http://www.wivb.com/investigative/doctors-paid-millions-by-drug-companies
Maybe the meds your doctor put you on are unnecessary?
But the Doctor is hitting their quota in the sales dept. Bonus Time!!
http://www.wivb.com/investigative/doctors-paid-millions-by-drug-companies Maybe the meds your doctor put you on are unnecessary? But the Doctor is hitting their quota in the sales dept. Bonus Time!!It's a problem a needed overhaul of the whole US medical establishment should address. Probably won't happen, though.
If you look at the list you will see there are a couple hundred names on it. On the flip side there are hundreds of thousands of doctors in the U.S. who are not guilty of taking much of anything from pharma. Let me clarify a few things here.
- Pharmaceutical companies can not hand doctors money in return for prescribing drugs. A small number of physicians give talks for drug companies and do receive significant payouts from them but again its a very small precent ( easily in the single digits) of the total.
- For the vast majority of physicians who aren’t consultants or speakers for drug companies there is very little pharma can give to physicians these days. If they invite a physician to a dinner the doctor can not bring anyone else. They can not bring physicians to an entertainment venue as they used to years ago. If they provide a lunch to an office there are strict limits on what they can spend (I dont know the dollar amount but it usually works out to a sandwich for each person at the lunch). Laws prohibit them from giving even small items like pens or note pads.
Overall the current laws do a lot to limit the financial influence that pharma reps can have on doctors. I think its a good thing that they are outing the small number that are receiving cash payments. In fact I would go one further and propose that these doctors should have to post a large sign in the waiting room and exam rooms stating what companies they have arrangements with, how much they receive and what drugs these companies manufacture so patients can see this at the moment an rx is written
90% of the drugs I prescribe are generic and I and my staff go to great lengths to educate patients about cheap sources for their drugs. Be careful about painting the whole profession with the same brush though. These physicians represent a small minority. The great majority of physicians are prescribing drugs only when there is a good indication and when they do they generally make choices based on the patients best interests not the drug companies.
If you look at the list you will see there are a couple hundred names on it. On the flip side there are hundreds of thousands of doctors in the U.S. who are not guilty of taking much of anything from pharma. Let me clarify a few things here. 1) Pharmaceutical companies can not hand doctors money in return for prescribing drugs. A small number of physicians give talks for drug companies and do receive significant payouts from them but again its a very small precent ( easily in the single digits) of the total. 2) For the vast majority of physicians who aren't consultants or speakers for drug companies there is very little pharma can give to physicians these days. If they invite a physician to a dinner the doctor can not bring anyone else. They can not bring physicians to an entertainment venue as they used to years ago. If they provide a lunch to an office there are strict limits on what they can spend (I dont know the dollar amount but it usually works out to a sandwich for each person at the lunch). Laws prohibit them from giving even small items like pens or note pads. Overall the current laws do a lot to limit the financial influence that pharma reps can have on doctors. I think its a good thing that they are outing the small number that are receiving cash payments. In fact I would go one further and propose that these doctors should have to post a large sign in the waiting room and exam rooms stating what companies they have arrangements with, how much they receive and what drugs these companies manufacture so patients can see this at the moment an rx is written 90% of the drugs I prescribe are generic and I and my staff go to great lengths to educate patients about cheap sources for their drugs. Be careful about painting the whole profession with the same brush though. These physicians represent a small minority. The great majority of physicians are prescribing drugs only when there is a good indication and when they do they generally make choices based on the patients best interests not the drug companies.Unfortunately, you are a doctor in the minority, MacGyver. Maybe not a small minority, but a minority nevertheless. There is just so much money in the offing. Lois
Unfortunately, you are a doctor in the minority, MacGyver. Maybe not a small minority, but a minority nevertheless. There is just so much momey in the offing. LoisMy point Lois is that I am not the minority. I know a lot of physicians, hundreds in fact, and I know only a handful who work as speakers or consultants for pharmaceutical companies. Its easy to read a story like this and assume that what they are talking about is the norm but its not. Physicians accepting cash payments from pharma are the small minority. If you read this story and come away with any other impression you have simply allowed the media to do what they do so well..distort and sensationalize and let the truth be damned. This sort of story does a huge disservice to the vast majority of doctors who go out of their way every day to do the right thing especially if readers naively buy into this nonsense.
