I eat lunch with drug company representatives and I’m proud of it

Today, I want to review another article I wrote in last year.  That article started with a confession: ”I confessed that I ate lunch with a representative of a pharmaceutical company.”

I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it.  At this stage of my career, I can well afford my own lunch.  I could sit quietly and relax over a cup of decaf and a salad.  I could spend a little downtime with my wife and staff, but I don’t.  Recently, I stressed my need to learn as much as I can, in the limited time I have, in order to stay current with the most up to date diagnostic and treatment options.

So, I take business lunches with representatives from Pharma, medical equipment companies, home healthcare providers, and other practitioners whose knowledge helps me be a better doc.  Make no mistake.  These are business lunches and bring value to both myself and my patients in the form of knowledge and medicinal samples.

In 2012, the Sunshine Act goes into effect.  Last year, I wrote:

In an effort to disparage my profession, the government has passed the Sunshine Act.  They are going to publish, on the internet, the names of doctors who dine with drug reps.  The inference is that the pharmaceutical companies are buying my business.  The inference is that doctors are cheap whores and will sell out their patients for a pad of paper, a pen with a product name on it (both now banned by law) or a lunch (still legal).

Our government will start collecting data on more than just lunches.  While no one knows exactly what their intent is, most physicians are afraid of this law and the innuendo that physicians are doing something wrong when they accept patient samples, patient educational materials, lunches, and speaker fees. (When I teach physicians on behalf of a pharmaceutical company, I am paid for my time and expertise.)

Rumors abound and even suggest that your physician will be taxed on the samples he/she dispenses to his/her patient.  I fear that the Sunshine Act will be the end of pharmaceutical reps, patient samples, and lunch time educational programs.  What a shame.

It is interesting that the same congressional leaders who freely take campaign contributions from big business, who lunch at pricey restaurants with lobbyists, and who take trips sponsored by those seeking favor, passed this act.  The year 2012 signals the end of business as usual for my profession.

I will continue to lunch and learn for as long as Pharma and others wish to teach me about their wares.  I will be proud to see my name on web sites listing the dollar values of my lunches and speaker’s fee.  I believe my business lunches are time well spent.  I will continue to accept samples on behalf of my patients.

I will also enjoy quiet lunches with my wife and staff when The Sunshine Act finally destroys Pharma’s ability to put reps in the field.  Unfortunately, my reps will soon be unemployed.  My patients will no longer be able to obtain samples.  Restaurants who thrived on delivering lunches to docs’ office will suffer.  Congressional leaders will congratulate themselves and then go to lunch with the lobbyists from XYZ Heath Insurance Corp and it will be business as usual for everyone except the medical profession.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • Nathan Johnson

    Whatever helps you sleep at night.  Someone ultimately pays for all this wining and dining.  In a free market this would all be fine, because consumers could choose not to pay the higher cost, but in the current systems all your lunches are hidden in our taxes and premiums.

    • Anonymous

      And the guy who installed my carpet was taken on a free 3 day trip to Florida to hear about the carpet company’s promotional, all the while being wined and dined and getting free fishing trips.  I’m sure that could be a reason why this installer promotes that particular carpet brand and that it added to the final cost of my new carpet, but I’m not upset by it.  Getting a small lunch while listening to a drug rep or his paid professional is not a big deal.

  • http://twitter.com/redbirds12 John Key

    I suppose that there may be physicians who will prescribe based on who gives them a pad of Post-it notes, but I have never met anyone of this ilk.  I’m from one of the last med school classes of physicians who received a stethoscope and reflex hammer from Eli Lilly and Company, but that hasn’t kept me from prescribing Novolog instead of Humalog.  The very premise is silly, but it has long been one of the articles of faith of the political Left.  Oh yes, I know a heart surgeon who was taken to Jamaica by Medtronic, Inc., but then again Medtronic makes some pretty good pacemakers, and I doubt seriously that his Jamaican Junket had anything to do with his choice of pacemakers….

