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That was the most ANNOYING post I have ever read. And I think I AGREE with the GUY.
Nicely done!!!Panda Bear said:Hi. Welcome to this months Morbidity and Conference. The first patient is a long-running thread....yes...you in the back....do you have a question?
Uh...uh....yeah...sure....
Yes, threads like this do suck up a lot of MICU resources and it is true that in Europe they would never take a thread so far. I like to think of this, however, as a testament to the drive of the thread's spirit to live.
Oh, I just want to mention that Marlo from Glaxo provided the lunch today.
Panda Bear said:Hi. Welcome to this months Morbidity and Conference. The first patient is a long-running thread....yes...you in the back....do you have a question?
Uh...uh....yeah...sure....
Yes, threads like this do suck up a lot of MICU resources and it is true that in Europe they would never take a thread so far. I like to think of this, however, as a testament to the drive of the thread's spirit to live.
Oh, I just want to mention that Marlo from Glaxo provided the lunch today.
tibor75 said:actually your "insight" (to use that term loosely) is what kept this thread going with 3 consecutive posts.
I love message board idiots who complain about a thread and are actually one of the lead players in it continuing. Comical.
Panda Bear said:Tibor75, I've been gentle with you because I can tell that you have a stick so far up your ass that everything tastes, well, "sticky."
Do they have humor in your country?
tibor75 said:So you assume I am not American because you don't agree with what I say?
Ah, racist message board idiots...even funnier.
tibor75 said:So you assume I am not American because you don't agree with what I say?
Ah, racist message board idiots...even funnier.
You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts. Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.dksamp said:You got a senior cardiology fellow (NOT in private practice yet) on this quixotic crusade who feels the need to cast aspersions, stereotype, and essentially calling anyone of us who accept any gifts/dinners as brainwashed drug rep ******.
There is no need to shout. Just as I have said pharm and device reps aren't bad people, the people that associate with them aren't inherently bad either. I think they are making poor decisions, but I am not directly saying anyone is behaving out of malice toward their patients. Relax. Try to have a discussion without getting too emotional.dksamp said:I fully understand the need to be a patient advocate first, as I AM ONE EVERY DAY. DONT EVER ASSUME that those of us who accept pharm company gifts AND go to the free dinners are not. Remember what they say about ass-u-me (ing) things.
Again, be careful with your assumptions. You don't know anything about me, so no need to make the discussion personal. Discuss facts which you have a clue about and stay on point, otherwise you have NO credibility, regardless of being in private practice or not.dksamp said:Even though you are a senior fellow, YOU ARE STILL a TRAINIEE
How many of the studies that I referenced in my talk are you referring to? I know the data I used as references may not be perfect (no research is), but the basic principles behind that research are valid and each study has some merit worth considering. Instead of throwing broad statements out about the studies, be specific so we can get something constructive out of this discussion.dksamp said:Your quoted research is EXTREMELY FLAWED, BIASED, and FULL OF HOLES.
At least we agree on something. I mentioned this reference in my talk and also earlier in this thread. I imagine most schools, for the med students, have free on-line access to this, so all should take a look.dksamp said:So what reference I use to determine which meds are good?? THE MEDICAL LETTER.
Again, I find your personal attacks amusing. You list a number of important issues, but I am curious what you have done to try to improve any of those areas. In my mind, this is an important issue which needs our attention.dksamp said:I will echo points made by some of my good colleagues here. In the world of private practice, there are WAYYYYY bigger issues that people have to deal with. For you to be crusading on this nonsensical issue shows your lack of real priorities.
tibor75 said:I love it when ignorant doctorbs make this argument. Just like if a ballplayer said, "Well, I take steroids, but I could still be a great home run hitter without them"
Comical.
NoPDM said:You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine. Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts. Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.
There is no need to shout. Just as I have said pharm and device reps aren't bad people, the people that associate with them aren't inherently bad either. I think they are making poor decisions, but I am not directly saying anyone is behaving out of malice toward their patients. Relax. Try to have a discussion without getting too emotional.
Again, be careful with your assumptions. You don't know anything about me, so no need to make the discussion personal. Discuss facts which you have a clue about and stay on point, otherwise you have NO credibility, regardless of being in private practice or not.
How many of the studies that I referenced in my talk are you referring to? I know the data I used as references may not be perfect (no research is), but the basic principles behind that research are valid and each study has some merit worth considering. Instead of throwing broad statements out about the studies, be specific so we can get something constructive out of this discussion.
At least we agree on something. I mentioned this reference in my talk and also earlier in this thread. I imagine most schools, for the med students, have free on-line access to this, so all should take a look.