No, he isn’t in the minority. The doctors described are the minority. In 30+ years, I’ve worked with easily hundreds if not at least a thousand doctors in 6 hospitals, and I have never known a doctor to prescribe based on kickbacks. Nor did I ever see a doctor prescribe something unnecessarily to get a kickback. I know there are bad doctors out there. There are incompetent and unethical people in all professions, but I assure you, it is not the norm, just as it isn’t in your profession.
Unfortunately, you are a doctor in the minority, MacGyver. Maybe not a small minority, but a minority nevertheless. There is just so much momey in the offing. LoisMy point Lois is that I am not the minority. I know a lot of physicians, hundreds in fact, and I know only a handful who work as speakers or consultants for pharmaceutical companies. Its easy to read a story like this and assume that what they are talking about is the norm but its not. Physicians accepting cash payments from pharma are the small minority. If you read this story and come away with any other impression you have simply allowed the media to do what they do so well..distort and sensationalize and let the truth be damned. This sort of story does a huge disservice to the vast majority of doctors who go out of their way every day to do the right thing especially if readers naively buy into this nonsense. I could have set my watch to your's and Asanta's response!! The above response is the same one you gave 1 or 2 years ago to me on this Forum. Similar topic. You think this article is the first one I've run across in the interim? Don't blame the Media. The media is either making up these stories out of whole cloth or they are reporting. In the past 2 weeks I have seen the Johnson and Johnson settlement, continuing exposure of FDA collusion, and a report from CBC on how drug companies don't have to publish negative findings on efficacy in any clinical studies they do. That's just in the past 2 weeks! Without even trying hard. You knee jerk so hard to criticisms about the Healthcare industry that you must be a spokesperson of some sort. I've watched you do it on here for years now. More power to ya! I get the fact you want to protect your profession. Good on you! But pleeeaase...... Oh and quick edit. I'm not arguing that all doctors are taking some form of payola. And it may be a minority. But I doubt it's a small minority! That's about where the level of downplaying you are using can stop.
MacGeyver when we had this discussion awhile back I remember you explicitly saying that this kind of
“compensation” didn’t happen at all. That at most, doctors get some free pens or notepads.
I mostly took your statements to heart then.
This article covered 200 doctors from the WNY region alone. $100s of Millions.
And it looks like from this article that the vast majority are for psychotropic drugs. Ironic.
MacGeyver when we had this discussion awhile back I remember you explicitly saying that this kind of "compensation" didn't happen at all. That at most, doctors get some free pens or notepads. I mostly took your statements to heart then. This article covered 200 doctors from the WNY region alone. $100s of Millions. And it looks like from this article that the vast majority are for psychotropic drugs. Ironic.The list shows the top 200 doctors in terms of fees they received for speaking and consultation. That's 200 in NY out of tens of thousands of doctors. When I told you that pharma was not allowed to give anything to physicians ( and I said they are NOT allowed to even give pens or note pads) I was referring to gifts. What these doctors are doing is giving lectures for which they are then reimbursed. I stand by my statement that this is a very small percentage of physicians who do this. the article does not dispute my claim, it just doesn't give numbers at all and leaves the reader intentionally or not with the impression that this is the norm when in fact these doctors are far and away the exception. Having said all that I will repeat what I said above, the law does not go far enough. These doctors should have to post signs in their offices stating which pharm companies they work for and what drugs those companies make so patients are aware there may be a conflict of interest. One last thing to clarify a misperception that you clearly have. For the most part this is not a situation where the pharm rep approaches the doctor and says " if you prescribe more of our drug we will pay you a hefty sum for a speaking engagement". What usually happens is that they look at their data, identify the doctors who already prescribe a lot of their drug and deciding this would be a good spoke person they then approach the doctor and ask them to give talks for them. Their hope is that this doctor will have some influence over their colleagues. Whether is works or not I don't know. I haven't seen any data in any of these stories addressing that issue, just a lot of insinuations. I'm not saying it doesn't work, all I'm saying is the assumptions are unscientific conspiracy theories until proven otherwise.