    The canard of “somebody having to pay” for these evil advertising expenses is without merit.  Anyone who wants to understand the reality of quid pro quo needs to look no further than the Washington political scene, not the pharmaceutical marketing crowd.

    But just as  physicians are not swayed by the gift of a scratch pad and ballpoint men, neither should they be frightened by the silly “Sunshine Act”.

    • Jim Richardson

      Whew!  I’m glad that poor cardiothoracic surgeon had his wish to get to Jamaica granted by Medtronic.  Poor fella – I guess he never would have had the chance otherwise…

  • Anonymous

    Really?  Seriously?  Restaurants will suffer because drugs reps won’t be taking docs out to lunch?  And you’ll have to wait until your drug lunch invites dry up before you can enjoy lunch with your wife/staff?

    Surprisingly, and despite virtually all physicians’ insistence that they are not
    influenced at all, not even one tiny bit, by receiving Big Pharma “gifts”, a review published in
    the Journal of the American Medical Association showed that even the smallest of gifts does indeed influence the choices physicians make.  Dr. John Santa also wrote for Consumer Reports Health: “Doctors deny it, but the evidence is clear that these financial
    relationships lead to significant increases in prescribing and sales. If
    they didn’t, the drug companies wouldn’t spend an estimated $20 billion a year on them.”

    Indeed, as Dr. Kevin Pho himself once wrote here, there is one type of pharmaceutical sales rep whose actions remain completely unregulated:

    “These
    reps have unfettered access to the top academics of all fields of
    medicine, are invited by medical societies to give keynote addresses,
    routinely publish articles in the best journals, and offer advice about
    medications that is accepted as gospel by doctors everywhere. These reps
    have medical degrees, and some have become millionaires by taking fat
    payments from drug companies.They are “the hired guns of medicine”.

  • http://twitter.com/sufisticat Sufisticat

    So you’re that time-poor that you need to lunch with drug reps to keep up on the latest knowledge, so what time do you have to ascertain whether the information they’re giving you is credible and based on genuine scientific peer-reviewed research?
    http://www.psychologytoday.com/blog/mad-in-america/201106/drug-companies-just-say-no-psych-drugs

  • http://twitter.com/livewellthy Stewart Segal

    Of course they lead to increased sales.  So does reading the latest research, reading medical journals, text books, and going to conferences and seminars.  Learning about new medications and treatment options leads to increased sales!  Should we simply stop learning?  After all, we have great generics.  Oops, if we stop learning, generic sales will increase.  Those crafty generic companies certainly know how to influence us.

    The same journals that published articles about docs being manipulated by pharma, take advertising dollars from pharma.  Maybe we should stop reading the journals that have advertisements in them.  Reading them could compromise our integrity.

    By the way, have you seen the ads on TV?  Maybe weak minded physicians should not watch TV.  Our patients certainly should.  Direct to consumer ads sell drugs!

    • Payne Hertz

      Unfortunately, studies have shown most of the info provided to doctors by sales reps is not based on science. Even where it is, the “science” in question has often been manipulated or misreported by the drug companies themselves. In other cases sales reps flat out lie. They are arguably one of the worst sources of accurate info for a doctor  but one that studies have shown doctors rely on heavily.

      http://www.bmj.com/content/328/7438/485.2.full

      Medical journals are also a source of misinformation due to fraud and conflicts of interest, but at least there is the potential for peer review to challenge questionable articles, however much of a joke the peer review process actually is.

      The moment you start handing out all those free pens and hang the calendars on your walls, you’ve sold out. You just turned your practice into a billboard for a drug company. There is no question when a doctor does this that he’s been influenced, even if the max extent of that influence is to get you to distribute the free pens. When patients see these things in the office they naturally assume the doctor endorses the drug in question and will be more likely to ask for it. Whether you realize it or not you have lent your good name to their ad campaign. You are thus promoting drugs you are likely to be misinformed about, The result of this is not only higher prices for patients, but sometimes injury and death as those new, largely unproven in the field drugs often turn out to be more dangerous than the older, cheaper standbys that have withstood the test of time.

