Contemplating medicine and the health care system
Kevin MD alerted me to this excellent discussion – Just because it’s new doesn’t mean it’s best
In September, the American Council for Continuing Medical Education issued new regulations ensuring that information transmitted in a format acceptable for CME credit is as free from commercial bias as possible.
So how can doctors protect their patients in this imperfect world?
* Remember that doctors, not industry, have the responsibility to make decisions in the best interests of patients.
* Consider information from the drug industry as advertising with inherent bias.
* Use the least expensive therapeutically equivalent drug.
* Be wary of industry gifts. Follow accepted national guidelines.
* Read the literature with critical judgment. Look at the disclosures of the authors. Read the best journals.
* Utilize practice guidelines issued by major national specialty societies.
* When possible, obtain information from sources that offer CME.Using the above criteria, I suspect the answer to our question remains the same as the one common sense originally dictated — don’t switch.
As Malcolm Gladwell suggests in his piece which I cited on Friday, we physicians must take responsibility for our prescriptions. We can easily blame “Big Pharma”, but I believe that argument akin to blaming McDonald’s for ones obesity!
My frequent and often brilliant commentor – Roaring Remy – argued that Gladwell was a shill for Big Pharma. I argue that we physicians must stop blaming Big Pharma for the cost of drugs and take responsibility for practicing the best possible medicine at the lowest possible costs. Big Pharma cannot shower me with gifts – because I do not accept them. They cannot influence me at dinner meetings, because I refuse to attend.
I read the Medical Letter to get unbiased information about new drugs. I refuse to meet with drug reps (and have been know to insult them).
Big Pharma has a goal of making profits. I have no problem with that. I must take responsibility for my own drug decisions. Blaming them is disingenuous. Supply and demand works. They will lower prices if that would increase sales.
So I remain cautious of new drugs, unless the data overwhelmingly support their advantage. I sit on the sidelines using the “tried and true”, while awaiting the seemingly inevitable reports of side effects.
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4 Responses to New drugs (part II)
RGL
October 25th, 2004 at 2:05 pm
Hats off to DB for his admirable attitude in evaluating new drugs and eschewing the corrupting influence of incessant drug detailing often masquerading as “medical education.” That is, unfortunately, not what we see in the real world. In that respect, Malcolm Gladwell was right in faulting physicians for not exercising better judgment about their prescribing practices (a point I don’t dispute), which is not to say Big Pharma should be free of blame.
The opinions rendered by Dr. Karatansky and Dr. Fleming are what we should expect – a balance of “economic concern, diagnostic elegance, and therapeutic parsimony.” I could not have expressed it any better.
With a few exceptions, the proliferation in the past two decades of “me-too” drugs should have alerted us to a self-evident truth: None of those drugs within a class is better than the others. Clincial trials leading to their production were all placebo-controlled, with none being tested against each other. The drug companies merely have to show that they are “effective,” not a stringent standard at all when they are promoting “superiority” of these new drugs.
Indeed, it’s important for physicians to be assiduous in acquiring their therapeutic information. The incestuous relationships among drug companies, medical centers, and medical experts (including authors) have become so pervasive that conflicts of interests have become commonplace, raising the question of bias on what is being fed to us. Hardly any CME meeting, as I previously observed, is held nowadays without sponsorship money from Big Pharma, or speakers with ties to the industry. Some medical journals bear that taint, too.
While I agree physicians need to exercise more prudence in prescribing drugs, the bigger burden still rests on the drug companies to make their products priced more reasonably. With as much money as they make, close to $40 billion yearly, that is not too much to ask for.
Gary Anderson
October 26th, 2004 at 2:11 pm
I wonder what would happen if all physicians refused to see drug reps, even if it was only for a few days or weeks?
RGL
October 26th, 2004 at 3:38 pm
Gary, please don’t tell John Kerry about that one week before the election. The army of the unemployed will get bigger. And that would be bad for the president.
arf
October 26th, 2004 at 3:50 pm
Think of all those poor stickypad and novelty pen manufacturers you would put out of work.