Consumers Want Gifts To Docs Disclosed: Survey
61 CommentsBy Ed Silverman // June 18th, 2008 // 12:08 pm
A majority of Americans - 68 percent - support legislation to require drugmakers to disclose gifts and payments to docs, according to a new survey by the Prescription Project. Americans also disapprove of many types of gifts and payments to docs, support legislation that would allow clinical experts to provide unbiased drug info to doc in the form of academic detailing, and think pharma has a moderate to extremely large influence on prescribing patterns by docs.
Other findings: 52 percent say accepting gifts from pharma influences how docs make prescribing decisions and another 26 percent believe gifts have a moderate influence. 86 percent believe free dinners should not be allowed; 80 percent believe speaking fees shouldn’t allowed; 78 percent believe free lunches at the office shouldn’t be allowed; 70 percent believe free note pads and pens shouldn’t be allowed, and 62 percent believe free attendance at mandatory CME shouldn’t be allowed.
What else? 64 percent believe it’s important to know a doc’s financial ties to drugmakers; 68 percent would support legislation requiring drugmakers to publicly disclose any gifts or payments given to docs; 62 percent support legislation that makes it easier to tell how much money and gifts a doctor receives from drugmakers; 71 percent would support legislation that promotes academic detailing; 55 percent say they would be unlikely to directly ask their docs if he or she has accepted gifts, speaking fees or other financial support from a drugmaker.
Here are the complete results. The survey was conducted between June 4 and June 8, queried 1009 adults across the US.
Justice in MI
“55 percent say they would be unlikely to directly ask their docs if he or she has accepted gifts, speaking fees or other financial support from a drugmaker.”
This last result surprises me. As a kind of informal project, I have been asking everyone I know over recent years if they ever asked such a question of one of their docs. Or could even imagine doing so. I’ve also asked my doc friends if they ever received such a question from pts.
The answer has been zero in both categories. I have a feeling the respondents in this case aren’t fully imagining themselves in the situation.
Justice in MI
Pursuing my informal survey (perhaps Ed wants to make it a formal one), I would be very interested to know if:
1. Anyone here ever “directly ask[ed] their docs if he or she has accepted gifts, speaking fees or other financial support from a drugmaker?”
[Of course, I mean gifts beyond the pens and clipboards usually scattered about.]
2. Any doc or other provider here ever had the question directly asked of them?
Thanks!
Promotional Whore
First off I would like to know more about the sample size used in this study and how random it really was? All of 120 respondents I’m sure.
Secondly, I doubt very much if a Doctor is really influenced by a promotional cup or pen.
If we do away with the promotions and disclose, I guess the Office should also disclose how many samples that they give to each patient, especially the ones that get a 6 month supply if birth control and have their next appointment when the supply runs out.
It is all the same, as Pharma we should push back a bit. Grow a set instead of backing away from everything.
There are a lot of good people in Promotions that will be put out of business and bankrupted for this mentality. Many have already gone under. I salute them all!!!
Suzanne
When my daughter’s specialist said he was going to Taiwan to make a speech, I just assumed from that point on…..
Allan
Dear Ms Whore,
Thanks for your question about survey respondents.
As Ed notes above, the survey includes responses from 1009 adults from across the United States. It was conducted by the national firm ICR during June 4, 2008 – June 8, 2008. Full results are available at http://www.prescriptionproject.org
Promotional Whore
I noticed that. I still don’t believe that Americans care, only when poke or prodded will they care. I think that they would rather spend their efforts on bringing our troops home then whether or not a Doc received a promotional anything.
Next time you get sick where should you go,” The survey say…..”
PharmaR&D
Of course if you actually go to the survey at the link provided by Allan you find that pages in the report describing the methodology are screwed up … pages 8 and 9 are duplicates … right at the point in the report where you would go to see any biases in the survey methodology. Not a surprise.
Interesting though is since it’s a land-line telephone survey you get 36% of respondants are unemployed.