    • SANDE MARRS

      What exactly are you trying to sell me?  Read the articles!  Be informed!  You don’t need to be bought by the big companies to do this!  You should be “bought” by your patients (they are actually paying you cash, not lunch) to do the right thing by them!!!  WAKE UP.

  • http://eric135.typepad.com/ Eric135

    Your free lunch and opportunities are not the issue here (and you guys know it). It is the possibility that physicians are prescribing medications that are needlessly expensive for the patient, and who may be doing so (possibly even unwittingly or subconsciously) because of free gifts. Don’t say it doesn’t happen, I am regularly having to call my physicians about expensive medications and when I ask why they were prescribed (from a pharmaceutical/pharmacological standpoint) they can’t come up with anything. I mean, if the generic doesn’t work or if the expensive medications clearly work better, that’s one thing. But I think physicians (yes, sometimes, many times by accident) prescribe expensive (lunch-laden) medications for no reason. _That’s_ a good reason to limit the practice. Come on, do like the rest of us and pay for your CME’s.

    • Anonymous

      That may be your doc, but I always think of generics first, and only consider trade name if there isn’t any alternative and discuss the problem and potential solutions (discussing cost as well) with the patient.  Sorry, a free lunch may seem an enticement, but I can take it or leave it and will not bend my professional ethics so some drug rep can get a year end bonus.

      • SANDE MARRS

        I like the way you think, but…  do you buy your own lunch?

        • Anonymous

          When the drug rep doesn’t bring one, yes.  About half of our days the reps bring a lunch, so I sit and talk with them while eating, more than half the time we just talk about our lives, not the drug.  The other days I eat my own lunch that I’ve purchased.

          • Anonymous

            How lovely for you!

  • http://twitter.com/jdanielhess Dan Hess

    Physicians’ professional responsibility is to care for patients. Despite the good they do, “Pharma” has a different bottom line. We must be careful not to jeopardize the trust and respect afforded to physicians by society – It wasn’t always so.

    • SANDE MARRS

      As a healthcare worker for over 10 years, my respect is earned not merely granted.  That includes physicians.  I hope everyone takes more responsibility for their own health care, does more of their own research, suggest alternative forms of therapy (nutritional or physical instead of pharmaceutical if possible), and stop blindly believing physicians without second opinions!  Everyone has the ability to do great harm and great good….  everyone.

  • http://warmsocks.wordpress.com/ WarmSocks

    When all other treatment options failed, my doctor was able to start me on a biologic and provide samples until my insurance company completed the PA paperwork (which took them six weeks).  Six extra week of treatment is a huge benefit.  I suspect that RA patients looking for a new rheumatologist will check the Sunshine list looking for doctors who will be able to provide us with samples.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    what a joke, physicians are among the smartest people this country has to offer, we arent easily swayed, i gladly will take a sample of micardis and then change someone who can’t afford it to cozaar, i almost never write for branded drugs, but that doesn’t mean i don’t want to know what is out there, they should make all forms of marketing illegal if they want to do this. I feel so bad for those reps, it used to be a viable career, now yet another wave of middle class jobs are going to eliminated, and for what really….

    • SANDE MARRS

      Vikas:  ”among the smartest people this country has to offer”…. really?  God complex much? Get over yourself and buy your own lunch.  I have a several girlfriends that were (some still are) reps, and they laugh all the time about how easy their 6 figure jobs are.  They smile, they cross their legs, they read notes reminding them of your kids’ names and interests.  Then they get in their company cars and call us, their REAL friends, and make fun of you for getting taken by a skirt and a smile, and that you were probably one of those geeks in high school that thinks he’s finally befriended a cheerleader.  Meanwhile, she can’t wait to get away from you.

  • Stephanie Katz

    It seems to me that since as you you say, you can “well afford my own lunch,” that there’s nothing stopping you from having lunch with the reps and paying your own way. You get the info you need – there’s no conflict of interest – real or perceived. And don’t kid yourself about doctors being too smart to be swayed by Pharma’s marketing tactics. If they didn’t work, they wouldn’t be doing them.