Oh and quick edit. I'm not arguing that all doctors are taking some form of payola. And it may be a minority. But I doubt it's a small minority! That's about where the level of downplaying you are using can stop.And you base this conclusion on what? Your conclusion is based only on your bias not on any facts
The article says Western New York alone. 200 in WNY alone. But anyways…
I’m not going to quibble. I’m sure the answer lies somewhere between our 2 positions.
The practice represents unethical behavior. These doctors are not selling Ziebart Undercoating for Oldsmobiles.
Money is being used to convince doctors to prescribe more of a certain drug than might perhaps be prescribed otherwise.
Really I can’t blame the doctors for taking the money…
The onus should fall on the pharmaceutical companies.
That’s right, you did say they are not even allowed to take pens or pads.
Do you have any idea of how many doctors there are in Western New York?? This is the same kind of crap the creationists pull when they say 1000 scientists against global warming. I don’t think you have any idea of how many practicing doctors there are in an urban population.
Do you have any idea of how many doctors there are in Western New York?? This is the same kind of crap the creationists pull when they say 1000 scientists against global warming. I don't think you have any idea of how many practicing doctors there are in an urban population.You are absolutely right. I didn't mean for this to be a thread about my knowledge about how many doctors are in WNY. It's a thread about doctors being paid by Pharmaceutical Cos to push their products. They pay doctors to give seminars and lectures. That must be the end run around the law I'm guessing. In the name of research and science. I'm wondering what the numbers would be though? It's hard to calculate because diagnosing things like ADD and other psychiatric issues is probably a subjective issue to an extent. But what if there was no Billions of dollars spent on seminars and lectures? Would the number of these drugs being prescribed decrease? Would the actual medical need for the drug generally determine demand(sales)? Probably... There's plenty of anecdotal evidence which shows these type drugs are being over-prescribed. Maybe more than anecdotal.. But again, who knows? It's such a relatively subjective field. As opposed to say diabetes or heart treatments. A quick look at some stats shown during the period of 2001-2010 shows huge upticks in the use of anti-psychotics and ADHD drugs. Kids usage doubled in the last 10 years. Women's(20-44) usage increased by 250% in the last 10 years. The question is this...is this because new drugs were developed in that time frame and there were millions of people who were badly needing them? So these new drugs came along and filled a badly needed hole? So the numbers doubled? Or have people in the past 10 years or so suddenly, mysteriously been developing increasing amounts of disorders? So the numbers doubled? Hmnnn.. we'll never really know will we? We do know that 100s of millions if not billions of dollars are spent by Pharmaceutical companies to advertise these drugs and pay doctors large sums of money to convince other doctors to treat with these drugs. I wonder if there is a connection there? Hmnnn... Just talking about the large scale chemical lobotomization of millions of kids and women.
McGeyver-What usually happens is that they look at their data, identify the doctors who already prescribe a lot of their drug and deciding this would be a good spoke person they then approach the doctor and ask them to give talks for them. Their hope is that this doctor will have some influence over their colleagues. Whether is works or not I don’t know. I haven’t seen any data in any of these stories addressing that issue, just a lot of insinuations. I’m not saying it doesn’t work, all I’m saying is the assumptions are unscientific conspiracy theories until proven otherwise.Oh they're Conspiracy Theories now are they? Is the data that shows a massive uptick in the prescription of these drugs a theory? But even more importantly, how many Billion dollar companies spend 100s of millions of dollars on unproven marketing? The answer would be none! But you're right Mac...it can't be proven.
Vyaz I never said that the money spent by pharma doesn’t have an effect. What I meant is that implying a specific effect ( ie. pharma pays a doctor to give a talk and that doctor now prescribes more of that company’s drug) without evidence is no better than a conspiracy theory.
I think this whole issue is far more complex than you are appreciating. As I said most of the doctors who are asked to give talks are the ones who were prescribing the drug before they were asked to give a talk so the implied conspiracy is not exactly what people are assuming. Pharma did not pay the doctor to prescribe more, they are paying the doctor who is already a fan of their product to be a spokes person in the hopes of getting their colleagues to prescribe the drug. That still may not be a good thing but its not the “payola” scheme you are imagining.
