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DOCTORS, DOLLARS & DRUGS

This article was taken from the DALLAS TIMES HERALD

Sunday, December 24,1989

By Robin Lichtenstein from Newhouse News Service

 

DOCTORS, DOLLARS & DRUGS

Is your physician helping the medical industry `push’ pills?

For most people, the idea of pushing drugs conjures visions

of criminals hunkering over piles of cash and illegal white,

powdery substances.

But drug pushing – the legal kind – happens every day in a

medical world that’s invisible to patients.

It happens in virtually every doctors’ office through face-

to-face meetings with gift-bearing drug salespeople, during

company-sponsored seminars held in vacation resorts and hotel

conference centers, and whenever a physician opens a medical

journal to page after page of colorful ads espousing the virtues

of prescription medication.

“It’s third-party marketing” to a middleman – the doctor –

whose prescribing behavior helps determine company profits,

according to a drug company salesman who requested anonymity.

“It’s not like getting [a consumer] to sign on the dotted line.”

Industry spokespeople and some doctors say that marketing

efforts generally result in a better-informed physician who is

better able to care for his or her patients.

Other doctors call third-party, or indirect, marketing a

waste of time and money.

Drug industry critics have produced some evidence suggesting

that drug marketing has combined with other factors to prompt

doctors into sometimes prescribing useless or harmful drugs.

Doctors also can be influenced be patient requests for certain

drugs, research suggests.

Ideally, a doctor prescribes a drug because the scientific

evidence shows it will help the patient. To what extent

prescribing decisions are based on science and to what extent on

marketing are issues of considerable debate.

 

And, with the average prescription cost at about $17.00,

according to a 1988 survey of 1,850 pharmacies nationwide, many

people are asking whether drug companies ought to devote some of

its marketing budget to reducing drug prices.

Robert Wood Johnson Clinical Scholar Dr. Michael S. Wilkes

of the University of California-Los Angeles estimates that drug

companies spent more than $2 billion on indirect marketing on the

country’s 479,000 doctors in 1988.

While in medical school, students on tight budgets are

frequently invited to lunches or dinners sponsored by drug

companies. Many received their first stethoscope, neurological

hammer, penlight and doctor’s black bag from a drug firm.

According to a 1982 study of 85 Boston area physicians,

however, marketing may have a much stronger influence on doctors’

prescribing behavior than doctors realize or admit.

The study, by Dr. Jerry Avorn of the Department of Social

Medicine and Health Policy at Harvard Medical School, found that

the vast majority of doctors surveyed said drug ads and marketing

efforts were “minimally important” factors influencing their

prescribing habits.

The majority also believed that two heavily advertised drugs,

vasodilators and propoxyphene analgesics (such as Darvon), were

effective treatments for senile dementia and certain kinds of

pain, respectively. Meanwhile, “the clinical literature

overwhelmingly indicates that they are not useful for these

indications,” Avorn and his colleagues wrote in the American

Journal of Medicine.

The most controversial way companies market to doctors is by

sponsoring or underwriting medical education seminars, many of

which offer continuing medical education credits, or CMECs.

Doctors need a certain number of CMECs to maintain their licenses.

Occasionally, the seminars are held in enticing locales such

as Florida or in Colorado during ski season. Wealthier drug

companies may cover air fare and accommodations for doctors whom

they perceive to be opinion leaders in their local medical

communities.

In addition to sponsoring seminars and buying advertisements

in medical journals, drug firms hire armies of sales

representatives, also known as “detail personnel,” to conduct

face-to-face sales pitches with any doctor who will listen to

them.

Nearly every doctor’s office sports an array of desk-top

items bearing a drug name or company logo. Personalized

prescription pads, pens and paperweights and other “reminder

items” all come from detail people, doctors say. In addition to

the perks, detail people leave behind medical literature, free

drug samples and patient-educational leaflets.

One potential way to neutralize biased sales pitches is

“academic detailing,” according to Avorn’s research. In academic

detailing, a doctor learns about drugs from a university-based

expert with no allegiance to a drug company. These one-on-one

meetings in the doctor’s office are even more effective when

supplemented by “unadvertisements,” which point out a medication’s

adverse side effects as prominently as its benefits, research

suggests.

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I would suggest two good books to read that give an excellent

perspective view on this subject of drug companies and the medical

profession.

1. Murder by Injection; by Eustace Mullins written in 1988

2. 100,000,000 Guinea Pigs, written in the 1930’s

Submitted by Ronald Barker

Vangard Sciences