    • Anonymous

      Pharma-fed physicians. I think I like free-range physicians better.

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        I know what you mean. The osteopaths are inundated with Jones strain-counterstrain reps, 

        soft-tissue myofascial release pens, those sticky pads pushing muscle energy lymphatic pump techniques.

         

        Then you get those cute reps, I think they’re
        ex-cheerleaders, with a breathy voice like Marilyn Monroe, urging me to
        try a high-velocity-low-amplitude thrust for those back pain patients.

        The psychiatrist in the office next door is up to his ears in Freudian reps, Jungian reps, and don’t get him started on those Kernberg psychoanalytic reps. They’re all borderline.

  • http://pulse.yahoo.com/_IIKZPK7ZKQOX26VUB54L7N3O5Y Dr Cuello

    Is this post for real? You are kidding right?

  • Anonymous

    I wonder how many Pharma lobbyists are dinning with politicians at this very moment? Sunshine? Really?

  • Anonymous

    The Sunshine act came after years of abuse. In my town, there was the “Famous Friday Lunch at PF Chang’s” by one of the pharmas. ANY doc could go and get lunch for free. Some of them starting ordering take out for their families for dinner as well. Lunch and learn… are you kidding me. If the reps and docs had kept it within reason, they could still be doing it. The pendulum has swung the other way and it is about time!

  • http://twitter.com/livewellthy Stewart Segal

    It’s not a pendulum, it’s a freight train and it is plowing over everything in its path.  The doctor-patient relationship is its target.  By breaking the trust between doc and patient, those whose primary goal is cost containment and profiteering can have their way with the public.  Suggesting that the integrity of your family’s physicians are for sale for the cost of a pen, pad of paper, or lunch is ludicrous.

    When you awaken your doc at 3 a.m. with a complaint, do you really think he considers what pharma wants him to do?  If you believe that, you’d better get a new doc. 

    Gross generalizations like “docs abused the system and are getting what they deserve” are just as unfounded as saying all of any group are bad because some crossed the line.  Yet here we are!  All docs are being acused of selling their patients out for a lunch.  It’s just wrong!

    If docs are really that easy to manipulate, its time to ban all advertisements just to keep us safe from those who apparently are so good at compromising our judgement.

    • SANDE MARRS

      Suggesting that the integrity of your family’s physicians are for sale for the cost of a pen, pad of paper, or lunch is ludicrous.  …..
      I was close personal friends with many physicians (family practice, specialists, surgeons, anesthesiologists, etc) and was told on MANY occasion, by most, if not all, that they absolutely DO consider who the drug rep is before writing a script, even at 3am in the morning when on-call.  If they didn’t write enough scripts of a certain prescription, the company may replace their “friend” who usually happened to be of the opposite sex, and awfully cute.  Some of these physicians (possibly nerdy as a teen?) actually believe these reps are their friends and worry about their status within the company, or believe they will get play and don’t want to ruin their chances.  ….How did these idiots get thru med school?  Easy.  It’s not so much a greater level of intelligence that is required.  Just a strong will to finish more years of school…..

  • Preston Gorman

    The Sunshine Act should be a welcome change to anyone interested in transparency for patients. Doctors can, of course, explain their presence on any such list with the articulate rhetoric displayed in the comments here. Of course, the 5 and 6 figure appearance fees paid to key “opinion leaders” will probably take another level of conversation. 

    Anyway, enjoy the harvest!

  • Preston Gorman

    Would it be so bad to publish the information and let patients judge for themselves?

  • http://twitter.com/livewellthy Stewart Segal

    Personally, I have no problem with publishing the data.  I am comfortable with who I am.  Unfortunately, many are afraid of the innuendo/inference of improper behavior.  Innuendo and inference can do grave harm to reputations an relationships!  In this case, they already have.

