Home Forums Discussions General Discussion Drug Reps Policy/Rant

I have been lurking on this board for some time, but haven?t really seen any discussions on sales representatives. It is to the point at our solo FP office that the front desk and MAs argue about who has to greet the reps when they come up to the reception window. We have a minimum of 6-7 representatives from drug companies, home health agencies, radiology centers, medical equipment vendors, and even reps from a large orthopedics practice walk through our front door EVERY DAY. We have accepted drug reps for the past 23 years, as we have grown from a 3 exam room, 2 staff limited-hours office to a 7 room, 8 staff full-time practice. In the last 4 years we have not had a single lunch with any drug or sales rep as we used to. I still speak with reps for 5-10 minutes at a time, but otherwise I instruct the employees to tell them we are too busy and that we are OK on samples. We also do not accept any gifts, whether food or little trinkets for the office staff. Some of the following practices irk me:

? The drug reps often state they need to see me sign their laptops for the samples and then try to rope you into a 10 minute sales pitch.

? They try to double team you ? they will either come with their supervisor, trainee, or sometimes 2-3 will come together from a single drug company pitching different products.

? They waste the time of the reception staff with pleasantries and personal questions as they try to butter them up. This is true of all the reps ? the drugs reps want to leave samples/speak with me, and all the other reps want our business or referrals.

? The worst is when 2 reps from competing companies come at the same time. They end up trying to one-up each other in terms of how close they are with us.

? When we remodeled and greatly enlarged our staff kitchen, multiple reps asked when they were going to have their lunch meeting, as if we renovated for THEM!

The reps are not evil, and we know they are just doing their job, but they are causing frustration and explicit opportunity cost. The office manager has been insisting for some time that we stop accepting ALL representatives. Her opinion is that the time our office spends with them is better spent on patient care. She states the benefit of the drug samples we receive for needy patients is heavily outweighed by the following:

- Almost all of the branded drugs require Prior Authorization from the insurance companies and almost all of them have a covered generic substitute.

-Even when we do have success with a needy or even affluent patient with a branded drug, when it comes time to pay the pharmacy, they request a more affordable alternative and we end up changing them to a generic. Some examples off the top of my head are Micardis or Edarbi vs Losartan and Crestor vs Simvastatin, Pravastatin, or Atorvastatin.

-A great deal of research time is required to properly evaluate the drug studies and assess the amount of biased information ? something very few of us even have time to do.

How does your office handle drug and other sales representatives? Do you have a sign stating no drug reps or solicitors allowed? Do you only allow them at certain times, on certain days, or by appointment only? If you have such a policy, how did you implement it? How did you explain the new policy to the reps?

Great Rant ATFP.

I adopted a policy several years ago of seeing one rep (they can bring reps from the same company if they like), at lunch (they bring lunch for me and office staff), once a week.

So I see one rep a week. I like it actually as we can have a detailed discussion, not a quick 5 minute thing when I am rushed.
The reps kind of like it as they know they will get to see me and have time to give their talk.
The staff likes it as they get a lunch once a week.
The patients like it as there are no longer reps delaying their visits.
I have a sign in the waiting room that says "Drug Reps seen only by appointment at lunch on Wednesdays."
Also sign up for the AMA data restriction program (even if you are not a member of AMA) - this will decrease the number of reps you see.

http://www.ama-assn.org/ama/pub/abo...-physician-data-restriction-program.page

This has worked pretty well. For me it was a good compromise between totally banning them and the chaos we had before. Good luck!

My policy-- if I like you and you feed me and I have the time I will see you otherwise not.

I guess I do not see as many reps as my IM and FP colleagues. We get about 1-2 a day. Most of our samples are NOT available generically, and it helps to have samples. We will let them schedule a lunch for them to get more time to pitch their product, I consider that a fair remuneration for my time and the staff gets lunch.

I feel they do have some very limited educational benefit, I primarily see them in order to get meds for under and uninsured patients.

Our office policy--Drug reps have a waiting list to provide lunch for our office of 8 docs, and no meandering allowed or you are not invited back. The front office gal does the education with the reps.