Lew
I’d like the organization to be transparent about it funding. What conflicts of interest does it have? Also, I wonder how much bias is in the question set. Based on my read of the results, I suspect the questions were somewhat leading. Suppose we turned it around and asked similar questions but with a pro-pharma bias. For instance, did they ask something like, “would you change doctors if he/she discussed clinical issues with a pharma representative who provided sandwiches for the meeting?” How about, “If you knew that your doctor is recognized enough to be paid by pharma companies to speak to his colleagues on clinical best practices, would your opinion of him/her improve or not?” Or, “does the fact that your doctor is using a pen given away free by a pharma company make you believe that your care has been compromised.”
I suspect the answers would present a very different story. My point is that these issues probably don’t really mean that much to consumers. Whoever is behind this survey likely has an anti-pharma agenda.
Cassie
Let me declare upfront that I have a lifetime anti-pharma agenda. You would, too, if Zyprexa killed your child. Anyway, I went to my doctor and sat to the side of his desk. Staring straight past him, I saw a Zyprexa calendar. I asked him to take it down and never put another one up or I would never come back to his office. Soon thereafter, I went out and bought him a very nice calendar with no Pharma logos. He has continued the tradition.
M Helm, MD
I’m an MD, though I split my time - part clinical, part consulting on PBM issues. I don’t see reps in the traditional sense (government affairs/managed accounts or science liaisons are the only ones I see). I don’t take food, money or gifts (including pens and notepads) from PhRMA. I also rarely give out samples. I have accepted gifts from patient families, but nothing of more value than a “singing” Christmas tie.
To answer J.I.M.’s “survey,” the only people who have asked me are (ironically) drug reps. They are also the only people who offer me food, which I refuse with as much grace as possible.
On the other hand, my PCP’s office is plastered with PhRMA posters, and overflowing with pens, pads, mugs, and samples (some of which he has offered to me at almost every visit). When he has suggested an expensive brand name medication to me and I know of a less expensive, but reasonable (if not equal) alternative, I have requested my preference. He is (I think) a good and experienced clinician, but I generally don’t trust his medication choices. I don’t have to ask him if he sees reps as he is one of only two in his location, and I see a rep there almost every time I go.
To Ms. P.W., First, I implore you to grant yourself a more dignified screen name (if you can’t just use some form of your real name).
Second, regarding the concern for the promotions people who may be displaced, fear not. I haven’t seen a PhRMA promotional item made in the US in about ten years. I don’t think your local marketing promotions brokers are doing much business supplying PhRMA leave-behinds.
I wonder how many container ships are filled each year with the stuff reps are expected to give away. I know there are some hefty delivery service and warehousing fees that go along with all of this (leaving less money for R&D).
As for whether the insignificant items have an impact, why would they contine to be made, shipped and delivered if there was not a return on the investment?
Regarding methodology, I’m not a fan of telephone surveys - especially omnibus surveys. They can be cheap, and they are fast, but there is not much control on who answers, and how hard they try to guess the “right” answer.
Justice in MI
Thank you, Cassie, for responding to my question. While I am certainly not “anti-pharma” in the sense of being against the industry as a whole, I am against fraud, cover-ups, mileading reporting, etc. etc.
I profoundly hope that it would not take a horrible loss like yours to allow pts to ask such questions. But I am not sanguine about that.
So, once again, I wonder if anyone else has been on the asking or receiving end of asking their docs “if he or she has accepted gifts, speaking fees or other financial support from a drugmaker.”
The fact that you are the only person who has responded as you have, and after such a loss, may already tell us the answer.
Nathan
Pens, notepads, coffee mugs, etc. do not constitute “pay for service”. Of course nobody in their right mind would prescribe a medication based on the logo on the notepads they currently use. The point of that kind of stuff is to REMIND doctors about these new drugs. Otherwise the drugs might get overlooked. For goodness sake, if we eliminate DTC advertising, medical journal advertising, and all promotional freebees, how are doctors supposed to remember anything about a new product? They’ll continue using the same old drugs they have prescribed for the past 30 years… Of course, that may be fine most of the time. But once in a while we in the pharma industry do actually come up with something useful…
M Helm, MD
Nathan,
Of course the leave-behinds are not the same as “pay for service.” Ms P.W. brought them up, seemingly out of concern for the employment prospects of those in that industry.