    • SANDE MARRS

      Who’s money do you think you’re spending? IT IS IMPROPER BEHAVIOR. Why not suggest they use all this extra cash (that spent on you & the reps themselves) to fund a bit more research?  To lower the cost of RX’s? To pay off the national debt?????  Grrrr……   

  • http://www.facebook.com/people/Roy-M-Poses/757544028 Roy M Poses

    Are you seriously suggesting that pharmaceutical representatives provide you with unbiased and reliable information?  Maybe you should read what former drug rep Shahram Ahari has said and written about how they are trained in sophisticated methods of psychological manipulation:
    http://hcrenewal.blogspot.com/2007/05/fool-me-once-shame-on-you-fool-me-twice.html
    http://hcrenewal.blogspot.com/2008/03/what-drug-reps-really-care-about.html
    http://hcrenewal.blogspot.com/2008/04/more-about-cynical-world-of-drug-reps.html
    Maybe small gifts alone do not actually sway the thinking of many doctors.  But the techniques discussed above in combination with those gifts are likely to.
    Furthermore, some doctors get more than small gifts.  In fact, in your own blog (http://livewellthy.org/) you disclose the following relationships, “Dr
    Segal has served as a speaker for GSK, AstraZeneca, Novartis,
    Sepracor, and Pfizer. Dr Segal has served as an Advisor for GSK,
    AstraZeneca, MannKind, Midmark and Atcor.”  According to the ProPublica data base, you got $6000 from GSK in the first quarter of this year (.http://projects.propublica.org/docdollars/search?utf8=%E2%9C%93&term=Segal&stateid=14)  Would you deny that earning thousands of dollars from drug companies might not affect a doctor’s thinking?  By the way, why didn’t you make these disclosures in the post above?
    Finally, I agree that congress critters have all sorts of conflicts of interest, that doctors are also manipulated by managed care/ insurance companies, that medical journals are affected by the advertising they accept, and that patients can be manipulated by advertising.  But do these ongoing practices excuse doctors from trying to avoid being biased by people whose main goal is to make money selling a particular product or service, given that these products and services are not always the right ones for individual patients?

  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    No matter what double standard you choose to go by, the fundamental question is this: Should people in a privileged position of power over others receive rewards from third parties who could potentially seek to sway their decisions?

    So, if I, as a physician, need some funds to expand my business career. Could I hold a $1000-a-plate dinner and invite pharm reps to come support my cause? Of course, I would be honor bound not to let their gifts sway my prescribing habits. Is this legitimate and permissible? Yes? No? OK, so maybe this is not good.

    How about if I, as a politician, in a position of power to control how much tax money to extract from the working public and how to direct that enormous fund of money towards whichever special interest groups “need” it the most decide to hold a $1000-a-plate dinner and invite union bosses and corporate CEO’s to come support my cause? Of course, I would be honor-bound never to let their gifts sway my legislative decisions. Is THIS legitimate and permissible? Yes? No?

    Hmmm………

    • SANDE MARRS

      BOTH are disgusting.  Do your part to change them both.  OCCUPY. :)

  • Anonymous

    If you are obtaining your CME through drug reps, then I fear for the safety of your patients. Throw all the drug reps out and decrease the cost of medications already!

  • Anonymous

    It’s interesting that so many of the female drug reps are drop dead pretty.

    Of course, I’m sure that has nothing to do with your desire to learn about all those new drugs. ;-)

    • Anonymous

      And it creates a really perverse situation with all these young pretties kissing up to older male doctors. This sort of sexually seductive marketing should not be permitted in medical clinics. (see my prior post up there somewhere) Some drugs reps have sex with doctors. My niece was a drug rep and told me the inside scoop. I’ve looked for statistics on this but can’t find any. No legislation will stop all unethical behavior. 

      • SANDE MARRS

        I was in a long term relationship (6 years) and residing with a family practitioner who frequently went to lunch, dinner, clubs, parties, and weekend flag football gatherings with pharmaceutical reps of both genders.  I’m sure it won’t surprise you that we ended our relationship due to his unfaithfulness.  More than once.  Most (the ones I’m now aware of) drug reps.

        • Anonymous

          yes. disgusting.