We never see reps any more. We accept samples, and will sign their tablets if needed, but only if passed thru the window, and carried back to me when I step from an exam room. We get the same amount of samples as we always did when they were allowed to meet with us.

Their jobs depend on them getting that signature. Nothing more.

Comments removed at the request of the user.

Admin

Wow, it is very interesting to see the different policies all of you have adopted. I think the office as a whole is just fed up with all reps. This afternoon, after I started this thread, we had a drug rep literally stand at our reception counter/window waiting for several minutes, not allowing patients and even the mailman to engage the receptionist and it just infuriated everyone. And to be honest, we never even liked listening to their spiels during provided lunches - nobody on the staff would enjoy their lunch as they felt like they were being bought - this is a large reason why we stopped all lunches 4 years ago. I even remember back in the early 2000s when a rep offered $50 gift cards for every new RX we wrote for a branded statin (of course we refused)!

We may have to enact a temporary hiatus/ban until we decide on a final policy. I had known drug reps had access to our prescribing data, but never knew we could opt-out; we will be signing up for that AMA program and it'll be interesting to see if we get any negative feedback. We never realized that they just needed the sample request signature. It's funny because we receive sample request forms for a certain purple PPI via fax, mail, and local rep. The local representative is the only one that requires direct contact with a physician. I guess we'll add this manipulation tactic to their list of tricks.

Another part of the issue here is that several of the drug reps are from the area and established in the community (one is even a congressman's wife) and a few attend the same church as some of the staff. We fear some derogatory comments will be made about our office to local pharmacies, physicians, and community members.

What James said about the use of sex appeal is very true in my experience. The sad part is that it may work - my staff and I have heard too many stories from the mouths of reps about physicians wanting more to the relationship. I even heard one about a rep being invited to the home of a physician to find him in a bathrobe! Who knows though how much is true, how much is embellishment, and how much is a result of physicians refusing to see those reps.

Please everyone, don't let this be the end of your input, we would like to hear from all different viewpoints.

Hi ATFP. Welcome to AC. If you could give us your name it would be great.
_____________________
OK, you asked for my opinion. On this board we have talked about EMRs, computers, networking, medications, and many, many other things. We have almost come to blows on the server vs P2P issue. But, I don't think I have ever disagreed more on a thread than this one. Wow! And, everyone has a right to their opinion. I understand the choice of not seeing drug reps because of time, but to make them HAVE to do something to get your time seems like a double standard. The rep does their job. They come to your office. You can have any policy you wish. I guess if you have a disclaimer like the advertisements on the radio or TV does, it would be good as well. You know, the really fast one, where one would throw in the part where we are only talking to you because you are giving us lunch. They know it, I'm sure, but it's different if you say it.

In Maine, most of the meds are covered whether they are brand name or generic. Many times Mainecare will ONLY pay for the brand name. It is always the cheapest drug that Mainecare will cover. We have maybe 20 samples now. We used to have over a hundred. Now, we obtain a urine from a baby and have to give the entire 10 days of Cefzil. Before we could give them two doses prior to the culture. Now we have to write for 10 days of Clinda for our penicillin allergic patients while we wait for the strep culture instead of giving them one day of Omnicef.

We see all drug reps unless we don't like them. That's it. If I have time, I give then 10 minutes. If I don't, then I don't give them any. We don't do drug lunches because of time (I have to work during lunch), but if we really like a certain rep, we'll do lunch with them. I really prefer advertising one on one, more than a Claritin commercial on television.

I have never used a drug because of a rep. One rep would take me to lunch and every time I would tell him how Strattera sucks. And, I could tell the company how stupid 10, 18, 25, 40, 60 and 80 mg strengths are. Make 10s and 20s and call it good. He agreed. Now he is the rep for Synagis, and he doesn't have to do anything other than help us get the drug. I have at least 20 Mainecare patients on Intuniv, and the sample kits are extremely helpful. When it wasn't covered by Mainecare, the rep brought in medications for those who needed it. It's a brand name drug and will be for awhile. I would hate to have to buy albuterol and Xopenex 1.25 mg times three is the standard of care for an asthma exacerbation. We can't afford to stock that. More than anything, Mead Johnsons and Ross provide formula that a lot of families could not afford.

