Roy Poses on drug reps

2

Category : Medical Rants

I have known Roy for over 20 years. I love to kid him that he reminds me of the character that Mel Gibson played in Conspiracy Theory.

But Roy thinks clearly and understands how medicine works. Yesterday’s post is brilliant – Fool Me Once, Shame on You, Fool Me Twice, Shame on Me: Drup Reps’ Gifts and Fake Friendships

One commenter tried to shift the blame to physicians. I assume that commenter is accusing us of being weak. Really the problem stems from us generally being geeks who do not understand influence theory.

Please read Roy’s article – his message is very important.

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Comments (2)

This may not pertain to the post at hand, but I have something to say. I have a great deal of respect for the medical profession, partly because so many family members are, or have been, doctors and nurses. So, I hesitate to tell my tale.

My 87-y-o mother (non-smoker) had the best insurance ever, so the cost of health care was not an issue. She had survived a bout of vulvar cancer several years ago. Then last year, on a chest x-ray taken after a heart attack, they found a small tumor in her right lung which later tested to be benign using “3 good samples.” The surgeon ordered a follow-up in one month with her GP, which was never done. Because the biopsy results were benign, none of us thought of cancer when the pain in her back developed, not even when she said the pain was severe. We thought she must have a pulled muscle. They gave her pain meds, which did nothing. She lost her appetite and became breathless from shuffling a few feet, experienced numbness in her right side and became very weak. She was labeled as “unmotivated” when she was told to walk more and couldn’t. I think her doctors hated to see her after a while. She even reluctantly agreed to go into a nursing home for two weeks of rehab so she could return to independent living.

This went on from April ’til August. The pain became increasingly severe and her legs gave out. FINALLY!, her GP ordered an MRI, which showed that the once small tumor was now large. It extended to her spine and was compressing nerves. We also learned that the lung wasn’t the primary site.

She lived just 44 days after the diagnosis.

Most of the doctors I know are wonderful, compassionate people. But the ones who are not are dreadful.

I don’t believe for a minute that had her doctors, including an oncologist, diagnosed her cancer sooner that she would have lived any longer.

However, she needn’t have suffered the way she did, both physically and emotionally, thinking the pain was somehow her responsibility because she didn’t walk enough. Her last few months could have been easier had her doctors, especially the GP, listened to her like a person instead of dismissing her as “elderly.”

At my institution [insert large academic medical center here] the powers that be have completely banned drug reps from the floors of the hospitals and from providing any samples or gifts both in the hospital and in the outpatient setting. In the hospital this is not necessarily a bad thing. Reps provided great lunches, but their samples and gifts did not affect whether or not patients got treated. In the hospital, a drug rep’s spiel may have affected which drug was administered (though it shouldn’t), but the hospital’s pharmaceutical inventory was unaffected, and the physician was always able to chose from the full formulary.

In contrast, at the outpatient offices, many physicians depended on a sample inventory to provide under-insured patients with short courses of treatment (i.e. 3-6 months of Plavix (clopridogrel) status post stent placement). Many physicians now find that they pick their drug of choice for a patient based not on the latest protocol and most highly regarded randomized controlled studies (aka evidence based medicine) but rather on a patients’ insurance. The drugs that are approved on formulary with lesser insurance are not the best drugs, they are the older, cheaper drugs.

During my clinical rotations I rotated through 2 outpatient primary care offices and 1 outpatient oncology office. 2 of these offices were affiliated with my academic center and therefore had no samples. I saw chemo patients who had to take Compazine (prochlorperazine) when Zofran (ondansetron hydrochloride) was undoubtedly the drug of choice, and I saw well controlled clinically depressed patients switched from Wellbutrin (bupropion) to generic Prozac (fluoxetine) because they could no longer afford to pay for their medication. In the unaffiliated office physicians I occasionally saw physicians prescribe drugs because there were samples in stock, but the drug was always appropriate and in many cases equivalent to other drugs in the same class. A free 10 day course of antibiotics guaranteed treatment.

Academic institutions need to strike a balance and trust physicians to do their job. I agreed that gifts cross the line, but a free lunch accompanied by a mini lecture on efficacy and same samples provides more benefit than harm. I have heard through the grapevine that re-allowing drug rep lunches, at least at outpatient sites is being reconsidered, we’ll have to wait and see.

Med-Source

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