    • http://nonmaleficence.wordpress.com Nonmaleficence

      It’s not just the female drug reps that are ‘drop dead pretty.’ The male salesman from the company that wines and dines neurosurgeons to use their products (essentially the same thing as a drug rep) was not ugly by ANY means.

  • Anonymous

    My niece worked as a drug rep temporarily and she had doctors take her in exam rooms and ask her,”what’s in it for me if I prescribe your drug?” and try to have sex with her. I wonder if the Sunshine act will cover what goes on where the sun don’t shine? And this stuff is going on. Trust me. I’m a doctor.

    • Gil Holmes

      Thinking of the last six or so drug reps I saw and including those who had a lunch(one that was horrible) I believe I prescribe 2 of the 7 drugs they represent. One of them I prescribe extremely rarely when the other drugs in the class just aren’t getting there as it is the most potent(but also 2nd most expensive). The other I started prescribing back in residency before I ever saw a drug rep that carried it as it is the only drug in its class and works better than anything else for the indication.
      On average, I would say talking with a drug rep tends to lessen the liklihood that I will prescribe a drug. I can say that with certainty about the drug presented today.

      • Anonymous

        Yep. I had adverse reactions to drug reps too. Less likely to Rx after hearing the spiel.

        • http://twitter.com/eatsdonuts I love donuts

          That’s quite interesting. You still let the drug rep decide whether or not you prescribe the drug. Why not read the literature and interpret for yourself the quality of the underlying data rather than listen to a pretty steward of the industry who may or may not understand the basic of science? 

          • SANDE MARRS

            Ryan, these cheerleaders are paid 6 figures to know their product and express all the advantages clearly.  If they are unable to do that, then by all means, they can have an adverse effect.  The basic point though, is this:  If the product works and the patient can afford it, why is an expensive (often wet) lunch necessary?  Why are pharmaceutical reps necessary at all?  Spend your money on research, and leave the cheerleaders on the field.

          • Anonymous

            Sande – I’m with you. I think you missed my point. The balance in medicine should be provided by the literature. Literature coming from well done and balanced research at that. That PamelaWIbleMD turns her nose at a Rx because a drug rep visited is just as bad as choosing a Rx because a drug rep visited. My point is that choosing drugs should have nothing to do with what a rep says or does. It should have everything to do with what the data says regarding whether or not it helps ones patient in their current situation.  

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      Say what you want, I am not getting rid of my Levitra pen.

      http://www.youtube.com/watch?v=Pm-bSAnlQBE

  • Michal Haran

    We can’t take care of our patients without medications. we need the pharmaceutical companies for that. Yet, their interests are their stock-holders and not our patients. This creates a conflict of interest that we have to be aware of. The drug reps are trained to promote their merchandise, just like any other salesman. And some of them are very good at their job. A few years ago, a drug rep walked into my office and told me she has heard so much about me, and how I care about my patients. (great start). She said, I know that you as opposed to many physicians, are also aware of the emotional effects the illness has on your patients. You know, she said, many patients with a physical illness also have depression. Yes, I said, this is a normal response to an illness. Of course, she said, but it also causes enormous suffering, many times more than the physical symptoms. I fully agreed with her. I have spent many hours sitting next to my patient’s beds alleviating their and their loved ones fears and concerns. So, why do they need to suffer, when there is such a good solution for that? She then took out of her briefcase a questionnaire which you can give your patients to assess their “depression” score and then if it is above a certain level-give them antidepressants. She also had with her quite a lot of medical literature supporting that approach (obviously she didn’t bring literature that led to very different conclusions). I politely thanked her and showed her the door. In most fields of medicine there is significant controversy regarding optimal management approach. Should we treat patients with high cholesterol or not? What should be the target blood pressure? Who should be given DVT prophylaxis? Which patients with reactive depression, if any, will benefit from antidepressants etc. Drug reps will obviously give you a very skewed approach. They will provide you with extensive medical literature (some even nicely summarized in very easy to view figures and slides) from the best medical journals (including studies that were fully sponsored by them). Keeping updated with the enormous amount of medical data is a very hard and nearly impossible task, and the drug reps have very smartly realized this and know how to make you feel that they are closing this gap for you. But, they aren’t. 