The only difference a drug rep makes as to what I write for is the one who gives me and my patients the better service. The Enfamil rep will drive 150 miles to give us three cans of Nutramigen for a baby while the Nestle's rep won't return our calls. Chalk it up to Enfamil.

I am offended by the comments on females. I have never seen a female drug rep dress any way but appropriate. Males and females piss me off as equally as the other. The story about the drug rep going to the physician's house has nothing to do with a drug rep coming to my office.

So, in short, I allow all drug reps. If they are courteous, then I spend time with them. By courteous I mean they realize when I am too busy to talk with them. The only thing I don't tolerate is the rep that says I won't take your time; I just need a quick signature and then tries to get a few sentences in.

I realize others will handle it in other ways. Now, if someone from Aetna came in telling me about deductibles for my patients, that would be different. Insurance companies are evil. Having said all this, I am probably the only one who called 911 over a drug rep. But, then what are you going to do when her drug is Focalin XR.

JamesNT,
Really inappropriate vitriole. Re-read your post, and this time imagine it's my BSN daughter you are disparaging.
As a non-doctor, you don't even have a dog in this fight.
-10 "cool points", dude
Dr. Dave

Or better yet, imagine it is your own daughter.

Looking at "the big picture", I see drug reps as just another group of people with a job to do. A job that is sometimes congruent with our goals (providing samples and education) and sometimes not (getting a message across; a message telling us to prescribe a drug we might not otherwise use). We deal with different groups of people like that all day, and the key to minimizing the anger and frustration is to feel in control of the situation and empowered rather than "put upon" and manipulated. The good news is that is easier with reps because you can completely define the rules (as opposed to with insurance company rules for payment, auths or referrals, or drug pre-auths, etc).
Decide on a policy that makes you comfortable, and put up a sign or just announce it to your front desk staff and tell them to stick with it. Only see reps by appointment; or just one day a week; or only for lunches. Or you sign for samples any day but without any discussion; your staff brings the computer back to you to sign. Anything is fine, just decide what you want and go with it. You will likely be surprised; the reps probably won't complain about even the most restrictive policy. Tired of that sinking feeling when you see the rep at the desk, trying to get in?; well, maybe you only see patients by appointment, but it doesn't piss you off to see someone at the desk making an appointment; you can say "hi" and move on. It can be just the same with reps, if you want it to be.
Keep in mind one problem. Reps depend on our sense of politeness and good manners. We were raised to be polite; if someone is friendly, and especially if they bring gifts (which might be samples, pens, or a lunch) then we are obliged to be nice to them, and return the favor, at least by listening for a couple of minutes. It is not just the reps who use this; the whole multi-billion dollar big pharma industry of physician-marketing is based on this premise. Nearly every physician says "I never prescribe based on a rep or an ad"; it is always someone else. In fact, the industry stats say the practice is extremely effective. Fortunately, we also have extensive training in politely shortening an interaction, and keeping it "on task"; we do it all day with patients. It is often necessary to do the same with reps. It is very rarely necessary to do so without remaining polite.

Our policy. Rep must speak to Wayne.

1)If we are busy, no they can't talk to Dr C. Give me your tablet, and I will have her sign it for samples.
2) If we are not really busy or have a break due to a no show, I will let them speak to Dr C. When I say the conversation must end because she has to see the next patient, rep must shut up and leave or become "persona non grata."
3)luncH? Yeah, we have to eat anyway. So bring a nice lunch and Dr C will talk to you. Do not bring tacos or Kentucky Fried. Bring real food.

See, this is exactly what we wanted - differing viewpoints. I found it interesting that 2 other Florida physicians, KenP and ryanjo, have more restrictive policies. It may be that the attitude of and towards drug reps varies by state. In our case, in South Florida, we have seen male and older female reps be replaced by younger, more attractive female reps. Now, how much is due to poor performance, career change, etc. is debatable. However, it is irrefutable that sex sells. We've observed that newer reps are less educated and more attractive than their predecessors, e.g., nursing or master's degrees vs bachelor's degrees and some have modeling experience. I have 3 daughters of my own, so I hope that my previous comments weren't misunderstood.