Again, I find your personal attacks amusing. You list a number of important issues, but I am curious what you have done to try to improve any of those areas. In my mind, this is an important issue which needs our attention.
Listen, the bottom line that I have been trying to stress in this thread is that pharm and device companies throw billions of dollars at us not out of charity, but to influence what we do. It works, so they keep throwing money at us. Plain and simple. Do you really think they'd spend that kind of money without a clear ROI? Of course not. Their shareholders would eat them alive.
zinjanthropus said:why would you ban sales reps? they perform a necessary function? device reps work closely with surgeons and work hard to develop new and useful products. i will take my free lunch and will happily continue participating in an industry that has enough profit to drive research and product innovation, thus making the lives' of physicians and, ultimately in some cases, patients, a little bit easier.
tibor75 said:Their profits drive research?
well, crappy research I guess....
Qtip96 said:that being said, i do think that pharm reps should have minimal interactions with us in training, so as not to influence our prescribing practices during these impressionable years. it's a pity too, 'cause this is when i'd most appreciate a free meal!
when we're done and in the open market, ahem, real world... everything is fair game!
Qtip96 said:tibor, dude, i just love reading your posts...
just the right combination of judgmental and stupid.
why don't we look at the "crappy research" in your field, tibor... cardiology isn't it?
hmmmm, that's a hard one. . your entire specialty is like WAY dirty.
why don't we try ALL the drug-eluting stent trials (Cordis and Boston Sci)
and like MOST of the statin trials, like PROVE-IT (BristolMS), TNT (Pfizer), etc.
and like ALL the ICD trials, like MADIT, MADIT2, COMPANION (Guidant), etc.
and like ALL the plavix trials, like CURE, CREDO (Sanofi)
the list goes on and on...
and i'm just gettin' warmed up, baby!!!
the products in these "crappy" studies save lives.
don't they teach you guys to read at upittsburgh cards?
perhaps i should just finish this post in the way you usually do...
"i just love {some insult like message board idiots, minions, etc}"
theatrical pause...
then the one word silly whammo, like "Comical." "Funnier." or "Pathetic."
tibor75 said:Wow, you mentioned 10 studies. Do you know how many are published on a monthy basis? Maybe if you actually read the journals and saw the amount of biased and crappy studies that are done (Statins are Antiarrythmic based on a ****ty retrospective study with 2 unequal arms), you'd realize the amount of money these companies waste and why they rip off hte american consumer with sky high prices.
I am a fellow who believes we need to work hard to remove drug and device manufacturers from hospitals and clinics, especially at academic medical centers. Feel free to view the talk I recently gave, which I have stored as a PowerPoint presentation here: No PDM Reps. I'm curious what you think and what you are exposed to.
Doctors and Big Pharma are not on the same side.
Completely anonymoussite. No name on the site, no one taking responsibility, but making astounding claims that being "no free lunch certified" in the not so distant furure "will be as prestigious as 'Board Certified' as an indicator of quality."
Hmmm...no one on this web site has the jubbers to put his/her name on it. Instead, an anonymous email address, a NYC PO Box.
but...
Web site is registered to a Chicago hosting company and by doing a bit of "digging" and a check of the friendly neighborhood DNS servers we find that it belongs to one Robert Goodman of NYC. The domain registrar lists a six (6) digit phone number for both voice and fax and the same PO Box. Didn't know NYC had 6 digit phone numbers. So, no way to figure out just who Bobby is that way.
So, doing a google for Bobby comes up with a long list of Robert Goodmans, but of the longish list, one in NYC comes to light. One and the same? who knows? pure speculation since we can't cross check addresses or phone numbers. Clever...verrry clever.
I do like its "Drug Free Practitioners" listing concept. Just say no to prescriptions! Then we can use a gamma knife which ain't cheap neither. (and perhaps more lucrative than the clinac SRS?)
Why don't you spend some of your free time trying to educate yourself about this issue instead of trying to pretend there is a controversy behind NoFreeLunch.
He's actually a pretty nice guy and is putting his time behind what he believes in. Can you say you put your time into a cause that you believe in? Also, I'm not sure why you are trying to act like a super-sleuth. You want a cookie because you can find out who registered a site?! I think my 2 year old can probably do it too...and she wouldn't act like she was something special for having done it. Bob's a nice guy and doesn't hide his name at all. Sending him an email gets a rapid reply with his name in it, so he's certainly not hiding. Why don't you spend some of your free time trying to educate yourself about this issue instead of trying to pretend there is a controversy behind NoFreeLunch.
Ok I know I am SOOOOOO on the LATE BOAT with my response. Been very busy lately. I thought that this thread would die a natural death. However it just keeps coming back. So in the spirit of beating a dead horse, and LATE on top of that, I will respond to NOPDMs response to me.