I do know MDs who have told me (rather proudly) that they are speakers/advisors/”investigators” or whatever for specific companies/brands. I don’t ask them how much they are paid, but I notice they rarely can find fault with the medications for which they have taken money. Often I find myself (internally) questioning their objectivity… Even with the meds I LIKE to use, I can see the risks/pitfalls.
We haven’t achieved panacea yet, so please keep looking.
Back in the days of my PhRMA employment, more than a few times, I saw MDs picking their treatments based on nothing more than what was in the sample closet, or what rep was standing closest. I don’t think this was because of the “home office visitor riding along,” especially since the meds chosen were often not the ones made by my company. I know this is not the rational prescribing we (as health care consumers) should hope for.
I believe there is a calculus to the spend on the reminder items and it is related to the value/innovation of the drug. I’ve hardly ever seen Tamiflu reminder items (maybe because of the timing of my training), but I don’t need to be reminded of that med. Medications that are relatively undifferentiated seem to have lots of reminders. At least that’s how it appears on this side.
I think it is easy to dismiss the “inconsequential” items, and focus on the more clearly conflicting payments for “sevices,” but even in the survey, the little items are troubling to most of the consumers surveyed - if you believe it has validity. I think BOTH physicians and PhRMA face trust issues with consumers, so why engage or participate in practices which raise questions of our ethics?
Justice in MI
Nathan writes:
“The point of that kind of stuff is to REMIND doctors about these new drugs. Otherwise the drugs might get overlooked. For goodness sake, if we eliminate DTC advertising, medical journal advertising, and all promotional freebees, how are doctors supposed to remember anything about a new product?”
I genuinely do not mean this to be provocative, but I find it a an incredibly illuminating statement. Meaning: What other profession can one think of in which trinkets from manufacturers are needed in order for practitioners to know “anything about a new product.”
Presumably, if there is some kind of new socket wrench or uniquely good motor oil, auto service folks will learn about them because the news and the buzz will simply be there about the best products. They will certainly not need promotional freebies or DTC.
In the meantime, there are all the other ways docs presumably learn about medicine after they get their degrees - through required CME (which need not be sponsored by industry); medical journals (which need not be sponsored by industry); medical conferences (which need not be sponsored by industry); word of mouth from colleagues (which need not be sponsored by industry); and on and on. Note that I am not excluding industry-sponsored studies in journals, which I view as fully appropriate so long as affiliations are made known.
My point is that we have gotten so used to the idea that docs need the pharm industry to “remind” them of how to practice their profession that we forget how utterly unique the concept is.
Also worth noting is that the very folks who insist that doctors are not unduly influenced by all of this say that those paragons of independent judgment suddenly become wooden-headed dolts who need “reminders” about what the fig they’ve got in their bags.
When you think about it - and it takes real effort because of how fixed a part of the landscape the relationship has become - isn’t it all a little bizarre?
Paul G
Surprise surprise, this comes from the extremely biased Prescription Project.
Did they disclose that everything they do or say is against the industry?
Was this study peer reviewed as they advocate? Probably not.
We all know that the operate, as someone else said, by shooting the dart on a wall and then drawing the bullseye around it. In other words, they know the outcome of what they want and then work towards it. They ar worse than pharma.
Justice in MI
p.s. Before all heck breaks loose, maybe what we really need is a survey of docs - not in any way “on the take” - about how much their professional competence has been enhanced as a result of journal ads, promo freebies, etc.
Anyone aware of such a survey?
I am keenly aware that some participants here, like some of my own best former students who are now detailers, are terrific people who do, indeed, believe they are contributing to medical excellence. I happen also to work at a university in which such detailers are no longer permitted entrance.
So what does it boil down to as “big picture” surveys of physicians might suggest?
Nathan
Ok, let’s get this strait once and for all: What type of gifts are we talking about? I could be wrong, but I don’t think doctors are getting new TVs and Ipods from pharma companies. From what I understand, they are getting notepads, coffee mugs, and occassional free lunches. Sure, we can ban this. I hope that people aren’t hypocritical about it though. As a researcher, I get mousepads, calendars, and coffee mugs from scientific suppliers. I guess that should be baned too.