Again, this is what I and the mostly female staff have concluded. Additionally, those anecdotes underline our concern that reps do speak about other physicians. I fear retribution if we ban reps. To my knowledge, we've never said or done anything that a rep could complain about to others, but I still feel like they may be vindictive. And now we've managed to sound paranoid!

I also see that in situations like Bert's and Wendell's, that reps do serve their purpose as their situation significantly differs from our own. Our experience has been that the drug samples don't benefit us as much because of the aforementioned reasons. We are never rude to drug reps and they are rarely rude to us, however their actions speak louder sometimes.

-Anthony

Bert,
I want to make sure that you realize I don't force any drug rep to do anything, however if a drug rep chooses to bring a lunch to the office, they have been educated by our office staff this will be the only opportunity to get any face to face time with me. I have found that any other encounter ties up not only my time, but my nurses. It then comes down to increasing my overhead expenditures because of lost efficiency if I do it any other way because of how I have structured my office. My nurse does everything for me such as scheduling appts/rooming patients/scheduling xrays/handling phone calls/secure messaging etc. My patients are my bread and butter, and allow me to keep the doors open. Drug reps do not. However they offer an opportunity to educate and provide a service. I admire your ability to be more accommodating, but my stance may seem harsh, but in reality it really works for me.
I can clear my brain for 10 minutes or so and usually just BS with the really good reps (and most are) over lunch and just relax, and most of the time spend about 10 seconds on detailing--however I think this service of providing lunches is soon to dissipate, so I do feel honored when a rep brings me lunch and I always make a point to say thank you.

"All doctors are really interested in helping their patients"
"All drug reps/drug companies are really interested in helping our patients"

"All doctors are just out to make money"
"All drug reps/drug companies are just out to make money"

All generalities are wrong. But in the first pair of statements above, I would give a 90% agreement to doctors, and 10% to reps. In the second set, I would reverse the percentages.

90% of reps want to sell their product. Period. There is a thin veneer of "help the patient", but it is thin. Truth is bent, statistics are distorted, managed care coverage is grossly exagerated, all to make the sale. Sex appeal is definitely a factor. Cost to the entire health care system is ignored completely.

We see reps, they are people, and we appreciate the samples. But, as a whole, the whole rep system is to tranfer money from the 3rd party payers to the drug companies. There is very very little real caring for us, or for the patients.

Gene

It appears Bert is right (no surprise there) that I really shouldn't post when it's late and night and I'm tired. So, do allow me to clean this mess up and better explain my position on this topic.

When it comes to sales reps, no matter the gender and no matter what they are selling, I do not express my opinions. I express my Expectations.

I Expect. . .

1. The sales rep to be knowledgeable about what they are selling. This way the rep has a decent chance of answering any questions I may have to better help me make up my mind as to whether the product he/she is selling is right for my needs. If the rep doesn't know the answer to a particular question(s), that's fine, they can get back to me later.

2. The sales rep to be invested in the product. The sales rep has done follow-up calls/visits with clients who have purchased the product previously to see how things are going and to collect some telemetry on which clients have best benefited from the product. This way, the sales rep has a better gauge on whether the product is right for me and may help save him/herself from wasting their and my time. Sales reps who simply jump from one sale to the next pushing product down people's throats do not care about their product, the clients, or their employer; rather, they are in it to get what they can as long as they can.

3. The sales rep to graciously accept the answer NO as easily as he/she might accept the answer of YES. Obviously, there are situations/products where the only way to know if a product is right for me or not is to come over to my shop and sit down and talk with me for a long time to see if I'm interested. If, after giving the rep a fair hearing, I am not interested the rep should bid me good day and not waste any more of my, or his/her, time. Sales reps that refuse to take no for an answer do nothing but piss me off and waste even more time.