First people have been speculating who is exactly is this NOPDM guy. From his postings, he says he is a senior cardio fellow at Pitt. When I challenged him on his lack of real-world private practice experience to be making such a wild generalization about physicians and their practice patterns, he replied as follows:
You make a point of spelling out Ass-U-Me, yet you're equally at fault. First, how many years do you think I was in private practice before deciding to come back to cardiology? You don't have a clue, do you. You seem to be forgetting there are many non-traditional's in medicine.
This induced me to do a little detective work. Now I am TOTALLY GOING OUT ON A LIMB HERE AT RISK ON COMPLETELY FALLING ON MY ASS .And if I am wrong, and discussing the wrong person, then I will just apologize and shut up at this point before making a further fool of myself, however, IF I am NOT, read on .
To find out who this NOPDM is, I looked at the link provided to HIS powerpoint presentation:
http://www.pitt.edu/~jmf29/
That leads us to a senior card fellow at pitt with the initials J.M.F. Upon looking at the list of cards fellows, there is one who matches the initials JMF (one with a Greek surname). His listed background is as follows .
B.S. 1992
PhD 1998
MD - 2002
Now since I.M. is 3 years, that would have you finishing in 2005. Since Cards is 2 years, that would make you a senior right about now. Now I am no math genius, but I dont see any significant time gap that would leave room for independent private clinical practice. Moonlighting as a resident is not private practice. Working under the auspices of a PhD is NOT private clinical practice. Therefore I can assume that you have no private practice experience as a practicing physician YET.
Like I said, if I am talking about the wrong person, I will apologize and shut up and eat crow.
Second, why is private practice the ultimate goal? It's not, so be careful getting all high and mighty when you aren't sure of your facts.
Private clinical practice is NOT necessarily the be-all-and-end-all ultimate goal for everybody, however, it is where the MAJORITY of people leaving fellowships and residencies WIND UP. The majority do NOT wind up committed to academic medical centers. Private practice can take may forms:
-Group practice
-Solo practice
-Employed practice
-Hospital-based hospitalist practice (both hired and independent)
-Independent practitioner loosely affiliated with a university for teaching purposes (like myself)
Finally, why do you take my focus on negative influence by reps so personally? Are you feeling guilt for your decisions? I've never understood why people get so defensive when this topic comes up -- unless they're just feeling guilty.
I am not taking this personally, however, whenever I am subjected to left-wing-communistoid-AMSAesque drivel which is tamtamount to doctor-bashing, I WILL SPEAK OUT. I have ZERO guilt on my prescribing patterns, because I practice in the real world and not in the artificial bubble. I have already explained in the previous thread:
Where I practice is an urban area that is mostly managed care. The main driver for prescribing patters is the ALMIGHTY MANAGED CARE FORMULARY I repeat the ALMIGHTY MANAGED CARE FORMULARY. Drugs are TIERED, and the goal is to keep most of the meds at tier 1, and if you have to write a brand, pick one that is on tier 2. Tier 3 are to be avoided unless absolutely necessary because of their high cost. IRRESPECTIVE of what a drug rep does/says, THEY ARE NOT THE CLINICIAN AND MOST HAVE NO CLINICAL TRAINING, despite what they are taught to parrot from their seminars.
Most recently, furthering the skew/shift in the prescribing patterns of docs in my area and in other areas too was an unexpected source (drumroll .)
WALMART!!!...Yes, thats right you heard it .WALMART!!
Huh?? How can walmart exert any influence??
By the fact that they flat priced most of the common generics at $4.00, IRRESPECTIVE of whether you have insurance or not. So if you have an HMO and your tier 1 copay is 10.00, if you fill that generic at Walmart, YOU PAY $4.00
This makes a HUGE difference.
Here is their generics home page.
http://www.walmart.com/catalog/catalog.gsp?cat=546834&fromPageCatId=5431
Now Interaction with Pharm Reps IS important for the following reasons.
1-they give you a heads up on the newest things coming down the pike. Doesn't mean that you have to use/prescribe it.
2-they provide you with samples that help patients try something first (in those cases where the patient NEEDS a Brand) and you need to see if they react to the med well BEFORE paying that tier 2 copay on the med.
3-they provide valuable coupons and vouchers which can minimize and/or neutralize the cost to the patient in those cases where a brand is deemed necessary.
4-they provide the practitioner with information about programs that may benefit the patient. Remember, we are the patients advocate and as such should be aware of resources and programs out there that can benefit the patient. Just because something is sponsored by a pharm company, doesnt make it inherently bad.
