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Thinking through pharma bans

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In theory, no thoughtful person would object to the idea of keeping physician decision-making independent, particularly where costly drugs are concerned. No one, including the doctors themselves, benefits if physicians are making decisions that drive up the cost of care unnecessarily.

That being said, many doctors have written to us here at FierceHealthcare to say that they don't support pharmaceutical industry gift or sample bans. Are they just naïve as to how such gifts affect their judgment? Not necessarily. I'd argue that their position deserves more of a hearing. As some readers may notice, I haven't been gentle to the pharmas in this newsletter, but at this point, I'd argue it's time to take a deep breath.

From my editor's chair, I learn a lot about the ongoing efforts to push drugmaker influence out of the care process. My sense is that some are carefully targeted and others are more a matter of bowing to popular opinion. I'm not visiting all of these campuses, so I couldn't go as far as to say gift, sample and drug rep restrictions weren't thought through, but my instinct is that there are a lot of politics involved.

At minimum, it seems to me that we in the industry ought to take care to look at the varied relationships pharmaceutical companies have with doctors on a case-by-case basis. Continuing Medical Education grants deserve a different level of scrutiny than vendor clocks and Kleenex dispensers, and free samples can't be lumped in with prescriber data-driven marketing efforts. Of course, practices and facilities should consider all of these channels, but it's important to distinguish between them. And my gut feeling is that disreputable pharma practices are being lumped in with lesser issues.

I'll readily admit that I'm probably missing some of the nuances here. I'm not suggesting that, say, Henry Ford Health System went to the trouble of banning unscheduled rep visits and pharma perks completely--even setting up a system to monitor them--without having in-depth discussions on the subject. But I am suggesting that the industry, as a whole, may be on the wrong side of one of those pendulum swings where the real facts regarding pharma influence (some of which are appalling) may be obscured by rhetoric.

By all means, let's be zealous in helping doctors avoid undue outside influences. But let's also treat them like adults. - Anne

Comments

Thanks Anne. As a CME coordinator in NYC, I agree. Physicians are one of the most intelligent people we have in healthcare, I do think we need to have barriers in place such as ACCME and FDA regulations but let's just please give our providers more credit.

Anne: I agree that the dinners, trips and cash are completely unnecessary and are harmful to physicians' decision making abilities. I have been to a couple of doctors recently and have seen drug reps "drop in" to woo the staff with lunches, pretty talk, etc. But free drug samples can be a boon to doctors to help poorer patients. We just have to draw the line somewhere.
Andrea Georgi

The detailmen now have robots that can add and subtract.

To Andrea Georgi, how many people are YOU able to "woo" with chinese food for lunch? Please let stop insulting people's intelligence... doctors, patients, et al.

I think that pharma has received enough scrutiny over the past few years. It has cleaned up quite a bit, and at this point, provides great resources to physicians and the medical community in the form of CME opportunities, samples, etc. We need to take a much harder look at the insurance companies who actually ask doctors directly to prescribe off-label medications just to save money.

I have been a Pharmaceutical Sales Representative for over 20 years and with in this time I do not believe any Physician worth his/her weight in salt would write a prescription in order to have a free salami sandwich.
As a Representative we have very little time to see the Physician and normally lunch is the best time for the Doctor. This way you do not stop the Physicians day by waiting and speaking with him/her.
With the changing times, Physicians must see twice as many patients a day in order to make a living. This means very little time for the Representative. This also means very little time for the Physician to keep him/herself up-dated on the latest treatments, indications, side effects or just the patient type for a specific drug.
We as Pharmaceutical Sales Representative are highly educated being tested three to four times a month. We are all required to get a 90 or above on the test or we lose our jobs. We all take are jobs very seriously knowing that their is a patient behind every medication that we promote. As a Representative, we are responisble to give the exact information on the medication including side effects and warnings.
Many times I have been in a situation where the Physician might not be aware of the fact that a drug that he is prescribing for a patient might be highly protein bound thus meaning drug to drug interactions. I am expected to educate the Physician in a fair and consise manor.
Personally I would rather my own Mother see a Physician who has taken the time out of his/her day to make sure that he/she has all the correct information daily in order to make the best decision for his/her patient.
Reading articles in the paper about Pharmaceutical Representatives being a glorified waitress with free food is insulting to all of the Medical Sales Professionals who study day in and day out to help educate our Physicians.
As for the free samples, why would this ever be a negitive? I would like the person who believes that samples should no longer be given to Physicians from Pharma Representatives to sit in a Physicians office or go to a Pharmacy to see the elderly/Medicare patients who have to pay too much for a prescription due to the " Great Donut Hole" That our government gave to the most vulnerable of patients.
Perhaps someone should spend a day with a Territory Sales Representative before deciding how worthless it is for us to even see a Physician.
I hope that your family Physician is one who see's the need for the Pharmaceutical Sales Representatives. At least you will know that they are up to date on each and all medications.
Sincerely,

A Pharacuetical Sales Representative who brings in a lot more then bagels!

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