The talks that these doctors give are also not some bogus commercial for the pharm company that sponsors the talk. I have been to several of them and for the most part they are informative talks by specialists that focus primarily on the disease itself with a discussion of treatment options. The few talks I have been to have been on subjects I am pretty knowledgeable about and I can honestly say that the discussion was scientifically accurate and informative. The doctors who went to these meetings actually learned things that were useful in patient care. Of course there is mention of the sponsors product but we all know who’s sponsoring the talk and product information is always given about the same amount of credibility as a jail house confession.
I’m not saying that marketing by pharma doesn’t effect prescribing habits. Familiarity affects prescribing habits just as it affects what type of Cola you buy or the Erectile dysfunction drug you ask your doctor for, but even that may not be as simple as you would like to believe. In many cases pharma may simply be stealing sales from competitors rather than increasing overall sales. The reality is probably some combination of increased market share and increased over all sales.
We are talking about two very different things here. Pharma marketing is clearly a problem and it probably does influence drug usage in a way that may not be in everyones best interest, but what started this whole conversation was the implication that pharma is providing gifts and money to lots of physicians and that physicans in turn prescribe drugs they wouldn’t otherwise give to patients. I stand by my original statement that this is not true. WHile some doctors are giving these talks, the talks are not without merit and the doctors who are doing them are a very small percentage of the overall number which gets to Asanta’s question of how many doctors are there in western NY. You can’t claim that my supposition about the percentages wrong if you don’t know the denominator of the fraction. The story you refer to mentions a couple hundred doctors who accepted speaking fees ( the numerator) but we dont know how many doctors there are in the area they are referring to. I can honestly say I know and work with 3-400 physicians in our area and of those I only know of 4 or 5 who have ever given talks for drug companies. Clearly thats a small sample but a story that gives us denominatorless fraction is not a counterpoint to my experience. To assume a given value for the number is in effect showing a desire to believe a certain thing with no evidence to support that belief
Vyaz I never said that the money spent by pharma doesn't have an effect. What I meant is that implying a specific effect ( ie. pharma pays a doctor to give a talk and that doctor now prescribes more of that company's drug) without evidence is no better than a conspiracy theory.The last specific effect I stated was the massive increase in the prescription of psychotropic drugs. That's a known effect. I'm not implying any effect. What's the cause of that effect?
I think this whole issue is far more complex than you are appreciating.No. No. It's very simple actually. There's absolutely nothing complicated about marketing or "payola" or other methods companies use to sell more product. Like when Pizza Hut or Burger King show graphic close-ups of their food on TV...that's been proven to increase sales and make people actually hungry. The same goes with Drug television ads. It's proven. There's nothing complicated about anything of this topic. Perhaps it's complicated for you.... When Pharmaceutical Cos spend hundreds of millions on marketing, maybe billions, including on lectures and seminars etc they are doing it for a reason.
The few talks I have been to have been on subjects I am pretty knowledgeable about and I can honestly say that the discussion was scientifically accurate and informative. The doctors who went to these meetings actually learned things that were useful in patient care. Of course there is mention of the sponsors product but we all know who's sponsoring the talk and product information is always given about the same amount of credibility as a jail house confession.Your brief experiences in no way speak for the industry or the thousands of other seminars and marketing techniques that are going on. Your's is just anecdotal evidence, which even with your specific experience, you can't speak for the other doctors who were there, or what there experiences are.
We are talking about two very different things here. Pharma marketing is clearly a problem and it probably does influence drug usage in a way that may not be in everyones best interest, but what started this whole conversation was the implication that pharma is providing gifts and money to lots of physicians and that physicans in turn prescribe drugs they wouldn't otherwise give to patients. I stand by my original statement that this is not true.For you. That's all you can really speak for. This whole thread got derailed immediately when you came on here to basically defend your own reputation through the auspices of "good doctors everywhere". The thread is about Pharmaceutical Cos. As has been shown already, we know doctors prescribe these meds. We know some doctors give these "lectures". We know that many more doctors attend these lectures. We know that the prescription rates for psychotropic drugs has skyrocketed.
Vyazma you started the thread off with the title “More Big Pharma Payola” and then posted an article that describes a specific practice whereby doctors become consultants for or give talks for pharma exchange for monetary compensation. My position from the beginning has been that this represents a very small proportion of the medical community and I already have gone on record saying that physicians who do this should be forced to post signs in their office outlining the companies and drugs they have represented.
