Wednesday, March 21, 2007

Is big pharma paying your doctor?

Very interesting piece in today's NYT about records showing drug company payments to Minnesota docs. See, Minnesota is one of a few states with a law requiring drug makers to disclose what they're paying providers. Snip:
The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.
There is nothing illegal about doctors’ accepting money for marketing talks, and professional organizations have largely ignored the issue. But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs — whether or not they are in the best interests of patients. “When honest human beings have a vested stake in seeing the world in a particular way, they’re incapable of objectivity and independence,” said Max H. Bazerman, a professor at Harvard Business School. “A doctor who represents a pharmaceutical company will tend to see the data in a slightly more positive light and as a result will overprescribe that company’s drugs.”

I have a great deal of respect for the handful of doctors who make up my medical posse, and it would never occur to me that they might be influenced by whatever goodies Serono, Berlex, Biogen, or Teva might be passing out. And I'm sure that my posse honestly believe that they haven't been, and couldn't be, influenced by goodies from drug companies. But there are dump-trucks full of money at stake for the drug companies, and you have to believe that there are lots of really smart people working very hard to influence my posse and your posse in very subtle ways, so that more of those dump-trucks end up headed in their direction.

So what's a patient to do, especially if you don't live in Minnesota or another state that requires disclosure? Is this something worth asking your doctor, even if it might be offensive? Over the last 13 years, I've been on each of the CRAB drugs for a while, switching drugs when I switched neurologists, based on their advice. And now I wonder whether any of my switches were influenced by drug company marketing efforts aimed at my neurologists.


Stephen said...

i guess i am lucky that my neuro is almost anti-drug, counseling me that using a CRAB is really up to me, and that he is not convinced they actually do anything, but that i might as well take one - my choice. "people SEEM to do better on these drugs," he sez. no drug pusher, him. i would think any patient should do their own research when offered any drug by any doctor. be your own advocate!

Doug Lee-Knowles said...

be your own advocate!

Good advice. I've always tried to be the smartest patient I can be, but the CRAB drugs might be the perfect example of a situation vulnerable to drug company marketing. A $1000+ per month, there's a lot of money at stake, there's a huge group of patients who desperately want to hear that these drugs will help them, but unless I'm missing something, there isn't anything close to a consensus as to how the drugs compare to each other.

I'm sure in the near future, the issue will be mooted by the availability of cheap, tasty stem cells. Mmmmmm...stem cells.

mdmhvonpa said...

You know ... in the music industry they call this payola. It's illegal there and it's just music!