1) Congress is considering “counter-detailers” to combat Big Pharma propaganda.
My take: The only way to fight pharmaceutical companies is with money. Having the government behind this effort is a promising start.
2) Match Day, the annual rite of passage for 4th year medical students, is today.
My take: Once again, there will be stories about how dermatology and radiology residencies fill easily while primary care struggles to fill their slots with American medical graduates.
After reading yesterday’s NY Times article (work 20 percent more hours for half the pay!), why should any other result be expected?
3) Tara Parker-Pope writes that the medical culture is “seemingly designed to prevent anybody from actually contacting a doctor while at work.”
My take: That’s true. This is unfortunate, as communication should be a pillar of any health care system. However, this is something that the physician payment system completely devalues. Patient e-mails and telephone calls, as well as communicating with specialists and other aspects of coordinating care are rarely reimbursed.
The only thing that pays are patient visits and procedures. Which not surprisingly, are what doctors focus on.
The first step to improving communication would be to appropriately compensate for it. Multiple studies have shown that physicians respond best to financial incentives. Sounds crass and mercenary, but that’s the reality.
Related posts:
- Daniel Carlat goes counter-detailing
- My take: Slow medicine, destroying the medical home, animosity, patient communication
- Does telemedicine reduce malpractice risk?
- Should doctors be paid to e-mail their patients?
- Surgeons and communication
- Poor health communication
- Can Twitter be used for doctor-patient communication?
{ 6 comments }
I admit I am bemused by your comment about “fighting the pharmaceutical companies.” I know it is fashionable right now to condemn pharma as the Great Satan, but I would ask you to give a little more thought to your proposition. (Disclaimer: I work for biggest Pharma of all; well, at least until Lipitor goes off-patent.)
Your job depends on big pharma. Sure, without pharmaceuticals, you can diagnose, but you often cannot treat. What will you tell your cancer patients after you kill off big pharma? What will you tell your MS patients: “Sorry, we were working on something better than the interferons, but then we slew big pharma.”?
I agree wholeheartedly with you and with PandaBearMD that we are overdoctored and overmedicated. I cringe at the thought of yet another SNRI coming out (Wyeth; Pratiq). Lord knows we don’t need anymore anti-hypertensives or statins. We could, however, use something to get us past vancomycin-resistant bugs. Some more AIDS treatments would be nice. The aforementioned MS breakthroughs would be welcomed by a friend of mine. I am hoping against hope for that Alzheimer’s cure before I get too much older.
My point is, big pharma is what it is. We need to work together to change the system, which involves changing Wall Street’s expectations (16% profit and it better be next quarter!) so that pharma is rewarded for long-term innovation. We need to educate the public that a pill is a good thing–but it is a better thing to take care of your health and do your part when you are ill. We need to educate the public on the risk-benefit ratio of medications.
Physicians and pharma could work together to change the system–before the government decides for us that advances in medication that mean convenience, ease of use, better tolerability and safety aren’t worth the cost. Or that medications that only change quality of life (those interferons again!) aren’t justified by the cost.
I find, in my daily travels around the medical world, that most reasonably intelligent physicians can listen to what I have to say and weigh it with their clinical experience. They use me as a resource, not an oracle. I try not to over-hype my meds, and I am well known among my doctors for being the first to point out when my meds may NOT be right for a patient. (Maybe that’s why I never win those award trips, come to think of it!)
I don’t want to pick a fight, but I do want to point out that what we need is a good working relationship. Fighting (and killing?) pharma sounds great as a sound bite, but the reality might not be pretty.
is the government going to pay us for our time while we listen to the counter detailers?
Big pharmaceutical companies are simply pursuing their business interests by detailing physicians and advertising to consumers. I would argue there is some benefit in the information and samples provided by sales reps. Ultimately, it’s each physician’s responsibility to interpret and judge the information being presented. Good physicians should come to their own conclusions by reading the FDA info, the medical letter, journal reports, etc, on branded drugs. Any physician who simply takes what pharma company sales reps present to them at face value is doing their patients a disservice.
The idea of the federal government hiring anti-detailers to combat drug company propaganda is both amusing and insulting.
Dr. Odom,
You are exactly right. (This is anonymous from above.) What we need to do, and I think we could do, is persuade pharma that their interests lie in innovation, not copy-catting.
