposed objective information has its financial future riding on making them believe their drug is more effective and as safe or safer than competing drugs in the class. And part of the mix -- the often lavish gifts drug companies shower on doctors.

In a shocker, the respected Journal of the American Medical Association just published what the authors call a “policy proposal” that calls into question not just the embarrassing pharma-funded junkets and lucrative consulting contracts that have received attention lately, but even small gifts and free patient samples. The JAMA article calls for more stringent regulation:

including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts.

The article goes to a core piece of the physician's identity:

Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised.

The New York Times covered the story and concluded that if broadly adopted:

the recommendations would transform doctors' day-to-day lives and shut off the focus of drug makers' biggest expenditures. But Dr. David Blumenthal, an author of the article, said it was "not very likely" that many in medicine would listen to the group.
"I'm not very optimistic," said Dr. Blumenthal, a professor at Harvard Medical School who, like many of the article's 10 other authors, has studied conflicts of interest in medicine for years..

And his lack of optimism may be as optimistic as it gets. The AMA (which has recommended guidelines for doctors getting gifts) board chair, Dr. Duane M. Cady, commented on the JAMA article saying:

drug and medical device makers can play a role in educating physicians about new products.

That’s the way the drug company argument seems to go as well: drug detailer visits and the concomitant swag provides essential physician education about prescription drugs. The argument almost leaves the impression that the tens of billions of dollars it spends annually should be thought of as some kind of public education expense.

Fine, but the drug company sales reps are measured by their performance – and not by giving doctors a pop quiz to determine their level of education after the drug company “educator” has made her educational visit. Here’s an example: drug reps pushing Nexium – and doctors prescribing it – when there’s an alternative available for a fraction of the cost over the counter. Another: drug companies getting doctors to prescribe Vioxx in huge numbers, though the drug was likely appropriate for a much smaller population of people with severe arthritis and gastrointestinal bleeding.

Who doesn't have great respect for physicians -- they do a difficult job that requires constantly aquiring the newest information. But they’re only people – and doctors seem to recognize the effect that gift-laden education has. According to the Times:

Surveys show that most doctors do not believe that these gifts influence their medical decisions, although most believe that they do affect their colleagues' medical judgment.

The piece concludes:

. . . even small gifts can lead to profound changes in doctors' prescribing behavior, with "negative results on clinical care," the article states. As a result, all gifts should be banned, the authors conclude.

The NY Times story also reports on one major health care provider, Kaiser Permanente, already substantially restricts gifts.

"We thought it was critical for us that our patients never had a doubt that the decision made about a drug or a device was based on the best interests of the patient and not the financial interest of the physician," said Dr. Sharon Levine, associate executive director of Kaiser Permanente Northern California.

Not only that,

Kaiser physicians prescribe heavily marketed medicines far less frequently than doctors nationally.

When drug company sales reps are limited and gifts restricted sales of the heavily marketed brand name drugs drop. Shocking news again. . . .

comments (1)

1 Posted by stoker at 02/10/06 03:47 PM

My best friend had taken Prozac for years during bouts of depression. She went to a doctor last spring and was prescribed Cymbalta. She told the doctor that she reacted well to Prozac, and it was very effective for her at low dosages. (and now that it is available as a generic, it is cheap)but the Dr. said Cymbalta was better and worth the horrible expense. Well, my friend had some side effects, like dizziness and a disasociative feeling from the drug. It seemed to me that the doctor was overly eager to have her patients take the Cymbalta. I wonder if she has to report how many prescriptions of Cymbalta she writes to Lilly, the maker of Cymbalta. (So she can get her free toaster or whatever) Just the appearance of misconduct should be avoided by professionals, otherwise they should become real estate agents or lawyers.(or legislators) In the good old days, my grandfather lost his job with the city of Los Angeles because he participated in high-stakes poker games. The authorities stated that because gambling was viewed as seedy and it provided an avenue to pay off a city employee (by losing on purpose,) citizen confidence was at stake. He appealed and sued, and lost.