My employer, like most employers out there, bans gifts from salespeople that are more than “nominal” value ($10 value is the limit my company places). We can accept lunches provided that legitimate buisness is being discussed. I’m *SURE* that most (or all) doctors abide by similar rules. Does anyone disagree? If not, then what is the problem here?
Nathan
Ed,
You seem to scrutinize most pro-pharma stories for bias and potential conflicts of interest. What about more anti-pharma stories? Why didn’t you scrutinize this one? Here’s what I dug up:
1) The survey was designed and paid for by a group called “The Prescription Project.” This group has a specific agenda to “promote public and private-sector policy solutions that reduce conflicts of interest in the medical profession.” They specifically say that a goal is to “Conduct research and issue reports that document the scope of the problem and examine its impact on health care quality and cost.”
(in other words, they designed a survey that would give them exactly the results that they are trying to prove — notice that they don’t give the exact wording of any questions)
2) Look at the advisory board. Do you see anyone from the pharmaceutical industry? NO! Why not? Aren’t they interested in prescription drugs? Opinions from pharmaceutical leaders might be relevant to their agenda. Instead, you see such pharma-foes as Steve Nissan (the Avandia killer who brought GSK to its knees) and Sharon Levine, an executive at Kaiser Permanente. Do you think that executives at Kaiser are particularly pharma-friendly? No!
3) Look at the funding for this group. Funding comes from a variety of sources - but look at a couple of them:
a) National Legislative Association on Prescription Drug Prices. What do you think their agenda is? To lower drug prices! Hardly pro-pharma.
b) Prescription Policy Choices. This is a group that promotes “innovative strategies and programs to reduce drug costs and expand access”. Again, a key goal is to reduce drug pricing. Of course they are interested in surveys that show undue influence of prescription patterns by the pharma industry.
I’m not saying that any of the above information makes the report irrelevant. But it is useful in evaluating the bias inherent in the survey design. As I said, you point out conflicts like this frequently in your pro-pharma stories. But bias works BOTH ways.
Jack2
If I ran a company that invented a great new socket wrench I’d be out there plugging that wrench to Firestone and Midas, rather than waiting for “natural” market uptake. I’d probably even set up a meeting with the head of purchasing of Midas and Firestone in some nice location, and maybe let them bring their family along. Whenever economically feasible and logical, I would also seek out independant auto mechanics to try to convince them to buy my great new wrench. I’d also hit up Pep Boys and Walmart to get them to stock (and maybe even co-promote) my great new wrench. Of couse I’d operate in a much less heavily regulated industry, so I’d go all out with this promotion - to the absolute limit I thought would get me the best return on investment.
Of course, pharma can’t do that. And I think there’s good reasons why they can’t do it (mostly because the product user/decider/payer are all different entities). But if you accept capitalism, and most Americans do, then you accept sales and marketing.
-Not in sales or marketing
Sam
S
I agree with those who think patients would not ask their physician if
they except gifts that may or may not influence their decision to
prescribe a certain drug. But where there is smoke there is usually a
fire.
some times patients perceive their physician of taking gifts by the evidence they observe.
- Time spent in the waiting room for an hour and then being “bumped” because a sales rep brings lunch for the staff.
- An appointment is changed because the physician had to go to a
a clinical meeting for 3 or 4 days. When this appointment was made
this meeting was not on the physician’s calender.
- Around Christmas time, the staff’s office is deluged with baskets
of wine, fruit and other types of food.
AA
Nathan,
Regarding the COI issues you raised, you’re right about no one being completely free of that. I think the difference is when it leads to deaths, that is big problem as in the Paxil study that claimed that it worked well in adolescents when actually, it raised the suicide risk. Glaxo paid the prime authors of the study.
Just to be clear, I don’t think that COI always leads to these types of situations. I think plain old arrogance can lead to devastating malpractice results.
AA
Ed Silverman
Hi Nathan,
A belated reply to your note this morning. I understand your point and so I’ll try to address the specific few things you raised.