  • Anonymous

    Of course
    lunches, speaking fees etc. influence prescribers. Drug companies are not
    stupid, and they wouldn’t do it if it didn’t work. Somehow you use the mess
    that we call the congressional lobbying system to justify this practice?
    Classic “two wrongs make a right” thinking. No, pharma reps won’t
    affect the 3 AM decision, but they affect the other 99% of decisions that occur
    during the workday, when physicians routinely prescribe the latest ARB or
    statin when the old ones are just as good (should be a punishable crime to cost
    a patient hundreds of dollars for no reason other than your
    “relationship” with the drug rep). The Sunshine act will not change
    anything very dramatically (although I hope it does). Loopholes will be found.
    Just look at the Lipitor fiasco, in which Pfizer is fighting tooth and nail to
    prevent people from getting the benefit of generic pricing for as long as
    possible.

     

    • Gil Holmes

      If I had any reason to think that losartan was as good as valsartan(Diovan) I would write it more. But it just doesn’t lower BP as effectively in my experience(nor in the studies). Fortunately valsartan is going generic soon. But I still write 10 times as much lisinopril($4 at most drug stores and I’ve never seen a lisinopril rep as I was still in high school or even middle school when it came out) as I do all ARBs combined and reserve ARBs mostly for the ACE intolerant. I see a Diovan rep 2 or 3 times a week.
      I used to see Micardis and Benicar reps but they are around less for some reason. And Edarbi has pushed hard but I’ve written zero and have little plan to do so. I guess if I really just needed the extra 4mm Hg BP improvement for a patient already on another ARB but really that’s a very small population and I probably won’t ever do it.

      As far as statins, my #1 statin remains $4 pravachol. If I go to another statin it is because I need a more potent one. I used to use a lot of zocor for my more potent statin since it was relatively cheaper as there is a generic. Up to 40mg I’ve had no more myalgia/CPk elevation than any other statin. At 80mg there does seem to be more. But the FDA hurt simvastatin bad by essentially making it non-viable with the CCBs. So unfortunately I am using more branded statins when I need something more potent. But no pretty FDA rep told me that. Just an impersonal letter. And of course the inevitable lawyer commercials that will come soon enough.

      I spent 15 minutes with a drug rep at breakfast this AM. I’ve never written her drug. I have no specific plan to do so at this time. There is no generic agent in the same class so cost is not a significant factor.

      I honestly cannot remember what drug was being pushed at lunch today. We did talk about college sports injuries for awhile but it was not an NSAID or pain med that I can recall.

      Do drug reps sway some. Well, despite all the above of course they do some. And some are surely swayed more than others. You are more likely to write the drug you have heard of than the drug you haven’t.  But I think for most doctors the effect is relatively minimal but when you are talking about millions and billions of dollars drug companies only have to sway a little to make significant income. Advair and symbicort are essentially the same. If a drug rep persuades me to use one equally expensive drug over another, the patient is not harmed as long as they needed that class anyway. Just make sure they didn’t just need the inhaled steroid(none generic anyway I don’t think)

  • http://www.facebook.com/people/Joe-Ketcherside/100000137792301 Joe Ketcherside

    Sorry, but I watch docs prescribe Mobic to patients who should be taking ibuprofen, and then I look in their break room and see Mobic-label junk everywhere. We all like to think we are very scientific and professional. I am amazed at the level of inappropriate prescribing I see.

  • Anonymous

    “In 2012, the Sunshine Act goes into effect”
    It’s about time! I schedule my doctor appointment at a certain time. I’m there 15 minutes before that appointment time. When I arrive, if I see any guys and gals in the waiting room, dressed to the nines, with briefcases, then I know it’s going to be a very long wait for me and the rest of the paying customers in line to see the doctor. PhRMA reps always get to see the doctor ahead of any patients. There have been times when an impromptu lunch might clear out the waiting room and everyone has to reschedule. Maybe the 2012 Sunshine Act will help end this scam practice, huh? 