4. The sales rep to be respectful of my time. If I say I don't have time for a meeting or a phone call, the sales rep should graciously ask me for a better time or just come back later. Standing there in my office or continuing to talk to me on the phone after I've said to come back later and trying to force their way into my day is not the way to earn my business.

Comment removed at the request of the user.

Admin

6. The sales rep to NOT use the usual shady sales tactics on me. Telling me that a product costs $20,000 but, because I'm such a nice guy, he/she will discount it down to $12,000 after having spoken with me for an hour is nothing more than a tactic. The sales rep is not interested in me as a customer by using such tactics. Sales reps should come armed with FACTS about their product and should offer me their best price up-front when asked. Sales reps that refuse to talk price until after the end of a long presentation are just trying to soften a large sticker shock. If I can't afford the thing, I can't afford the thing. Simple as that. Best to find out now and leave wtih my respect rather than after wasting two hours of my time only for me to throw them out - harshly.

I could make other points, but I think everyone sees where I'm coming from. I am not some schmuck with $10,000 free cash laying around waiting for someone to talk me out of it. I'm just like you: Someone trying to get their work done. And, YES, I have had some pretty bad experiences with sales reps in the past. I have delt with people from Ferguson Enterprises, Grainger, Motion Industries, Oracle, Dell, HP, Microsoft, etc. In 1998 I literally watched in disbelief as Grainger sent a dressed-down gorgeous blonde to the manufacturing facility I was working in at the time to talk with the older maintenance department manager we had and by the time she was done, he had purchased thousands of dollars of crappy equipment at a premium price. Our jobs became harder as we had to make less-than-adequate parts and tools work as he then had to cover his butt to his boss for all the money he spent.

Does this mean I hate all sales reps? Of course not. For example, I get along great with my Dell sales reps and have for the past 8 or so years - both male and female. They took the time to invest themselves in me as their client. The give me the facts and did their best to answer my questions. The result: I have been with Dell for almost a decade now. I have returned, in all those years, only 5 pieces of equipment. We have a lot of fun talking and joking around when I have time. I am respectful of them and they are respectful of me. We have a relationship that works to everyone's benefit.

@AmazingDave

I do have a dog in this fight. As a patient, I expect that whatever medication my doctor is prescribing to me is for the betterment of my health to his/her best determination rather than whatever the big pharma sales babe managed to rope him/her into buying.

Clearly some of you have had good experiences with drug reps. More power to you. I sincerely hope your relationship with them continues to be to your mutual benefit. But for those of us who have not always had good experiences - for those of us who have been lied to and wake up one day to realize that we will never see that $5,000 again or that we have to explain to a boss why this thing we bought won't work as advertised or where all those hidden costs came from - I respectfully request from you a bit of understanding and leniency in this discussion.

JamesNT

@James,

I think it would be helpful for those in the thread if you clarify if you are referring to salespeople in your line of work or drug reps.

Bert,

Good idea.

I would say the line items I detailed would apply to all reps but that is up to the reader to decide. As far as my personal experiences with sales reps goes, they are all in my line of work as a maintenance person/IT person/software developer.

JamesNT

Anthony, exactly what is it that you fear? What can they do to you?

Good Comment Bert
I was in sales before I became a doctor and have seen both ends of the street. I like to be courteous. Sales training made me a better doctor as we sell cures all the time. I hate to say it, but we could all use some sales training and then medicine wouldnt feel so bad. As for the female thing - my young female reps have all been completely above board, full of knowledge, and helpful. I even tutored a young rep (with her boss present) when they changed her drug to Levitra as she was going to get beat up selling it to some doctors that I know - as she was a former Penn State Cheerleader....she did great and I was proud of her. Now she runs a small insurance company. You never know who walks in your door and will be able to help you tomorrow.

Like any company, you work hard to maintain a healthy image in the community. With some of these reps being involved in the same social circles as patients, other physicians, etc., we fear they may try to denigrate our image. That being said, I don't see how they would go about doing that, but it's never a fun prospect to have someone upset with your practice, whether a drug rep or former patient.