Now where I am at, I do NOT see many lunches sponsored by reps. That is more in the university setting, because in the private world, offices are too busy and the doc is not always available. It is just not practical. Me personally, I am VERY PICKY eater and I wouldnt eat 90% of the stuff they bought anyway, so a sponsored lunch in my office would be COMPLETELY USELESS.
As for the dinners, they are of some use, because the dinners provide a venue for docs to get together who otherwise would NOT be getting together. You sit down, have a meal, chat and network. The lecture is there, and is usually a colleague known to the docs present or an outside speaker. Irrespective of what is said in the lecture, even though most of it is biased towards the drug, 90% of docs recognize that and go back to their usual prescribing patterns. Anybody who is THAT influenced is already weak-minded to begin with.
As for reps, I will gladly speak to them, especially if they are pretty ;-P. If I do not write their drug, I tell them upfront. If they never come back to my office, well, as we say in freemasonry So Mote It Be. I gotta do right by the patient and keep their costs down. I guess I am a PISS-POOR R.O.I. (Return on Investment)
Remember, it does not benefit ANYONE by locking people out. You get places in life by INTERACTING with people. Remember, we are ALL adults. We are NOT kids who need to be told who we can talk to. For a university to legislate whom people can talk to is downright FASCIST. NOPDM (J.M.F.) if your moral compass is that fragile/insecure that you feel that interacting with certain groups of people will skew your prescribing pattern, then YOURE the one with the problem.
I know I know I DEREK SAMPSON SERIOUSLY NEED TO GET A LIFE!!...LOL But hey, its Sunday, it is my day off, so in the spirit of tossing off a few hours of my free time, I decided to finally respond.
Now let this thread die a natural death I will GLADLY cosign the D.N.R.
and NOPDM, if I misidentified you, then I truly apologize and will gladly accept egg on my face.
PEACE!!
-Derek Sampson, MD
To you and everyone else who thinks these gifts have no influence on decision making, please answer a simple question: why do the pharm companies spend millions and millions of dollars on these gifts (which they categorize as marketing in their budgets) if the gifts have no effect?
Because it reminds us that IF we need that drug it IS available and it does make us aware of the touted differences as well as the legitimate differences to the old drugs when they give their presentations.
It also allows us to more easily say "no you don't need new and improved drug X just because you saw it on TV, here's why the cheaper, proven drug Y is still your best bet."
If an ink pen or a sandwich can persuade you to write a certian drug for a patient that gets no real benifit from it you have personal issues with honesty and integrity that have nothing to do with the drug rep.
let this stoopid thread die.. please
To you and everyone else who thinks these gifts have no influence on decision making, please answer a simple question: why do the pharm companies spend millions and millions of dollars on these gifts (which they categorize as marketing in their budgets) if the gifts have no effect?
yeah, a great way to let a thread die is to bring it back up saying "let it die"
Great logic.
I realize they give you updates, but I think the goal is to limit face time, because it is that exposure which affects our behavior. Why can't they send informational fliers to us? Oh, that's right, because we'd just trash them in our busy days.1-they give you a heads up on the newest things coming down the pike. Doesn't mean that you have to use/prescribe it.
I understand the individual benefit of using samples, but since you took the time to find the site I linked, hopefully you saw the negatives of samples. They may help an individual try a new drug for cost and/or side effect purposes and/or efficacy issues, the choice of drugs is far from perfect. They are usually only the latest and greatest as opposed to being alternative tried-and-trues. As you mention below, there are other models of free/cheap samples such as vouchers that can be pursued. A problem we have as docs is that patients feel good if they get something for free and like getting meds right away instead of having to go to the pharmacy. So, patients will also like the samples. It's an uphill fight, but I think the current sample system is in need of reform. Easy? Of course not. Worthwhile to consider? Yes.2-they provide you with samples that help patients try something first (in those cases where the patient NEEDS a Brand) and you need to see if they react to the med well BEFORE paying that tier 2 copay on the med.
This can/should be done without face time. The whole goal of the rep is to get face time with you. If you got something impersonal from the company (e.g. monthly or quarterly batch of coupons or vouchers), you wouldn't be as interested or motivated to talk to a rep.3-they provide valuable coupons and vouchers which can minimize and/or neutralize the cost to the patient in those cases where a brand is deemed necessary.
I agree that pharm money isn't all bad, but I think the link from dollar to specific company raises concerns of influence. The idea of companies pooling their money, such as in funding derm residency slots, is slightly better, because you can't link an individual dollar to a company. So, have the pharm companies pool their money and then use that pool to fund educational processes. The patient would still benefit, but the company is less likely to do it because they don't get as good of a return on their dollar. Naive? Possibly, but pharma is already showing they are willing to pursue some models of pooling money, so why not others?4-they provide the practitioner with information about programs that may benefit the patient. Remember, we are the patients advocate and as such should be aware of resources and programs out there that can benefit the patient. Just because something is sponsored by a pharm company, doesnt make it inherently bad.
