Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, July 11, 2008

You Want Evidence Based?

From the New York Times:
The pens, pads, mugs and other gifts that drug makers have long showered on doctors will be banned from pharmaceutical marketing campaigns under a voluntary guideline that the industry is expected to announce Thursday.
Medicine may still be struggling with the whole idea that one should be able to show that one's proposed interventions actually work, but there is another industry in this country that has evidence down to a science (if you'll pardon the expression.) This other group has extensive research to buttress every move it makes and every cent it spends. Missteps are rare. Of whom am I speaking? Advertising, of course; unless you want to call it Marketing.

I have no doubt in the world that the recent withdrawal of pens and mugs from the drug reps' goodie bags is nothing more than the result of a consultant's report that the return on that investment is not worth it. That same consultant probably then suggested that the announcement be couched in such a way as to present Pharma as the good guys. "See? We're not trying to buy prescriptions with cheap dreck like that anymore."

Cut me a break. They're still dishing out cash left and right: directly to doctors via "consultant fees," "speakers bureaus" and executive vacations disguised as educational meetings, not to mention direct-to-consumer advertising. That's where the ROI is.


At Fri Jul 11, 07:23:00 PM, Blogger Lynn Price said...

Holy goodie bag, Batman. We integrative healers have been doing it all wrong. We need to give all our doc buddies freebie Reiki treatments. Dino, sweetie, sit down and let me rest my hands on your melon.

At Fri Jul 11, 10:32:00 PM, Anonymous Anonymous said...

Oh, for pity's sake. What a crock of cathair. Have you ever written a script for anything because of a pad or a pen or a mug? Didn't think so. Me neither.

At Sat Jul 12, 12:59:00 AM, Blogger Doctor Ayche said...

Agreed. Those small freebies are such a tiny drop in the bucket. As a med student, I can manage at least four free meals a week on the pharmaceutical company dime. I can't prescribe anything for another several YEARS. Still, the money trickles down.

At Sat Jul 12, 02:54:00 AM, Blogger LicensedToILL said...

I have a friend of a friend who is a NP specializing in cardiology. She works for a cardiologist who does not take lunch breaks 3 days a week. Because on these 3 days he is giving speeches at luncheons for various pharmaceutical facets. He makes $3500 on a bad one hour lunch, 5K on a good one.

I bet they even pay for his drinks, too.
The MD is such a powerful degree. It speaks to certainty, to doctor knows best, to authority. It is as impressive as it is pimped out.

The best pimping of something sacred is when I see ads for say, a pill that magically makes your body stop storing fat and it is endorsed by, "John Hammerston, Medical Resident"
He looks like a doctor. He wears a white lab coat. There are lots of flashy monitors around him. Oh yeah, and that is a stethoscope hanging around his neck. The MD is certainty.

I do like the free Pollo Loco and the Papa JOhn's twice a week. Even the RN might be a potential ally.

At Sat Jul 12, 09:38:00 AM, Anonymous Anonymous said...

Sadly, I agree. I spent 10 years in the industry at various levels of sales and management. There is much more money in speaking engagements, lunches, etc.
Every move is calculated. The things I have seen, and sometimes done, would make your skin crawl.

At Sat Jul 12, 10:16:00 AM, Blogger OHN said...

They have to at least keep the pens coming. Nothing beats the look on a cashiers face than when I whip out my Viagra pen at the checkout line.

At Sat Jul 12, 11:09:00 PM, Anonymous Anonymous said...

$3500 for a speech at lunch? Where can an FP get a gig like that? Some MD degrees are more "powerful" than others.

At Sat Jul 12, 11:57:00 PM, Blogger LicensedToILL said...


The specialists seem to be reaping the rewards.

I think it's the media. Shows like "House", "ER", all that garbage. Make surgeons, even surgical residents, and specialists into heroic geniuses.
Why not have a heroic genius speak at your lunch for a couple grand?

"House" should dramatically show a GP adjusting a patients BP meds. Like in slow motion, with dramatic music, lots of crying. Beef up the ol' media image.

At Sun Jul 13, 02:47:00 PM, Anonymous Anonymous said...

I totally agree that specialists are overpaid compared to general practitioners. Or perhaps I should say that GP's are grossly underpaid because the money is going to the specialists. That's one of the biggest problems in US healthcare.

Some specialties are underpaid as well, which is unfair. There's no reason a pathologist diagnoses someone using a cell sample and a radiologist using a scan, and the radiologist gets 3x the money. Yeah, the radiologist volume is higher, but something needs to be done about reimbursements to make salaries more balanced between fields. Bless the GP's and those who go into lower-paying specialties for all the "right" reasons.

At Mon Jul 14, 12:39:00 PM, Anonymous Anonymous said...

Other then the obvious responses to the post which speaks to people who are not really involved in this area and strike me as sour grapes "Where can an FP get a gig like that?"

When are residency and fellowship programs going to teach physicians how to read clinical trial data, know the difference between effect size and p value. Physicians should know how to do a critical appraisal of the data and make decisions on prescribing or dx based on evidence and what is best for that patient, that condition, that side effect profile, and the best care. But that takes a lot of work and knowledge. Every year new guidelines come out and it takes work to stay current. (Consider strep throat and RX for antibiotics. All the guidelines say no antibiotics for strep, but look at what the vast majority of physicians are doing… writing like their lives depend on it. And not one pharma company is pushing this.)

There is little time in the day to keep up and most CME is being selected to accomplish one thing: just give me my credit so I can get my recertification without any work. And without forcing me to learn.

I agree there have been some real shady doings in pharma (i.e. Vioxx, TAP, etc.). But we are speaking as if physicians are victims and not the best and the brightest. If every physician took the time to learn EBM and understand what their patients were learning on TV from the ads pharma would be forced to do better. Pharma is an easy target. And if you talk to physicians the insurance companies make Pharma look like Pollyanna but of course those checks from Oxford, United, etc. help keep the silence going and shift the blame to the easy target. Learning is hard and you have to understand your learning needs and the needs of your patients... god forbid.

At Tue Jul 15, 02:18:00 PM, Anonymous Anonymous said...

In my community one could easily attend 3-4"educational meetings" a week! Great meal,great wine $100 stipend, some even bring their spouse "let's go out to dinner honey".
As noted above, the speaker gets the most money, but alas no time to eat! Can you box that up for me? Does it influence anyone? Well judging by the fact that the efforts continue, I would say yes

At Wed Jul 16, 07:03:00 AM, Anonymous Anonymous said...

Tom I have a question why do you go if the education is questionable given the limited time most physicians have? Wouldn't it be better if you were to seek our CME that helped you solved problems you are seeking solutions too?

At Wed Jul 16, 02:16:00 PM, Anonymous Anonymous said...

I don't attend-just pointing our that there is no shortage of folks who will.


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