First, I often run surveys and, for better or worse, don’t always have access to some or all of the questions. If I have them, I will try to include them or appropriate links.
As to the advisory board, yes, there are members who are often critical of certain pharma practices. But how is this different from PhRMA, to use an example? The trade group members are only from industry.
As for Nissen, specifically, I know he’s a lightning rod, but I don’t think he’s a pharma foe, per se, because he and the Cleveland Clinic also do research work for drugmakers. He seems to single out certain instances, right or wrong, as opposed to hammering on the entire industry.
Finally, I understand your point - the groups involved want lower prices (although that doesn’t necessarily mean they are anti-pharma or anti-medicine). And so you wonder if perhaps they structured a survey to suit their means - results that indicate undue influence on physician prescribing.
So why not then mention a bias? I have no evidence that the survey itself is biased. To do so would suggest the survey is corrupt, and I would either be writing about a corrupt survey, which is pointless, or a post speculating it’s corrupt, which could be interesting, but only if there is good reason to believe the survey design really is corrupt.
That said, yes, I can mention the modus operandi of the groups so there is better understanding of the perspectives brought to the issue. I will do a better job of that in the future. So thanks for the note.
Regards
ed
Nathan
Ed writes:
“So why not then mention a bias? I have no evidence that the survey itself is biased. To do so would suggest the survey is corrupt…”
That was EXACTLY the point I was making a couple weeks ago when you insisted on pointing out the affiliation of Mark Thornton after he wrote his editorial! Pointing out bias is fine — but it suggests corruption!
Anyway, thanks for your responce Ed.
Justice in MI
This thread seems to be moving away, but I’m sure we’ll be back to it in a variety of contexts.
I’m not against promotion, for socket wrenches and what have you! Even Congressfolk and Presidential candidates!
I guess the question comes down to whether there isn’t something pretty unique in the relationship medicine has with the pharm industry, and whether there is any other _profession_ which has a relationship with an industry in any way that even approaches similarity. If not, one begins to ask about need, impact, appropriateness, etc.
Regarding topic, I do think there is ambiguity in the original story. Personally, I don’t have problems with pens. Speakerships, consultancies, directorships, etc., are - to me - are a different issue.
But re: gifts, wasn’t there just a story that the max went up to $500? Or am I confusing it with something else? You can get a lot of pen for $499. Maybe not a Mont Blanc, but a lot.
In any event, I remain most fixated on the questions of (a) what pts really will ask or ever do; and (b) whether, overall, there is any other industry that has a similar relationship with a profession, and the impacts. Certainly, the quality of practice at the university hospital I mentioned does not seem to have suffered as a result of reps no longer being there, just to think about that level of connection.
Justice in MI
And, btw, “Jack2″ is not a bad brand name for a new socket wrench and related automotive products. You’ve won me over!
Cheers, and well said.
Atlex
Ed,
I disagree with you. The Prescription Project itself acknowledges an anti-pharma bias. Take a look at the press release on this link:
http://npalliance.org/news/stories/prescription_project_npa_join_forces_to_stem_negative_influence_of_drug_ind/
Certainly, they are entitled to their opinion, but it must be acknowledged that they may have developed a survey to support their own view of the world. If Drug Wonks put out a survey, wouldn’t you acknowledge that they have a pro-industry bias?
Atlex
Ed Silverman
Hi Nathan and Atlex,
To briefly address your points, I see the PP survey and Thornton as being different, in so far as we don’t know which questions were asked, so we can’t tell if it’s biased or not.
As for Thornton, I didn’t write that he was biased, only that he failed to mention his complete connections so that the public could understand the context in which he presented his views. We’ve spent lots of time on this already and I’m not going to do so again.
I’m not defending nor attacking PP, by the way. I posted their survey. There seems to be an assumption that because PP has issues with pharmaceutical marketing, its survey is biased. But in the absence of picking through the questions - which I’ve asked PP to provide - there are only assumptions left to conjure.