One example of changing the pressures of the system would be to have a guaranteed patent life after a drug comes to market. If a company knows they will have a guaranteed interval in which to recoup their investment (say 12 years), then taking more time to get to market (more safety studies!) will not be punitive. As it is now, companies fight the clock trying to get the drugs to market so that they have as long as possible to make money before the drug goes off-patent. Safety gets compromised, obviously.
I must confess to being at sea when it comes to the ways of Wall Street. I am probably naive to think that pharmaceutical companies need to come out and say, “Look guys, we aren’t going to make 15% profit anymore, and we aren’t going to have a next-quarter more profit mentality.”
I do think that physicians who use the internet (and get on blogs!) are a self-selecting group when it comes to how they view drug reps. It stands to reason that a person who is comfortable navigating the internet for information, and who takes the time to do so, will see a drug rep as less valuable. There is nothing that I can tell you (legally) that you can’t find on the internet.
Having said that, there are many physicians, young and old, who do not make use of the internet. They often don’t read journals regularly, either. So drug reps do offer valuable information to them. Sometimes it’s just reminders, like taking a drug with food. You have to remember hundreds of drugs and how to dose them, etc. I only have to remember about a dozen.
I think drug reps of course shoot themselves in the foot. I know reps who barge in on doctors when they are with patients!!! Who don’t honor a doctor’s time when he tells them, “Hey, I’m swamped. Just a signature today.” Who are really somehow deluded that only their drug works. I can only hope that in my interactions with my docs, they see that I respect their time and judgement, and that I know my medications are just one tool out of many (including non-pharmacologic treatments) that they have in their arsenal.
Dr. Odom,
Something else occurred to me that is a benefit from the rep-physician interaction. Communication goes both ways. Physicians tell reps things that get reported back to the company. When reports reach a critical mass, the company responds.
A great example of this is one of my drugs. Time and again, physicians told me about a certain side effect when they dosed the drug as they were told in the PI. I got in touch with the Disease Management Team and they told me I was nuts (didn’t happen in the trials!). When scores of reps reported the same thing, though, the company did some investigation. Seems the drug was dosed differently in the trials than was being promoted in the field. Both ways were on-label–it just depended on how the label was interpreted. Turns out common sense, start-low-go-slow, didn’t work for this particular drug. We could then communicate that back to our docs.
Would this have happened in a rep-less world? Maybe, over time. Much more slowly. Docs are more likely to mention a side effect or an observation in passing to a rep than they are to take the time to formally tell the company about it. Reps are required to report all observations of side effects, so the company builds up a huge post-marketing database. A doc is not going to call the company every time a patient gets diarrhea with Zoloft, but the rep has to report it every time. (OK, so THAT probably doesn’t happen, but you get the idea.)
Ideally, there is a dialogue taking place between doctors and industry that is probably most easily done with reps. Ad boards and things like that are fine for doctors giving feedback, but the average doc doesn’t get to participate in ad boards; and ad boards really aren’t geared to finding out the nitty gritty details of how a drug is working out in practice.
If the government were to hire people to go around and “counter-detail”, aren’t those folks just government propagandists? Is that what we want to do as taxpayers, pay the government to propagandize us. Why don’t we have the government set up newspapers in each town in American to counter the local newspapers. They could run ads countering all the ads that the local businesses run. Run articles telling you not to waste your money on a new suit, etc.
I enjoy your blog Kevin and appreciate the privelege you extend to me of posting to it, but sometimes I think that you need a bit more depth in your education regarding the true nature of freedom and it’s preservation, and of tyranny and how it gets started.
I don’t see reps anymore. It started about 15 years ago with a shift from knowledgable technicians to mere salespersons–shills. It came to fruition with the realization that too many of these companies play fast and lose with the data, continuing to deny and dissemble regarding obvious adverse reactions. Big Pharma has abused my trust one time too many. While this was going on, some of the reps began to show the real disrespect with which they held me and my practice–leaving sales brochures for their products in my waiting rooom without asking was the final straw.
But the answer is not government–it is adult self-responsible physicians taking control of their own education. “Please Mr. Govmint Man tell me what to think” is not the cry of a man who will long be free.
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