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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, June 29, 2007

    Influence: Congress wants to start a registry of drug company gifts to doctors. One Senator had the inside scoop:

    Senator Claire McCaskill mentioned that she had a brother who runs a restaurant.

    “And he said that the most lucrative part of his business was the private room that is used mostly by drug companies” to entertain doctors, said Ms. McCaskill, Democrat of Missouri. “He said that you wouldn’t believe how much expensive wine these guys buy.” The tab often totals thousands of dollars, she said later.

    Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, assured Ms. McCaskill that major drug makers no longer offer doctors expensive dinners. The industry’s code of ethics mandates that free meals be modest — pizza, for instance, Ms. Powell said.

    “I would, with all due respect, suggest that there has been a change in your brother’s restaurant in recent years,” she said.

    Ms. McCaskill pressed, “Are they allowed to buy alcohol?”

    Ms. Powell responded, “Our code does not go into that level of detail.”

    Do lobbyists buy senators' meals? Or are they limited to campaign financing? They can give them meals, though according to the Senator, Congress is thinking about putting a stop to that. Registries for both politicians and doctors and their respective lobbyists may not be a bad idea. I'm game if they are.

    The drug industry, of course, isn't so keen on the idea:

    Asked whether the drug industry would support a mandatory national registry of payments and gifts to doctors, Ms. Powell told the committee that similar state efforts had become enmeshed in difficult details — like deciding whether free drug samples should be classified as gifts.

    “There are those kinds of complexities that would make a registry very difficult,” she said.

    After the hearing, Ms. Powell’s trade association released a statement criticizing the state registries, saying they “disarm doctors by inhibiting access to critical scientific information about the benefits and risks of treatment options that help patients win their battle against disease.”

    Registries don't "disarm" doctors. They disarm the drug industry.

    But it isn't the wine and food and nice resort get-aways that are the real problem. It's this kind of influence that's the problem:

    Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.

    "Most of what doctors know about drugs comes from the industry, and that's not healthy," said Jerry Avorn, a Harvard Medical School professor and critic of the sponsorships. "Academic organizations lend their names to courses that are nothing more than infomercials."

    It has become very difficult to get good, reliable, independent information. Even when a doctor is able to find good information, he may find it difficult to apply to his practice if he's obligated to hold to a local community standard of practice. What if everyone else in the community has based their standard on the drug company lectures and lobbying?

    posted by Sydney on 6/29/2007 07:59:00 AM 2 comments


    Or myths. One myth I hear often is that in business free lunches, ball tickets, etc., and moving between reviewing information and working for a company are the norm. The truth is quite the opposite.

    The June 28th WSJ has two stories that show the fallacy of this myth. In one story a unit of Wells Fargo was fined $250,000 when a former analysis did not disclose they were going to work for a company they did a series of research reports about. One does not have to look far in the medical community to see doctors being paid to tout a medication at an educational seminar or other forum.

    The other story involves Hedge Funds' Gift Grabs. This highlights how the State of Massachusetts regulators are going after the practice of providing free ball tickets, breakfast, and Friday lunches, along with below market rents, receptionist and other perks to hedge funds who invest on behalf of a number of non-profits. An interesting quote is "... have a fiduciary responsibility to their customers to choose brokers based on cost and service." I would contend that doctors have this same responsibility in choosing, or advising, patients on health care choices, and free food does create a conflict.

    Myths abound in medicine, just as they do in any other field. We see where sun exposure and damage is not just for kids, but those who are retired have a greater need for sun block. A recent JAMA story highlights how they turned down studies for scientific reasons, only to see them in other publications. Patients, as well as doctors, need to be aware of the veracity of the information we are receiving, often it is not good.

    Steve Lucas

    By Anonymous Anonymous, at 9:34 AM  

    My sister works for a psychiatric practice as a clinical social worker. Drug reps are a constant presence at this practice and at least once a month take the entire staff out to dinner at an expensive restaurant where the wine flows freely.

    By Anonymous Anonymous, at 9:28 AM  

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