My experience is not as you claim only valid for me. I am a member of a large local medical community, dozens of whom i deal with every day. This may only represent a few hundred doctors but my experience is far more extensive than yours and far more than the author of the article you site so when I say that the claims in the article are the exception rather than the rule I stand on more solid ground than either you or the author.
My goal was not to defend myself. I have nothing to defend. My goal was to introduce a more accurate perspective into a sensationalized claim and thread posted by someone who appears ready to believe the worst of an entire group of professionals because it fits his world view. A little confirmation bias goes a long way even around here it seems
Yes Mac I get it. I’m not really looking to make this a personal discussion.
Thanks for all of your helpful input.
What do you think the overall percentage is of doctors who are paid to lecture and the doctors who attend those lectures(like yourself)?
What percentage of doctors is that number? Would you happen to know?
Because it’s not just about the doctors who get paid to lecture, it’s about all the doctors who attend those lectures.
After all, they are the target audience so to speak.
It’s important to highlight all of the doctors taking part in the whole lecture process. Not just the paid lecturers.
After all a Giant Pharmaceutical Co. isn’t paying some doctor hundreds of thousands of dollars to lecture to pigeons from a park bench…
Also I wonder about the amenities that are provided these doctors at the lectures.
Food, drinks…
You wouldn’t believe what you can accomplish with that old soft-shoe. Suggestion rates go up noticeably.
I just have an intense interest to find out what is behind the massive increase in psychotropic drug treatments in the past decade.
I have another question.
Can any doctor prescribe those type meds? Or does the doctor have to be a psychiatrist?
Who can prescribe these anti-depressants. These anti-psychotics, the ADHD drugs, etc etc, the anxiety drugs?
Obviously the total number of doctors who attend a lecture is much higher than the number who give lectures. Lectures come in many sizes from those given to hundreds of doctors ( usually these are at symposiums where pharma is not providing any food etc to the doctor) to smaller meeting hosting only a handful. I can’t really give you a good figure on where the mean is though except that my experience at the dozen or so I have gone to over the past 23 years is that most are attended by 10-20 doctors. That may simply be due to the fact that I don’t often travel to places where they would have large meetings.
While it would be naive to believe that people are not influenced at these meetings I think its a lot like any sort of marketing. Some people are heavily influenced, others mildly so and some not at all by the message. I tend to be an inherently skeptical and suspicious person ( hence my time here). I don’t trust a source unless I can verify it. Other people are more than happy to accept what they hear as gospel if it seems to be coming from a friendly somewhat reliable source.
Patients ( consumers) are equally if not more vulnerable to this sort of marketing. I am deluged daily with men asking about “Low-T” because they saw the ads on TV and are convinced this is their issue. Patients also ask almost exclusively for Viagra even though there are two other drugs that actually work better. Name recognition is everything in marketing and that’s the biggest reason pharm markets to patients and doctors because they know we are more likely to ask for or prescribe something that is familiar.
As far as the amenities, as I said earlier there are strict limits on how much can be spent to provide food at a meeting and to whom. Since the rules changed about 10 years ago doctors are not allowed to bring a spouse, family member, or any member of their office staff who is not a doctor. A meal can be provided but as I also mentioned it may be provided but that is where it ends. There was a time when the meeting could take place at a ball game or a show but that is no longer permitted and rightfully so. I just wish the people in washington who passed these rules applied the same rules to themselves.
Regarding your question about psychotropic drugs, This requires the longest answer and I will try to organize it as best I can.
First of all anyone who is an MD can prescribe these. Obviously you don’t want to limit this to psychiatrists since there are no where near enough psychiatrists as it currently stands to treat all of these people, and many patients who need help refuse go to one. The vast majority of meds that are used for these conditions are used to treat depression and anxiety which are not difficult conditions to recognize or treat in most cases. Due to the way our health care system has evolved, the way professionals are trained and the way reimbursements are designed psychiatrists (MD’s) rarely provide what you would think of as psychotherapy or talk therapy. They use meds as their primary tool. Psychologists ( PhD’s) do most of the psychotherapy and are not allowed to prescribe at all. Because their skills are so labor intensive ( an hour is an hour is an hour. You can;t work faster and squeeze more patients into an hour session), many psychologists do not accept insurance. Because of all these limitations the lions share of people with psychological disorders are diagnosed and treated by their primary care doctor. 99% of this is depression and anxiety though. Patients with bipolar disorder and schizophrenia would almost exclusively be treated by a psychiatrist.