In the private setting where I work, it's not uncommon to see the lonely rep sitting, waiting for a glimpse of the doc. Often the staff will even wander by to visit. You're right in that it's not a good setting to get face time compared to academic setting, but they still do get some time, which is better than none.Now where I am at, I do NOT see many lunches sponsored by reps. That is more in the university setting, because in the private world, offices are too busy and the doc is not always available. It is just not practical. Me personally, I am VERY PICKY eater and I wouldnt eat 90% of the stuff they bought anyway, so a sponsored lunch in my office would be COMPLETELY USELESS.
See, this is the problem. Docs are a very smart bunch and think only the other guy is influenced. It's our arrogance that the pharm companies play off of. Why did congress just pass lobby reform legislation about free lunches? Because it's clear free things affect choices in our government and buys influence. Why on earth would the doctor's office be different? Because we're smarter? Now that's naive.As for the dinners, they are of some use, because the dinners provide a venue for docs to get together who otherwise would NOT be getting together. You sit down, have a meal, chat and network. The lecture is there, and is usually a colleague known to the docs present or an outside speaker. Irrespective of what is said in the lecture, even though most of it is biased towards the drug, 90% of docs recognize that and go back to their usual prescribing patterns. Anybody who is THAT influenced is already weak-minded to begin with.
Agreed. Gifts buy an obligatory moment for you to say "thank you", so then they have you for a moment to talk about what they want.This doesn't make sense. They could provide all that information without the gifts. The question is why they provide the gifts, not why they market informationally to physicians.
It amazes me how often this comes up as a reply. I've been doing this long enough that this is one of the most common responses I hear. The studies I referenced in the talk have addressed this issue and suggest we are more often influenced than we realize. That's the whole point of why the companies interact with us. We aren't always aware of all the factors we use in making drug choice decisions.If an ink pen or a sandwich can persuade you to write a certian drug for a patient that gets no real benifit from it you have personal issues with honesty and integrity that have nothing to do with the drug rep.
I agree that these massive companies can, and should, market their products through whatever means they can. They need to make money for themselves and for their shareholders, otherwise they will collapse. Point blank. The problem is that we as physicians are in a unique position. As you have already mentioned in prior posts, we are our patients' advocates. We're not just deciding which drink we want with lunch, we're deciding what pill our patients' will take. We're making decisions for those that place implicit trust in us and that trust comes with responsibility. Do I think that writing with a Coreg pen will suddenly have me switching from atenolol? Of course not, but I think it's important for us to discuss that there are consequences to our interacting with pharm reps and we need to be aware of them. It just seems too often that some docs don't want to consider the possible effects of these interactions.Why?? because they CAN, and just because they CAN spend money, doesn't mean they have to do it in a logical manner. There is a LOT of marketing out there that doesn't make sense. Look at coke vs. pepsi. ZILLIONS are spent marketing coke and pepsi, yet people already have their preferences. (mine is diet pepsi), not because of a marketing ploy, but because I like the taste of pepsi better. Just because someone can market something doesn't mean it will be successfull.
A company can spend ALL THE MONEY THEY WANT...doesn't mean it will work, NOR does it have to make sense. Also, keep in mind that all the marketing people were trained under the old school of thought that said VISUAL EXPOSURE = SALES. Thats why you see pens, and notepads, and computer mouses with viagra. Remember, we are in a FREE ENTERPRISE Capitalistic economy...THIS IS NOT CUBA...Companies can spend their marketing dollars AS THEY WISH, no matter how illogical it is.
I realize they give you updates, but I think the goal is to limit face time, because it is that exposure which affects our behavior. Why can't they send informational fliers to us? Oh, that's right, because we'd just trash them in our busy days.
This doesn't make sense. They could provide all that information without the gifts. The question is why they provide the gifts, not why they market informationally to physicians.
At least you can wear something with pride on your coat that shows you put your money where your mouth is. All the rest of us get is our college alma mater's logo or a darn viagra pen. Congrats and thanks....the only "flair" on my white coat is a Marine Corps emblem.
We have been thru this and the studies you and others with your agenda cite are at best crappy. There havent been great studies done.
Gosh I hope I get a free lunch today. Also I do my best to only use pens given to me by pharma. After all since the hospital I work in doesnt provide free pens I feel I should use the pens given to me by pharma since they are free.