This leads me to one other thought, which is that PP may have myriad issues with marketing, but is that the same thing as being against the entire industry or medications? I’m not trying to parse, because it’s the job of the PP folks to defend themselves - which I’ve asked them to do - but I do think those are different points.
That said, as I indicated in a previous comment, I will note pertinent perspectives, connections and what-not when discussing surveys in the future (just as we’ve chatted about market research firms and the surveys they issue to drum up business). Hope this helps.
Cheers
ed
Kathy
The Prescription Project is an organization working to promote evidence-based prescribing and ensure that pharmaceutical industry marketing doesn’t undermine the best standard of care. We believe drugs should be sold on their merits. We believe in a constructive interaction between industry and medicine. But patients need to be confident that their physician’s prescribing decisions result from careful examination of all the independent scientific evidence, not from sales pitches sweetened with gifts. For these reasons, many other professions adhere to strict ethics codes that bar receipt of gifts, while elected and government officials are guided by public finance laws prohibiting gifts from lobbyists. We do not believe physicians should be treated differently.
The question about bias is, of course, completely valid. It’s good to question assertions from industry or interest groups. But there’s one difference here: while both camps claim to serve the public good, industry benefits only by moving more product; we, on the other hand, would have nothing to lose from increased use of pharmaceuticals if it produced a net public benefit (and, indeed, we advocate increased use of pharmaceuticals in many situations).
Indeed, while we advocate a number of policy and legislative responses to these issues, our primary focus has always been medical professionalism. Ultimately, we’d rather see the profession take responsibility than leave it to blunt legislative remedies. Unfortunately, there is widespread concern that the profession hasn’t been an adequate shepherd of its relationships with industry.
The Prescription Project is not, as suggested above, “anti-pharma”. Indeed, we look to the industry to develop new and innovative medicines that contribute to public health. And make a profit doing so.
With regard to the survey, each question was developed with, and fully vetted by, our research survey firm, ICR, to ensure it was not biased. We stand by the methodology. For public consumption, we moved the methodology pages to the end to get the results up front and make it easier to read. Please visit our website (www.prescriptionproject.org) for a re-posting of survey results with questions.
Jack2
And JIM, I’m not saying some regulation of pharma-promotion isn’t desirable. For this specific issue I don’t think gifts relate to healthcare as a special, “sacred” place. I think it just relates to how healthcare works at the nuts and bolts level.
When you buy a TV you look to find the one you want, you evaluate the cost, you buy it, and you bring it home and use it. In healthcare (mostly) your doctor picks the drug you get, (mostly) your insurance company evaluates the cost and buys it, and you (the patient) use it. That’s where the risk of corruption enters. The doctor isn’t buying the treatment.
But I also don’t think it’s fair to eliminate promotion. Frankly, the idea that all docs will read all the medical literature is overly optimistic. Someone on here likes to post “that if the drug was so great you wouldn’t need to promote it” or something…and I just don’t agree with that. Someone needs to tell docs about it.
I believe most doctors are trying to the right thing for their patient. But from a purely self-serving financial perspective a doctor needs to 1) not do anything so badly they get sued and 2) see as many patients as possible. Doctors are reimbursed based on volume. They don’t really have a financial incentive to learn about additional treatment options, even when they can benefit a patient. So if a rep needs to give a doc and his office staff a sandwich to get the doc to listen to his schpeal (sp?) I have no problem with that.
*I’ve got nothing against doctors, and again, I think they’re trying their best.
HorusCat
JiM,
$500? We can only give promotional items that are nominal in value and/or have a direct benefit to patients. So…I have little pin-jabber things to give away to test for numbness and alcohol prep pads because I sell a biologic. We have given away prescription guides before–like miniature PDRs. In 10 years, I have never had anything really neat to give away–nothing that you would want to take home and use for anything! The occasional kitzchy clock that has liquid sloshing around in it…penlights now and then.
