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Wednesday, June 12, 2002The Polyclinic's decision, rare among clinics, startled drug-company officials. They warned of a chilling effect on the flow of free drug samples and educational programs aimed at doctors. And the American Medical Association's ethics-committee chairman said such fees may violate ethical guidelines for doctors. The Polyclinic's medical director, Dr. Richard Clarfeld, said the value of information provided by drug salespeople has been outweighed by the disruption they cause and their promotion of expensive drugs, which undermines the clinic's effort to promote lower-cost alternatives to its doctors. Drug-industry officials disagreed: "Physicians receive important information about new medicines and their characteristics, including potential side effects, from technically trained sales representatives," said Jeff Trewhitt, spokesman for PhRMA, a drug-manufacturers trade group.(actually, a lobbying group) These drug companies are constatnly overstating the value of the information they provide to doctors. It is without exception biased and unreliable. Any doctor who actually relies on them to learn about a new drug is a fool. Some companies say they won't be visiting the doctors anymore (which is probably what the doctors are hoping), but others are eager to beat down their door: One saleswoman showed up at the Polyclinic yesterday with both her checkbook and credit card, unsure how to buy some face time with those who hold the prescription pad - but sure she needed to get inside. The doctors are coming under criticism for charging for the drug rep visits, and rightfully so: Another Northwest pharmaceutical executive, who requested anonymity, predicted that drug firms will be afraid not to pay entry fees. That's because if they abandon a clinic, their competitors may be better able to sway doctors' prescribing habits. The executive said he believes the Polyclinic made the decision to boost its cash flow rather than to ban sales reps. But the Polyclinic's David said the clinic will likely bring in only about $3,000 a month from the fees... ...For the American Medical Association, the interactions between drug-company representatives and doctors have been a focus of attention for some time. Recently, the Council on Ethical and Judicial Affairs updated its policies to clarify the problems with payments by drug-company representatives. Dr. Frank Riddick, chairman of the ethics committee, boils it down: Doctors shouldn't take money, directly or indirectly, to be "educated" by drug reps, nor should they accept gifts. Fees paid to doctors should be for professional services, he said, and drug-company visits don't qualify. "Either way you slice it, it's in violation of the existing rules on the interaction," he said. "Our decision was: Physicians shouldn't be paid to educate themselves, and if it's not education, then it's a gift." Riddick emphasized that the AMA's guidelines are voluntary, and meant to apply to doctors. When it comes to a clinic's decision to charge for time, "then it's not all that clear what we've said," Riddick said. "It's somewhat murky. However, by extension, if one doctor can't do it, then 80 doctors shouldn't do it." A practicing endocrinologist in a 500-physician group in New Orleans, Riddick said he worries about the role of money in the relationship between doctors and drug companies. "The clinic has a right to make certain business decisions. If they find they're overrun with pharmaceutical reps and patients can't get in, then they have a right to limit hours, or the number. ... I'm not sure I would choose a cash payment," he said. "If money's changing hands, then the money may create a conflict of interest in making the right decision. That's the real reason we put those little rules out there." The doctors say they chose to charge the drug reps rather than ban them because they still want to get free samples. The free samples are a powerful carrot for doctors, more so than the little gifts of food and paraphenalia. Doctors rely on them to help out their indigent patients who can't afford drugs. For a long time, this was my sole reason for continuing to see drug reps. However, the samples they provide aren't all that useful. They are invariably the newer, more expensive drugs; drugs that are not necessarily the best choice for what ails the patient. For example, strep throat is still best treated with penicillin, which you can get for less than ten dollars. But a doctor with a sample closet and a patient with no insurance is too often tempted to treat it with Zithromax or Cipro instead because that's what they have in the closet. This may seem to be no big deal, but it is. Overuse of antibiotics like Zithromax and Cipro can foster antibiotic resistance in other bacteria in the body, making future infections more difficult to treat. Since I've stopped seeing the salespeople, I no longer have a sample closet, and I really don't miss it. My patients weren't being served well by it in the long run. My advice to doctors everywhere: Ban the reps! Get your information from credible sources, like The Medical Letter. ADDENDUM: What it really feels like to listen to a drug rep. Pharmaceutical Pique Part II: The other story of drug company sales tactics regards the annoying letters they send to doctors and patients: "Patient education" letters from pharmacies that advise consumers to refill a prescription or change to another medication are drawing attacks from drug industry critics who say the letters may undermine patient care, inflate the cost of treatment and violate privacy. As the fine print sometimes acknowledges, many of the letters are funded by drug companies, which stand to gain if patients comply.... ...The letters in question range from the comparatively benign - like those reminding patients to refill a prescription for a chronic condition like high blood pressure or heartburn - to more potentially jarring and pernicious notifications that a prescription has been changed by the pharmacy without any doctor-patient consultation. Somewhere in between are commercial pronouncements promoting a new-generation drug, a different brand or a less expensive generic... ....One letter from Walgreens informs patients that the pharmacy has been in touch with their physician, who has already approved a switch from one prescription to another -- in this case, from the brand name Synthroid to the generic levoxyl -- leaving the patient out of the loop. Unless the patient phones his doctor to discuss the matter, he won't know if his medical history was considered in approving the change. "We sent this - it was not funded by a drug company - just to let patients know [cheaper] levoxyl could be substituted for Synthroid," said Walgreens spokesman Carol Hively. That it not only could be but was substituted in this case, she said, "doesn't seem shocking to us. Pharmacists communicate so much with doctors about patients and their medicines. There was no intent to leave out the patient." She declined to say whether most patients accepted the switch. While such a switch might save money for many customers - both cash-paying and insured - the pharmacy may make out too, since profit margins can be higher on generic drugs. David Pearle, a professor of medicine and pharmacology at Georgetown University Hospital, said that a pharmacist may not even call the physician in such cases. The contact about the switch would come via a pharmacy form letter; if the physician doesn't respond, a more strongly worded form letter might follow.... This is exactly what happens. The letters sent to physicians are couched in such a way that they fool them into thinking the change of medicine is mandated by the patient's insurance company formulary. You really do have to read the very very fine print to see that it isn't. I was once fooled by this, but a patient complained and I finally read the fine print. If it's obviously a pharmceutical gimmick, I shred it. If I'm not sure, I call the patient. This, of course, has increased my paperwork time, something that I resent deeply. The worst part of all of this, however, is how the drug companies and pharmacies try to paint the whole thing as "patient education" rather than the profit seeking it is: Schumer's complaint refers to the pharmacy letters as "marketing campaigns disguised as patient education campaigns." But NACDS's Wright rejected that idea. "Patient compliance programs are treatment programs that save lives, not marketing programs," she said. "Drug companies pay for the programs so that patients won't have to." Oh, please. Pharmacies send the letters so patients will be more likely to return to them for refills and in an attempt to get them to buy drugs that are more profitable for the pharmacy. Pharmaceutical companies send them to get the patient to switch to their drug. There is no motivation to "educate the patient." In the past two weeks I have had a flurry of phone calls from patients who are requesting changes from Claritin to Clarinex, which are essentially the same drug, that have been spurred by just such a letter. Such tactics are deplorable, and I applaud Senator Schumer for taking action on the issue. Pharmaceutical Pique Part III: Opensecrets has more on prescription drugs and politics. posted by Sydney on 6/12/2002 07:39:00 AM 0 comments 0 Comments: |
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