Well as usual, I was going to offer my opinion. But, Jon, again as usual summed up what I was going to say completely. Everyone has a job. I am sure those who make cold calls hate it, but they needed a job. You can listen or you can hang up. As Jon stated, you can end the conversation easily. If they continue to go on, you can refuse to see that rep. I do think the companies have a right to advertise, and you can listen to it or not just like you can DVR them right out of your program. Only difference is they don't change my prescribing habits "based on gifts." And, I think it was better when they could bring pens. Well, I guess I did offer my opinion. I also think there is a fine line between having rules and using doggie biscuits to get them to the drug closet.

Thanks Todd.

@ATFP, I agree with Jon that it is hard for them to hurt your practice and, if they did, and you could document it, they would be out of a job. I guess the one I called the police on may have. But, on the other hand, they can help. My Vyvanse rep loves us, because he is nice and we have fun talking with him and joke around. He constantly tells us how he prefers to come here rather than the other practices who give him the cold shoulder (again being civil helps). So, I am sure that trickles down. ATFP, thanks for the name (Andrew). If you wish to have a signature line, it is in your profile. A lot of people put their names and what they do and where they are from. And, maybe a cute saying or something.

@James See I think your line of work in sales where the rep is directly making a difference in your pocketbook and wanting you to buy their product is different. Well, somewhat the same and somewhat different. Thanks for your edits. Much appreciated. No more Tequila and posting,

Does anyone feel like this is Twitter? @bertatrp.org Hash line Mr. Opinion. Is it hash line or cash line?

I'm beginning to see why everyone loves Bert and why he has the most posts on the forum.

He keeps the peace and keeps all of us from killing ourselves and each other.

JamesNT

Thanks James. Except the time I banned that user. Whew!

Hi everyone,

This is a particularly bad time for me to address this topic. Last week our hospital had a speaker from Physicians for Responsible Opoid Prescribing

http://www.supportprop.org/index.html

give a presentation.

Basically, he presented very compelling evidence that our current epidemic of rx pain pill abuse is due to Purdue Frederick, and their marketing of OxyContin in the early 90s. Essentially, thru their advertising and marketing, as well as their funding of "independent" organizations, they changed chronic high dose opoids from a specialty drug to a primary care drug, and they changed the clmate of opiate prescribing from sparingly used only in terminal cancer, to close to first line for any pain. He also gave evidence that Purdue influenced JCAHO to emphasize pain, including "the fifth vital sign."

He also gave evidence of extreme misrepresentation and distortion of the medical literature to support the safety, and effectiveness, of long term/high dose narcotics.

I remember all of this. I remember the ads, and the marketing,and the detailing. I remember the rep visits too.

How much of this is our fault, being blindly led? Probably not that much. When the literature "supports" something, and "thought leaders" advocate it, we usually follow.

But I was left feeling sick afterward. The deliberate distortion from Purdue has seriously harmed countless patients.

I remember a visit from the Rezulin rep, assuring me of the safety of the drug. 2 days later it was pulled from the market. I remember a similar situation with the Vioxx reps.

Anyone remember how much was made of the HOPE trial, and the many benefits of Altace, that were disproven by followup studies?

I am now much more suspicious of any pharmaceutical marketing.

Is this the fault of the FDA, the pharma industry, the individual rep, or of us? I am not sure, but the most direct influence on me is the rep.

Gene

We have an even simpler policy. We never see drug reps. Period. The information they leave is distorted, they encourage the inappropriate use of medication, and they contribute heavily to the cost of medication. I subscribe to The Medical Letter and use UpToDate several times a day. I wish reps were outlawed. Let the comapnies make their case in the scientific literature.

Yes and last week a marketting agent stating they represented walmart wanted to tell me about an offer for levitra...they called me at my home...made my daughter run across the yard to give me the phone, she tripped and scuffed her knee.....when I asked who she was she hesitated.....waste of my time...walmart executives cannot tell me if they sanctioned this or not...