As for docs needing reminders…docs are creatures of habit. They learn about certain drugs during residency and tend to stick with those until they have a compelling reason to change their habits. An honest doc will admit that to you. It makes perfect sense–even specialists have many disease states and many, many meds from which to choose. The brain can only hold so much detail–why not learn a lot about a few choice drugs and stick with those? As for all that internet learning that is supposed to go on….some physicians will spend a lot of time on the net, reading journals and doing CME. Most won’t–they have families and hobbies and lives just like the rest of us. After putting in a 10-12 hour day in the office (where they don’t have a spare minute to read a journal or browse the internet), they go home and worry about dinner and kids and paying the bills, etc. I have found that the docs who are really into extra learning are also the most likely to be early adopters with meds.
I think of a psychiatrist who used to be in my universe. Never talked to a rep. Never read a journal article. Never went to a dinner. Did the minimum CME. Only writes (to this day) Zyprexa and Clozarel. Could he have learned something from a rep selling Seroquel or Geodon or Abilify? At least the names of the drugs and how to dose them?
Docs don’t network and chit-chat very often unless it is as drug lunches and dinners. It’s not like you calling up your dad and giving him a stock tip or telling him how much you love your Saturn Sky. I have one doc who won’t let a rep bring in a speaker to the office (even from 1000 miles away) because he is afraid the speaker will poach his patients. Very weird.
The downside of promotional efforts is that they lead to overutilization of brand-name meds–who needs a brand-name anti-hypertensive or even a statin these days? The upside is that docs hear about new meds that aren’t me-too’s and that offer better efficacy, safety or tolerability. I happen to think that market forces (formularies, patients investing more of their own money in their care) could take care of the me-too’s, leaving the innovative stuff to shine.
About non-industry funded CME and research…exactly where is that money going to come from? I can think of only a couple of sources: private philanthropy (Bill Gates decides to fund ALS research, say) and taxes. First problem with either of those is that private philanthropists will pick diseases with “cache” like AIDS and ignore mundane, boring stuff. And government will ultimately make funding decisions based on cost/benefit analysis…probably leading to lack of research for diseases where treatment doesn’t prolong life. MS is a great example: in England, MS drugs are considered lifestyle drugs because MS patients by and large have a normal life span. Who cares if they spend their last decades in a wheelchair? Wheelchairs are cheap compared to injectibles. I would hazard a guess that the British government wouldn’t want to spend a lot of money on MS, knowing there won’t be a cure, but only more effective meds that reduce the burden of disease.
As for source #2–taxes. I don’t believe it is the government’s job to provide healthcare or fund medical research and education. Taxation is coerced funding essentially at the point of a gun. Not only do I view using taxes to fund medical research/education immoral, it is also grossly inefficient. We don’t need another federal bureaucracy soaking up 80 cents of every dollar as they try to figure out where and how to do medical research and education.
CMC guy
JIM/Jack2 the wrench analogy has an additional twist as I worked at a gas station during college. Vendors regularly stopped by to promote their wares (tools, oil products, shop equipment) and left trinkets and such with product logos (playing cards, pens, magnets). The owner/mechanic was always polite and honest (telling them to go away when he was busy which was pretty much always) and placed most the stuff in a bucket which usually went to occupy kids while waiting. I also don’t think it influence him much as he had been around a long time, knew what he liked and what worked.
I also think commonly MDs can be overwhelmed trying to keep up with advancements, which include more than drugs, and they are not as knowledgable as desired. Usually the best informed ones I have seen are the ones involved with pharma as consultants and/or clinical researchers so I would have more respect knowing they have been active beyond what they learned in Med School.
pg
Kathy, thanks for the explanation. All in all it seems a very well balanced view to me.
Former pharma Marketing Exec
Haven’t posted here in a while due to excessive traveling. What an interesting topic…
Small trinkets can not really be classed as any form of payola - so I agree with some of the posts here on that issue.
It really is the bigger stuff like paid speaking engagements, trips and co sponsored CME events that has the potential to cause bias. The reason being is that all humans like to earn their keep, or pay their way so to speak and doctors are no different.
However, it is the paid speaking engagements, trips and “research” grants that helps to keep the level of buzz fairly high on the product.
I am not going to comment on the results of the survey, the biases or the way it was conducted. Read through some of the articles here and we will find that research figures are being fudged, data is being with-held and all sorts of tactics are being used on a regular basis that obscures the facts and impairs decision making.