Why is there such an increase in the number of people being treated? I hate to sound like a broken record but this is multifactorial answer. I’ll list as many as I can think of.
- Public acceptance - psych illness used to be kept in the closet. People suffered and wouldn’t go to the doctor or admit they had a problem because it as deeply stigmatized. That has changed a lot in recent years. We can all have misgivings about pharm marketing but one of the positive things that comes out of it is that it can also make something seem normal that was previously snickered about. Before Viagra came to market men almost never admitted to me that they had ED. now its common and no one seems embarrassed. I think the same is true for psych disorders.
- Public awareness - As the public becomes more aware of what to look for many people may be gong to the doctor for depression who previously thought they were just sad and had to suffer through this sadness. This has resulted in more legitimately ill people being treated but unfortunately has also led to a lot of people being treated with meds who might be able to work through their problems easily on their own.
*We have a tool we didnt have before -Obviously if you don’t have the tools to build a house not a lot of homes get built. If we don’t have meds to treat psych illness not a lot of people will be treated. Prior to the development of Prozac 20 years ago the only meds we had for depression and anxiety were less effective and had far more side effects and drug interactions. Prozac and the drugs that came after it changed that.
*There are few alternatives - psych illness is difficult to treat with non medical means Its time consuming, It requires the help of highly trained expensive professionals, and its inconsistent in its application and results. Primary care doctors are not trained to do psychotherapy nor do they have the time so they have few options when treating a desperately depressed or anxious patient then to offer them medication especially if availability to psychotherapists is limited.
*Marketing - both to patients and to doctors. No doubt this is playing a big role in both good and bad ways. Marketing affects usage because it influences the factors mentioned above. The more you hear about a treatment the more the doctor and the patient will become comfortable talking about the disease and accepting the medication as a solution. It also may lead to over usage if it becomes the cur all for every anxious or sad individual. If society is unwilling or unable to pay for other forms of treatment then we have no other option.
I think we all need to look at ourselves too. I find these days that an awful lot of people are unwilling to wait for things to get better on their own, whether its a cold, a back ache, or depression. A lot of people also have difficulty accepting the changes that come with age. When thats the case many people look for an easy answer and something that works quickly. The result is often a prescription.
From the viewpoint of the physician, time is money and non-med psych care takes a lot of time. The invention of managed care 20 years ago forced physicians to find ways to see more patients in less time. If a patient comes in with a complaint of depression and I spend 15 minutes with him and write a prescription I may get paid $50. If I spend an hour talking to him about the problem I get paid $50 or maybe $65. When it costs nearly $170/hr just to pay the overhead to run the office you can see pretty quickly why physicians are under intense pressure to try and provide the best care they are able to in the least amount to time they can. If we aren;t trained to provide psychotherapy, are forced to treat most psych illnesses rather than refer them out, and aren’t given the opportunity to spend the time we would need with the patient the only option is often to use medication.
Absolutely an A-One response. Very insightful.
To my untrained ears and eyes I find it fascinating that any doctor can prescribe these drugs.
And you made an excellent point regarding the necessity of this, and the more open attitudes regarding these issues.
However perhaps a point could be made that expediency of this kind could lead to a percentage of over diagnosis? Maybe?
And your point is well understood about the marketing being focused towards the patient too.
Which again has good and bad points. I would cite the 250% increase in women aged 20-44 who take these meds since 2001.
This illustrates the following paragraph…
MacGeyver, as you have shown there are numerous factors contributing to the increase.
However special care must be given when analyzing statistical data which shows a huge 100%-250% increase over a decade.
This overwhelmingly points to some specific factor. I’m not sure what that factor is-I’m guessing aggressive marketing through
all facets by Big Pharma.
And this takes us right back to the title of this thread, and the news article I cited.
I didn’t write that article, and obviously this type of corporate behavior is under heavy scrutiny by at least some concerned citizens.
So when you call this type of journalism “sensational” I get a little “perplexed”. Maybe “vexed” too.