  • http://profiles.yahoo.com/u/4RVC4DAZQO5I7ZLJ5SG67UH7FE Marla

    (1) You could learn all that stuff WITHOUT having your palm greased by the reps.

    (2) You might want to look up the words “inference” and “implication.” They don’t mean the same thing.

  • susan popp

    I’m certainly glad that you are not my doctor. Drug reps are sales people and they want to sell you drugs. They do not tell you the whole story about the horrendous side effects of these drugs. If you do not do your own research on drugs, then I feel you are failing as a good doctor. Don’t tell me you do not have time to research. I worked for a very good popular doctor who never talked to a drug rep and researched all the drugs he prescribed. I know from personal experience that some drugs have serious permanent side effects that can be deadly and my doctor did not tell me anything about that happening. Shame on you.

  • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

    20+ Years ago, I did an inhouse “lunch and learn” on the pros and cons of direct to consumer advertising of RX drugs. Obviously we thought it was the worst thing going. But now that more people are talking to their doctors about depression, incontinence, even asthma, maybe there is a tiny bit of merit. I personally don’t like the specifics of the commercials but it is nice to know that many of these problems are not so “horrid” anymore and people ARE a bit more willing to confront them now.

    But really, how many of us are sitting around watching 8 hours of TV a day or reading 3 popular magazines “as seen in Reader’s Digest, Woman’s Day, etc” to know what patients will walk into the office and request. How foolish will you look if the drug rep hasn’t been by to tell you about that new drug to “help my depression, bladder, prostate, pain, etc”.

    The reality of it is that while many of the new drugs on the market are “me too” meds, every once in a while there is a breakthru med and we depend on drug companies for their research and money to find these lifesaving drugs. It’s the piddly “me too’s” that make the money for them to continue that research for the next big thing. And no, I’m not a drug rep, but I have had to explain to my elementary age kids what ED is while watching baseball. UGGHHH!!!

  • Jon Nixon

    I have struggled with the lunch thing with pharm reps.for many years  and have finally stopped the practice, much to the chagrin of the office staff. I have never learned anything from a drug rep that I couldn’t learn in 5 or 10 minutes of reading. Having to listen to someone go on and on is what I do with patients all morning, and dealing with an aggressive salesperson during lunch gives me no reprise. The ones who bring in their family pictures and vacation photos and try to remember my kids names are particulary obnoxious. It just feels wrong.  The office staff has since started organizing potlucks several days weekly which I believe has contributed to the office morale, some being very proud of their culinary skills….

  • SANDE MARRS

    Oh, how silly of me….  your patients don’t pay you nearly as much, take up 15 minutes of your precious time, and require actual WORK.  What was I thinking?   If you think WE think you have your patients interest at heart first before the real hand that feeds you?  Think again.

    • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

      The approval and happiness of my patients ARE the real hands that feed me. The survival of my practice depends on happy satisfied patients who go out and spread praise through word-of-mouth. This leads to healthy and appropriate accountability on the part of me and my staff. Without a doubt, this is one good argument for the advantages of the free market over central planning.

  • Anonymous

    I used to be a pharma rep who supplied free pens, pads samples and patient education material to physicians, nurse practioners and phtysician assistants We were directed to choose our speakers based on those doctors who could attrack colleagues to come to dinners. If the doctor of influence was not writing our drug for at least 30% of qualified patients we were instructed to have a conversation with that (speaker) physician that went something like this; Doctor, you really need to gain more experience with our product to speak with authority regarding patient outcomes and the safety of said product. In other words, as a speaker we need you to increase the number of prescriptions you write of our drug over the competition because we pay you for this.

    We would look at the percentage of prescritions all of the doctors wrote immediately following these dinners to see if you were having an influence. And yes we would regularly check your numbers to see if there was an increase in the volume of product written after you received your check.

    Once you became a speaker you were called a whore behind your back by the reps who made sure your check was in the mail  This is how that conversation would go; Yeah he is a whore but he is our whore.  

    All of the above is called influence. Evidently, it works with you.

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