What is one of the most fundamental priciples of any economic system?

If you answred anything other than sales then you’re wrong.

Sales is always a good reason have people talking…whether its booze, drugs, food, cars, stocks, medical advice???

C’mon doc…We live in a free market…the inconsistencies of our current healthcare system have far more ramifications than those of a few “good looking, nice” pharmacy reps.

Maybe not yourself, but the doctors of this generation are 100% ENTREPRENURIAL

DOCTORS more worried about how many patients walk throigh their doors than the quality of the care they give.

I agree with you to a certain extent…some of these SALESmen dont have the best intentions. Unfortunately, Money has always been the BIG reason to join the healthcare field. But because a few companies and sales teams are more agressive than others, those individuals give evryone else a bad name. Its like the car business…whats the first thing you think of when you drive up on a lot? What car , and how pushy is that salesman going to be? It is inevitable in any market…SALES drives evrything we see and own, including your 190,000 a year salary. What happened to the hipocratic oath? Does that exist anymore? Maybe doctots shopuld give a free check up day one day out of the year…would you do it?

I dont even know what im arguing about anymore, but i just cant stand it when another american capitalist such as yoursef compalins about the hard work of other individuals in the healthcare field…IF YOU DONT like it then move to CANADA…im sure the reps there are less agressive.

HAVE A NICE DAY

Let me guess…your a democrat and you

Aerobic exercise 1/2 hr b.i.d.
Vegetables and fruits 5 servings daily

get the message.
My last doctor didn’t dare tell me to diet. She was 300 plus pounds herself.

Now I have another issue to rant about.
I can’t get Prevacid as my insurance company has a deal with Nexium. Prevacid costs $450 for a 90 day supply. Well now I get mine from India. It is called Lanzap….a generic prevacid. It’s only $40 dollars.

Do you really (and honestly, “really?”) believe and maintain that drug companies are doing all of this in the interests of physician education and public health? Do you really truly believe that their marketing materials are totally honest, with full transparency about their internal studies and conflicts of interest?

Finally, how about some transparency on your end—-what are your conflicts of interest, if any, with the drug industry?

The first issue–the capability of the FDA to assure drug quality–is an important one. Too bad most of the supporting statements are recycled media pap. The fact is that the only perfect drug is the one that hasn’t been tested. As Dr. Toub mentioned above, all drugs have side effects. And testing in even 10,000 clinical trial subjects won’t reveal every problem that occurs when millions of people take a drug. But new drugs ARE tested, quite extensively, and for the right patients the risk is low. Certainly the risk-benefit ratio is a lot lower than drinking booze and smoking cigarettes in a bar, and then driving without a seatbelt–all of which are subject to other regulatory regimes in the U.S.

The Vioxx issue is less a regulatory failure than a representation of patients’ (and doctors’) desire for a magic pill, exacerbated by some overpromising by Merck. And while it certainly looks like Vioxx adds to the risk of heart disease, we don’t really know where it stands among all the other NSAIDS out there. It is likely the whole class of drugs has effects on heart disease, including over the counter ibuprofen and naproxen.

So what do you do? In the pursuit of perfect drug safety does the FDA yank ibuprofen and naproxen until comparative testing is completed in a decade or so? Oh, and did you know one of the most dangerous drugs in terms of hospitalizations for overdose is acetaminophen (Tylenol)? Yep, it can kill your liver, and at a comparatively low multiple of the effective dose. So maybe the FDA should yank that too, as well as aspirin, which is well known to cause Reye’s Syndrome in kids. Too bad that we will be left with sugar water and caffeine for pain.

The fact is that there is no perfect solution. The FDA can mandate testing, but no one can make drugs perfectly safe. Doctors are paid to understand when to prescribe drugs, select the right ones for the patient in front of them, monitor for effects (good and bad), and modify the treatment as necessary. If a doctor doesn’t want to take the time to do a good job prescribing drugs he/she should turn in his/her license and do something else. Low reimbursement is no excuse–if money is more important than the patient, go do something else that pays more.

