Pharmed Out!!

[cabinetman]

For those of you like me that have to regularly visit doctors, are probably aware of the following: While sitting in the waiting, and waiting, and waiting room, notice a suit, or suitette walk in with a small hand cart wanting to see the doctor. I know who they are. They are sales reps that push my appointment even later.

The last AARP bulletin had an article about the perks bestowed on doctors about their wares. It talks about perks that could include gifts, consulting fees, trips, free samples, pens, clipboards, calculators, and pizza boxes, whatever they are.

You can enlighten your day with this article and this one.

It goes on to say the visits are to promote "new" drugs that can be more expensive. As for any of my prescriptions, my wife (who is a medical professional) required my doctors to include with the prescription the words "Dispense As Prescribed" and/or "Medically Necessary", so generics would not be provided.

No offense intended for any doctors on this forum.
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[BobSch]

It goes on to say the visits are to promote "new" drugs that can be more expensive. As for any of my prescriptions, my wife (who is a medical professional) required my doctors to include with the prescription the words "Dispense As Prescribed" and/or "Medically Necessary", so generics would not be provided.

What is the problem with generics? My doctor and I have had several conversations about brand name vs. generic drugs and his feeling is that there's no sense in paying more for a company name.

[bradley_osu]

By law generics have to contain the same active ingredient and release in the same way. They must prove this with laboratory tests. Aside from reactions select individuals might have with different food dyes or fillers used in generics versus brand, there has yet to be a single major study proving that generic medications are inferior or more importantly that brand medications are superior.

New drugs will always be more expensive. For every 10,000 compounds a drug company tests 1 will make it on the market. R&D is expensive especially in healthcare where you have to check and double-check and triple-check because people's lives are directly at stake. Advertising and sending those reps around is also expensive which helps to contribute to the cost of new drugs. Insisting on brand only (with the exception of the situation listed above) is first off expensive for you and second helping to contribute to the overall rising healthcare costs in the U.S.

[germdoc]

What's the problem? How else are we docs going to get our writing utensils, free meals and all-expenses-paid meeting trips to Aruba??

I'm being facetious of course.

I agree it's a travesty. My current practice has very strict guidelines on even meeting with pharm reps, as well as what you can accept as gifts, etc. A previous practice I was involved with in Kansas was literally overrun with drug reps--generally VERY attractive young women (the Pfizer foxes, the Merck minxes), guess why--to the point it actually interferred with patient care.

The story behind this is complicated. On the one hand, pharmaceuticals are a business like any other and docs should be able to meet with its representatives just like Norm meets with the Delta reps. (A friend of mine who ran a manufacturing business in New Jersey--name NOT Tony Soprano--took me to the strip club where met with all his suppliers, so let's be honest about the "real world".)

On the other hand, there are differences with the pharm industry. That industry has had some of the highest profits in all of business and IMO despite what they say have not had sufficient "oversight" by the US government. Unlike docs, who can't charge more than the government tells them, the pharm companies can charge darn well whatever they want to for their drugs--especially since in most cases someone else (Blue Cross, Medicare) is paying for it.

BTW, drug costs account for 10% of health care spending: http://www.kaiseredu.org/topics_im.a...ntID=61&id=358

My opinion is that like every industry Big Pharm needs to buckle up and get with the program. Spend less on marketing, more on R&D. Fewer "me-too" drugs that cost just a smidgen less than their competitor. The economy's tanking, there's a war going on, and you guys need to do your part. JMO.

[cabinetman]

What's the problem? How else are we docs going to get our writing utensils, free meals and all-expenses-paid meeting trips to Aruba??

I'm being facetious of course.

I agree it's a travesty. My current practice has very strict guidelines on even meeting with pharm reps, as well as what you can accept as gifts, etc. A previous practice I was involved with in Kansas was literally overrun with drug reps--generally VERY attractive young women (the Pfizer foxes, the Merck minxes), guess why--to the point it actually interferred with patient care.

Well put Jeff. Cabinet shops get inundated with tool and material reps. Sometimes we get freebies to "test". Can't complain about that. New introductions to the field are demonstrated and explained. Development in finishes and materials are welcomed along with product data information. Most of them call ahead to see if it's an appropriate time to get together.

My wife's GP has a system for seeing sales reps. They have to be in a group that they all see the doctor at one time together, right before lunch break. Now that has to be an interesting gathering.
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[Uncle Cracker]

My father had a pharmacy degree, and spent his entire working life as a pharmacy sales rep. (they called them detail men back then). He spent 5 days a week on the road covering four or more states, usually three or four towns a day along the two-lane roads. He ran up 100K miles a year on his cars. It was a thankless job.

This was back in the day, of course, when there were no perks to give the doctors, except the occasional lunch, or notepads for the desk. There also were no generics, but nearly every drug had two or three name brand competitors. Income was by commission, and if you didn't out-hustle the other guys, your bills didn't get paid.

And after 40 years or so of busting your hump, when your body began to slow down a little, you'd be replaced by somebody flashier and quicker, right out of college, without so much as a gold watch and a thank you. So forgive me if I have just a little more tolerance than most for those folks wheeling around those literature bags, and holding up my doctor's appointment for a few minutes, because I've seen the world through their eyes, and it ain't pretty.

[germdoc]

Cracker--

I miss the old-fashioned detail guys. They were not only knowledgeable but also nice to be around. Not quite as easy to look at as some of the current crew though.

