Monday, April 12, 2004

Turning A Non-Issue Into A True Problem

Econopundit, I respectfully disagree with your point that "people can be trusted to make correct judgments when given product information -- even when presented with the slick, manipulative, entertaining, well-packaged product information typical of television pharmaceuticals ad." Even outside of pharamaceuticals I would not have as much faith in the consumer as Econopundit does to make valid decisions given any amount of information (if advertising didn't work to the company's benefit, it wouldn't exist). In my limited experience thus far, the majority of patients really cannot handle this sort of decision. Hell, many cannot even handle taking doses correctly, let alone decide which anti-diuretic would be most beneficial. This is why MDs get the script pad, not patients. It's very dangerous to start thinking the patient can do more with less, especially since mortality and morbidity lay in the balance.

Back up....need a little background on this post....

An issue close to my heart happens to be 'ethics' in medicine. I put quotation around 'ethics' because as it is taught @ the medical school I currently attend, 'ethics' appears to have correct and incorrect answers (or "best choice" answers as they are lovingly referred to). I always thought ethics was a complex mix of values, norms, etc. Nope, here (and on USMLE1) it is as predetermined as the physiologic response to nicotine. In effect, it comes off as more black and white, rather than as 100 shades of gray.

Example: A case we were given stated that a 'supplement' company has offered to pay off your student loans and give you 10% of all scripts you write for their supplements. Do you sign on? Well, I caused quite a ruckus when I said "Hell yes". In fact, not only were the other students looking @ me like I was from Mars, but the resident ethicist simply scoffed and said "No sir, that would be very wrong". Not enjoying being wrong, I proceeded to explain why I would do it. It boils down to me signing a contract that does not require me to prescribe the supplement, nor provide any sort of reference at all to the company. If the company wants to pay off my bills and entice me with 10% sales revenue, I'm all for it. However, in no way does that bind me to actually prescribing the supplement (which I obviously wouldn't do because of the inherent conflict of interest present). In fact, to me it was merely a way to pay off my student loans without doing anything at all. The way the situation was presented, the company involved was stupid (and apparently so were my classmates who failed to see what a great deal this would actually be for them). Suffice it to say, everyone still looked at me like I had no morals, and was doomed to merely 'scribing those drugs that I got after some free pens and dinners came my way. After a few minutes the ethicist finally realized that the situation, as presented, was deeply flawed and that I 'had a point'. Of course I did, I'm a finance/economics student. Hell, anyone with common sense would agree.

So why didn't the other students jump @ the same opportunity? I blame it on 1) not being very good in business (relates to having little common sense compared to the average american, a sad commentary on those currently in medical school) and 2) this inherent fear that whatever outside companies (i.e. Big Pharm, Insurance, etc) do within the medical field is inherently bad. Just look @ how students/doctors have shunned the historically common practice of Big Pharm sending students/doctors on trips, paying for dinners, etc. in exchange for listening to information regarding Drug A. My question is, when did this become so taboo?

Probably about the same time someone started complaining that drugs cost too much, and look, part of that cost comes from sending doctors on vacations to learn about the latest anti-depressant or ACE inhibitor. Solution == stop courting doctors and the drug costs will go down. Anyone think that worked? If you said 'yes', grab your dunce cap and visit the nearest corner for a few minutes (then come back and continue reading). In fact, in my opinion, the 'problem' that individuals were attempting to 'rectify' has actually now become a legitimate problem.

First off, Big Pharm still visits doctors. Dinners are still paid for, and trips are still paid for. It's not as open as it used to be, nor as commonplace, but it still occurs. So, the original 'problem' that needed solving still exists. Well done guys.

Secondly, Big Pharm has moved on to providing tons of free samples for their doctors in lieu of trips/dinners/hookers. Personally, I think that's a wonderful idea, and support it completely. Incidentally, the ONLY plus that came out of the incessant whining regarding Big Pharm exerting too much influence over physicians.

So if I agree with the above, where are the problems? Well they are two fold. First is the objection that doctors are 'bought'. This seems rather ludicrous to me, even after reading some research on behavior patterns associated with Big Pharm influence (see here, and here.). I know I have yet to enter the fray, but with family in the business (both med and pharm), I can see how doctors are not influenced, simply smart enough to realize a free ride. I know the studies show otherwise, and of course Big Pharm wouldn't continue to do this if it did not produce results, but to me that more readily demonstrates an inability by physicians to separate 1) business from 2) patient health/well-being and 3) advertising/sales pitches. Being a field that prides itself on 'correctness' (even to the point of keeping people alive that would be better served by death), I don't expect many physicians to admit this to themselves, let alone outsiders.

The other problem is that due to market forces being what they are, Big Pharm must still get their name and their drugs out. What does this mean? Well, instead of sales people visiting physicians, individuals who understand pharmacology, pharmacokinetics, SE, contraindications, etc., Big Pharm is now selling directly to the public. EEEGAADS!!! Talk about turning a non-issue into a large cluster f--k. Anyone who took a glance @ the superbowl saw a multitude of ads for 3 different ED drugs. Want to bet on how many men proceeded to call their doctors asking about their favorite PDE-5 inhibitor?

Talk about a bad dream. From non-issue to patients requesting name-brand drugs. The internet has done wonders for patients attempting to diagnose themselves (often to their detriment since 1) they are wrong and 2) cause increased anxiety in the process). We now have the second installment, whereby not only can a patient diagnose himself, but he can request the 'right' treatment for his condition based on a 30-second, obtuse collage of muzak and smiling faces. That's bass ackwards, even to an uneducated grunt like myself. Wonder how long this cycle will take to play itself out. I'm hoping sooner rather than later, but that probably means the exact opposite will occur.

Does the first paragraph make some sense now?