As for the lies? Sure there is selective omission of facts, spin, and even some misinformation. Outright fabrication seems to be rare–and is prosecuted. Hysteria over ‘everyone’ lying is akin to “Bush Lied about WMD!” We are awash in information. Each side tries to spin the facts to support their cause. But if someone puts lipstick on a pig, are you going to kiss it? And if you do, whose fault is it?

“Pharmaceuticals are one of the most highly regulated industries, and the jihad against pharma giving out trinkets is, if anything, having negative effects on patient care.” “Since when is prescribing a drug, new to you, but having full FDA approval for the condition the patient has, make that patient a guinea pig?”

Wow — “Full FDA approval” – that really fills me with confidence. “Highly regulated” – really???? – red tape obscuring that regulatory blind eye more like it.

It doesn’t take a genius to figure out that FDA approval is hardly worth the paper it’s written on. That’s why we have VIOXX. That’s why a large number of FDA workers are reporting that they are being pressurised to manipulate scientific assessments. That’s why we have David Graham. It’s why the FDA feels the need to try to pass legislation preventing legal action against their corportate clients. It’s why individual scientists such as Blumsohn here in the Europe are exposing companies for altering research findings in University/Pharma research through blogging and the media instead of via the regulators
http://www.scientific-misconduct.blogspot.com
(with considerable effect, forcing Procter and Gamble to Issue a Bill of Rights for Researchers that goes a lot further than anything anyone has forced on PhRMA).

The free pens are a distraction. The much more important problem is of paid “Key Thought Leaders” disseminating pseudoacademic bullshit for companies at $4000 a lecture. And that’s also why we have drug reps, DTC advertising and sponsored CME – to bypass scientific thought in the absence of an honest regulatory framework.

And on the topic of logical fallacies, I’m not sure if there is a name for the fallacy that attempts to say that some problems are not important because they are not the only problems. Sure insurance companies and other vested interests are also a problem – what the hell does that have to do with the problem of companies shoving lies down our throats.

Notinng out kind host’s admonition to avoid ad hominem attack, I will end.

Your faithful and humble servant

Jennifer

In my opinion these practices have just as much potential for poor healthcare outcomes as drug detailing because they:
1) target the patient instead of the (presumably) more knowledgable doctor,
2) have little accomodation for individual patient differences, unlike the decisions of a good doctor, and
3) are so biased in favor of dollars that even acknowledged inferior substitutes are promoted (look at the rush to simvastatin).

“all drugs, even H2O, are associated with potential side effects. There is a decision process involved in choosing between one drug vs. another. Vioxx vs. Naproxen is a good case in point.” Agree with no reservations.

“Let drug selections be based on science and evidence. Not upon which drug rep visited me last, who gave me the better lunch, etc. We’re physicians, and should be held to a higher standard than that.” Agree totally. But this is a straw man. Who do you know that chooses a drug JUST because a drug rep visited? I agree that any physician who prescribes a drug on criteria other than clinical judgment should be out on his/her can, but this is NOT equivalent to trying a new drug when there are clinical indications and the patient has failed your first-line drug. If a doctor is changing the drug the patient is on, and one drug is clearly better than another, how many doctors that you know will choose the inferior drug? And if the doctor is facing three options which all seem clinically equivalent in potential effect, why is it a big deal if he/she first tries the one that the nice drug rep promoted?

“Conflicts of interest, even those you would deem trivial, are unacceptable by our lawyer colleagues, so are you suggesting that physicians aren’t as ethical as attorneys?” Ha! You know this is going to bring a comment by CJD… Balancing conflicts of interest is at the heart of a physician-patient relationship. If your patient need surgery, do you refer to your golfing buddy or that asshole at the university? Do you use that fancy new diagnostic machine you are making payments on (and that reimburses sooooo well…) or do you wait and see? Do you ask the patient to come back and see you in a month, just to make sure she is doing well, or do you trust her judgment on whether to return? Do you order that extra blood test because Medical Economics had an article about someone who was sued when they didn’t? Good doctors do their best to put the patient first, whether or not there was a visit by the drug rep. Bad docs have plenty of opportunities to make a buck off a patient’s ignorance, whether or not drug reps are banned.

Regarding attorneys–my understanding is that there are unethical ones out there. There are unethical doctors out there too. I really don’t know which is more prevalent, but both groups are a blight on civilization.