Monthly Archives: April 2007

I’m stuck on this issue because it’s so pervasive and there has been a number of media and medical studies recently published that show the inappropriate relationship between physicians and drug companies.

The following is from the Washington Post article cited above:

“A quarter receive honoraria or some form of payment for their services, and that was much higher than we expected.”

“Drug companies also purchase prescription records from pharmacies and, with the help of an American Medical Association database, identify individual physicians’ prescribing patterns and rank doctors based on how many prescriptions they write, the authors wrote.

The tactics work. Another study in PLoS Medicine last week found that visits by detailers prompted nearly half of 97 physicians to increase prescriptions of gabapentin, a drug approved to treat seizures.”

It’s fascinating to watch the pie of health care expenditures enlarge and observe the various players working to get a bigger slice. Drug companies are really amazing at this, charging confiscatory prices (as much as $30,000-$60,000/Year) for new drugs and mobilizing an amazingly effective sales force.

Physicians seem to play the mundane role of tools in the game. Finding their percent share of the pie, represented as fees for service, declining, they work on other sources of funding and sell their services to PHARMA. Not an edifying picture of the profession.

The New England Journal of Medicine has an article this week on the relationship between PHARMA (the drug industry) and physicians. The article notes (its available on-line):

” Most physicians (94%) reported some type of relationship with the pharmaceutical industry, and most of these relationships involved receiving food in the workplace (83%) or receiving drug samples (78%). More than one third of the respondents (35%) received reimbursement for costs associated with professional meetings or continuing medical education, and more than one quarter (28%) received payments for consulting, giving lectures, or enrolling patients in trials. Cardiologists were more than twice as likely as family practitioners to receive payments. Family practitioners met more frequently with industry representatives than did physicians in other specialties, and physicians in solo, two-person, or group practices met more frequently with industry representatives than did physicians practicing in hospitals and clinics.^“

These companies don’t give away money for nothing.

I see parallels between the student loan scandal and standard practice in medical office.

“numerous college aid offices have been caught conspiring with lenders to carve out sweetheart deals that benefit everybody but the students

The shady practices include fees to colleges to put lenders on their “preferred” lists; trips and other perks for financial aid officers; and valuable stock benefits for college aid directors.”

In medicine, physicians and researchers receive fees, trips, consultant contracts, salaries, stock benefits and other gifts from drug companies and other vendors. These gifts seem designed to influence the physician’s choice of treatment or procedure. If you will, the company wants it’s drug on the physician’s “preferred” list.

While it’s not clear how effectively these emollients subvert physician’s decisions, the companies continue to spend billions of dollars on this type marketing.   There is, as in the student loan scandal, the damning appearance of a conflict of interest .

The non-news of the day. This issue was generated by anti-abortion types who started what can only be called a rumor about an association of cancer and pregnancy termination. The issue is difficult to analyze because of the high rate of 1st term abortion (spontaneous and other) and the long lag time between supposed events and disease development. This appears to be a definitive study on the subject–there is no risk of breast cancer from pregnancy termination.

However, what has been long known known about breast cancer and sexual activity is that nuns have a higher rate of the disease.

Bad week for Hormone Replacement therapy–here and here. What does this say about all the studies in the past showing little risk–almost all drug company sponsored.

Do you think this financial disparity has anything to do with our ineffective health care system?

“According to the U.S. Census, black households in 2005 had a median income of $30,858, compared with $50,784 for non-Hispanic white households. The black poverty rate was 24.9 percent. The white poverty rate was 8.3 percent.”

The answer is obvious as is the need for a systematic approach to health insurance.