I do sympathize with what they do, and as they say, some of my best friends are drug reps. It's some of the practices of their employers that I have issues with.

[cwithboat]

A few years ago, while boating in Canada, I got a tooth ache so I went to a small town dentist (also the mayor of the town). I had three surprises.
1. The dentist saw me within a couple of hours.
2. He wrote he prescription for penicillin-plain old penicillin. I had not taken any for 40 years, I was always given some souped up anti-biotic.
3. I walked across the street to the pharmacy and paid $4 for 50 tablets.
At that time the Canadian dollar was worth about 85 cents U.S.
I took the penicillin as directed. My tooth ache was cured.

[JSUPreston]

I work for the state agency that provides health insurance for almost all the state employees in Alabama. I'm the network admin, but I hear quite often about rates, etc.

We have studies that prove that since the FCC allowed advertisements on TV, more is spent on advertising per year than on R&D at pretty much any drug company. We can also prove that our costs, which get passed on to the taxpayer, have dramatically risen since advertising started. We know of people who see an ad for a particular drug on TV and will basically "doctor shop" until they find someone who will prescribe that one particular drug. Sure, they spend a little extra on copays going from Doc to Doc, but we pay the bulk of the visit(s) out of the health care plan. Then, we usually pay the bulk of the prescription cost out of the same plan. Once again, Joe Taxpayer foots the bill.

Really, I can't fault the Doctors for the situation they are put in. In a way, if they don't give the patient what they want, the patient will quite often go away. Thus, the doctor loses a patient and may have misinformation spread because of the disgruntled patient.

That being said, I don't think certain "lifestyle drugs" should be covered under a health insurance plan. An, amazingly enough, most of our costs are considered "lifestyle drugs." However, even that is not an absolute. My wife takes medication that is considered "lifestyle" under my plan, yet they can be considered life sustaining in her situation. It would be nearly impossible to create a structure to make these medications life sustaining for her, yet lifestyle for the person down the hall. Thus, I pay a higher cost for her medications (between my wife and the 8 1/2 year old, we pay several hundred a month out of pocket).

Please make note that the opinions I expressed are my own and are not necessarily those of my employer or the State of Alabama.

[jziegler]

I don't have much of a problem with the pharma companies going to docs to tell the docs about the new drugs. The problem I have is with the pharma companies blasting us with TV and magazine ads telling US which drugs our doctor need to give us. I've heard that due to this, doctors are more likely to perscribe newer, more expensive drugs rather than trying older, cheaper, but still effective drugs first. Anyone else see a problem with that?

Of course, the way Jeff describes the current marketing reps, that sounds pretty bad too... Sounds like we need to go back to the old ways for drug marketing all around....

Jim

[DonHo]

It goes on to say the visits are to promote "new" drugs that can be more expensive. As for any of my prescriptions, my wife (who is a medical professional) required my doctors to include with the prescription the words "Dispense As Prescribed" and/or "Medically Necessary", so generics would not be provided.

What is the problem with generics? My doctor and I have had several conversations about brand name vs. generic drugs and his feeling is that there's no sense in paying more for a company name.

My insurance company says the same thing.

DonHo

[Ed62]

I guess the TV marketing to the patients is working. I'd sure like to see it where you could just leave it up to the doc to prescribe what's needed to do the job instead of getting a presription for the big buck meds.

There is a way to do away with all the perks and high out-of-pocket costs for meds. Just take Aleve. I saw on TV that it's good for everything.

Ed

[MilDoc]

I don't see reps at all. Period.

I do fault docs who jump on the "latest and greatest" new drugs. New drugs are tested in most cases against placebos, not against their competitors. Thus there is never (or hardly ever) information showing that the new one is better than the old one, but docs jump on it just the same.

Drug tests that may show a new drug is not very effective may never see the light of day, although that is changing with the urging of Congress.

And advertising is the largest cost anymore. Example. Lipitor advertising was $129 million last year.

And the US consumer effectively subsidizes much lower drug costs for other countries that regulate drug costs, which our Congress will not do (except for Medicare/Medicaid and the Military). In other countries the exact same prescription med may cost as little as 25% of what you pay.

As for generics, the chemicals are the same but the bioavailabilty (what actually gets into your system etc) may not be. The FDA allows some variation in this. There are some drugs I will prescribe only by brand name because of this.

I get so tired of seeing things like Zithromax prescribed for just about everything, as well as other examples. That is the docs fault for not looking into expert guidance and truly understanding a drugs benefit, risk, and proper prescribing practice. It's also the drug companies fault for almost never pointing out these things.

As for research into new drugs, yes, it costs a lot, but no where near what the companies say. And far too many "new" drugs are only "me too" variations designed for competition. They may or may not be "better" than the older, often cheaper, meds.

Consumers need to educate themselves and not trust drug advertising. And lobby Congress for true change.

[BobSch]

As for research into new drugs, yes, it costs a lot, but no where near what the companies say. And far too many "new" drugs are only "me too" variations designed for competition. They may or may not be "better" than the older, often cheaper, meds.

I was told by a doctor that a lot of new drugs are actually developed by universities, not drug companies. And as far as advertizing for prescription drugs, UGH! I have to chucle when I see a drug ad in a magazine — one page of flashy pictures followed by two pages of microscopic print. It's worse than End User Licenses for software.

[chopnhack]

Last issue of Smart Money had a great story on just this issue. They also mentioned how in 1995 there were only about 30k drug reps and today they number around 100k. Of course all of this pushes the price of medicine higher.