Our policy is we have 1 person in the office who deals with the reps. We schedule luncheons only on Fridays and only if it is a new product and if they bring a speaker with them. We don't allow reps to talk to the providers in between patients unless the provider requests to speak to a particular rep. We ask them nicely to have a seat in the waiting room and we will bring out the signature when it is done. If they insist on witnessing the signature we have the rep stand near the front desk and have the provider step out of their office and wave while signing. We do accept coffee and treats from time to time and have a pretty good relationship with many reps. Most are very polite and get out of the way when a patient is trying to check in. If they are in the way we ask them to please have a seat or come back at a better time. We get lots of samples and have 3 drug closets in our office and have very few issues.

I would have to disagree. From our four years in medical school to at least our three years of residency, we are taught how to scrutinize the medical literature to insure it is evidence based. We learned that a double-blinded, placebo-controlled study was the best and that the NEJM was to be more relied upon than an Internet blog.

I must admit I know little about Purdue, but I would say it is ALL on US if there is bad subscribing. How many of us read their brochures and journal articles they leave on our desk to see if their reasoning is flawed?

I am sure it happens, but I just don't think drug reps come around knowingly telling you something false. I would think we would be rather skeptical of anyone who advertises their own product. When I see an ad about HP or Dell or if a rep for either company came around, I would take their spiel with a grain of salt. I must get brochures from DSL, Satellite and cable twice a month, each sounding better than the other. Ultimately, it is up to me to do the research as to which is which.

Maybe Oxycontin did move narcotics from a specialty practice to primary care. It has its place in primary care. Maybe that was a good thing. Too often, hospitals were prescribing Morphine 1 mg every four instead of 2 mg every two for fear of creating addicts while the patient lay there in pain.

We had a surgeon at my hospital who refused to write for narcotics on a post-op patient because he was an abuser on the outside. Well, that was abuse.

I believe everyone welcomed Oxycontin, because it was supposed to be much less addicting or easy to abuse. They were wrong. We were wrong. The same as when we thought Strattera would replace Ritalin.

I just can't see how we can blame Purdue. He just marketed it. We bought it.

Hi Bert,

I would have agreed totally with every word of your last post until I heard that talk. I had no idea how severe a problem this was.


http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm?s_cid=mm6101a3_w

from the CDC states that there are 27,000 deaths annually, and that rx drug abuse is the fastest growing area of drug abuse.


http://www.youtube.com/watch?v=DgyuBWN9D4w

is a clip describing the marketing and misinformation from the 90s. I heard this information in the early 90s, and changed my prescribing. I wish I hadn't.

Please please take 5 1/2 minutes and watch this clip.

Thanks. Gene

As much as it pains me, I have to side with Bert.
When being detailed, I realize the data is presented in such a way as to make the particular medication, seem like the next best thing made since apple pie. But it is data that needs to be analyzed in the context of other data, and like David utilize up to date, epocrates, and medscape on a daily level.
But ultimately it is up to the individual practitioner to decide what to prescribe after having a rational discussion with his patient.
However, with that being said, I would be willing to go hungry for lunch, if the pharmaceutical companies would do away with their gimmick % off the cost of med cards (that aren't even available for the medicare patient who needs the help the most), equalize the cost of med across borders (as there is no reason why my patients should get the same branded med in Mexico or Canada for a fraction of the cost) in order to reduce the cost of branded drugs.
I do buy pens now, except the free one I received from the government for filling out their EHR user survey--

Hi jimmie and Bert,

I agree completely with the theory that we are scientists, who research, evaluate, and make the best decisions. In real life, I rarely conduct a critical analysis of studies, I think I am doing well to skim the methods and conclusion. We are all too busy. Without really thinking about it, we tend to remember the conclusions that are presented to us.

http://apps.who.int/medicinedocs/en/d/Js8109e/6.7.html

from the WHO tends to support this (scroll down on the link's page.)

Or, if you just want to skim the conclusions,

http://apps.who.int/medicinedocs/en/d/Js8109e/6.14.html

Again, scroll down on the link page.

I just cut and pasted the conclusion below:


Summary of conclusions
Increased promotion is associated with increased medicines sales, promotion influences prescribing more than doctors realise, and doctors rarely acknowledge that promotion has influenced their prescribing. Doctors who report relying more on promotion prescribe less appropriately, prescribe more often, and adopt new drugs more quickly.

Samples stimulate prescribing.

Doctors who receive drug company funds tend to request additions to hospital formularies. Drug company sponsorship influences the choice of topics for continuing medical education and the choice of research topics and the outcome of research. It leads to secrecy, delay in publication for commercial reasons, and conflict of interest problems for contributors to guidelines. Researchers often do not disclose funding from drug companies.

DTCA leads to increased requests from patients for medicines. Doctors who prescribe a requested drug are often ambivalent about the medicine.


End of cut and paste.


Please watch this 5.5 minute clip

http://www.youtube.com/watch?v=DgyuBWN9D4w




Gene

I will watch it.

Gene,
Thank you for spending the time and providing the information you have. There is no doubt I am a bit conflicted on this issue, and David's approach may be the noblest of all.
Even though I received the pen for filling out the governmental EHR user survey, I did not accept the pen and sent it back. Maybe it is time for physicians in general to respectively decline cost producing marketing efforts that are then transferred back to the patient.
However, I think there is only a limited time left in which marketing by major pharmaceuticals in individual offices will continue to exist as is.
I have to admit, I rarely use branded drugs, and pre-authorization tactics by the insurance companies keep me from prescribing branded drugs 99.9% of the time, and 99.9% of the time I can find a generic drug that will work just as well as a branded drug.
So I have to ask myself, why see drug reps for lunch and get detailed. And this is part of the conflict. 99.9% of the reps are great people trying to make a living and I have gotten attached to them over the years and know they are all trying to make a go of it and raise a family etc.....And have seen quite a few over the past several years get canned, or are next on the chopping block and it is hard to see this first hand.
And I like getting lunch brought to me and learning about new drugs or being reminded of semi-new drugs even knowing about the spin placed on the data.
So I don't know what the hell to do.

Your post is perfect. This phrase sums it up.

Gene

Just to make certain we are clear: I do NOT Tequila post.

I Crown Royal post.

JamesNT

Interesting discussion.

Let me add another point.

In the past decade or two, the drug reps had breakthrough branded medications like glucophage, simvastatin , lisinopril. They really were game changers and we needed their samples and info. There were no generic alternatives. The medications clearly helped the patients.

But over the last 5 years, there has been little innovation. R&D money has dried up. So most of what we get is me-too drugs or isomers. The pharmaceutical industry went willy-nilly with erectile dysfunction drugs last decade instead of developing new antibiotics (as the ED drugs were more lucrative).

So this may have an impact on our desire to see drug reps. If they really had innovative products I think I would like to see more of them. Sometimes it is easier to learn about new medications from reps (but still back it up with your own research on the internet and with journals and newsletters).

Vyvanse -- vision problems (drug rep here in two hours to take report) Received info back from corporate both written and on the phone. Turns out glasses were broken.

Intuniv -- 1 mg way too drowsy (drug rep here next day to take report) same thing. Reminded not to cut in half. Patient playing X-box until 3 am, but still related to Intuniv.

Focalin -- causes lability. Saw it multiple times. Drug rep denies this happens and I am only physician with this problem. Goes on tantrum, yelling and screaming at me in office. Likely on her own med. Police called. Drug rep left. Has not returned.

I remember when we had aerochambers. Mainecare won't cover most. Those were literally life savers. We had multiple, multiple drugs which helped. Eye drops and ear drop companies likely lose money as one sample covers entire course.

I simply don't think it is accurate to state that drug reps and samples increase costs. Again, how do you want them to advertise? Are they not supposed to advertise?

I do not remember the sources, but multiple sources have stated over the years that sampling and advertising does, in fact, make a huge difference in costs. I remember being shocked when I heard this, and dismissed it, but have since read it from multiple sources. There is advertising, and there is advertising. You want to take out a full page ad in the NEJM? Fine. I can note it, and look it up at leisure. But the pretty lady with sandwiches and a free shiny gizmo is not advertising in my view; it is pandering.