Let’s pretend for the sake of argument that the results of this survey are accurate. It would make sense to me that consumers who are stuck paying the bill would want to have a say on the expenses that re being incurred for the marketing of the products, if only for the reason of being able to see where expenses could be cut.
As for the comments about marketing a wrench - well, I’ve said it before and I guess I will continue to say it, patients are not willing consumers. They do not walk the aisles of Wal-mart shopping for an illness and the treatment to go along with it. I know this is a capitalist society we live in, but I do not accept that it has to be this way - it shouldn’t for the sake of humanity it must change.
I am not too worried about the trinket makers, they will find other ways to earn their money - besides they overcharge PhRMa anyway.
About Doctors being overwhelmed - really? That is a very bogus argument. If a drug works no one will have a hard time remembering that. If a doctor can’t remember what is the right drug to use, then it isn’t the fault of the marketing department of the drug companies. It is the problem of the doctor for not staying on top of his game. If there are too many drugs of the “me-too” genre that makes it difficult to know what to chose then there should be some sort of legislation.
When a drug is brought to market it is done so with clinical trials that serve as evidence of the drugs expected level of performance. Conveying this message clearly to the doctors is relatively easy and doesn’t really need all the fan fare, hype and wasted money that we seem to believe is necessary.
A further thing to think about with regards to doctors being “overwhelmed” - I wonder how they made it through med school, and then how did they cope with residency - the long hours, the lack of sleep etc….
To JIM’s questions, owing to my background, I have had long discussions with my doctor on the level of involvement with any pharmaceutical company and the potential for conflict of interest. Much like Dr. Helm, I balance everything he may suggest or prescribe and question the choices in an appropriate manner. There are definitely biases, this is the nature of human beings. Disclosing the biases is critical because it leads to important information exchanges that can only serve to improve the communications between patient and physician and perhaps positively affect the level of care a patient receives.
Hopefully we will have more of these studies. I wasn’t aware of the prescription project, but I will certainly look them up.
HorusCat
Former,
Overwhelmed med students and residents 1) were on the whole, young…I pulled all-nighters in my twenties, too; 2) make mistakes, some fatal; 3) have no lives–and usually no families, no money and no interests. They suffer through that torture willingly because they know it will end and they will begin to live again.
Your lack of understanding of how physicians learn about and then continue to prescribe meds is clear from your comments.
Yes, a physician will continue to prescribe a drug if it works. But first, he has to try it. And he has to try it many times before he will know if it works and for whom–especially if there is a spectacular failure in the first couple of tries. And he has to learn the little tricks with prescribing it that aren’t spelled out in the trials. And he has to learn what side effects to expect (not always clear from the data presented in a trial) and how to coach patients through them. Given all that, even a physician “on top of his game” can be forgiven for finding a med and sticking to it.
Talked to a doctor today who shies away from one of my drugs because of a couple of patient complaints back when it was launched 7 years ago. He didn’t know that it had been reformulated to reduce the particular side effect of which his patients complained. He also admitted that since the drug has a 25% market share in a crowded market, it must be pretty well-tolerated–so perhaps he shouldn’t have let a couple of patients’ experiences determine his opinion of a drug. He also didn’t know about the top-of-the-line patient assistance program provided–no journal would cover that, anyway.
I would describe this physician as “on top of his game,” in that I could see referring a friend to him. And he does listen to reps when he has time–it is just that he hardly ever has time, will only see reps at lunch; lunch is only on Fridays…etc., etc.
I think many physicians can learn useful information from their reps about a variety of products–information that they can’t and won’t find in journals.
Justice in MI
A small piece of a big discussion - CME.
As a doubly licensed mental health provider (even though I’m mostly a teacher), I also have CE requirements to sustain my licensure. The number of hours required is about the same for my M.D. pals; actually, a bit more given both licenses.
I purchase mine through relevant professional organizations or offered through local university professional schools. I assume the AMA passes on CME programs as “kosher” from their persective, is that correct? Does anyone know how thorough is that oversight?
Second, do any medical schools offer CME?
Welcome back, Former!
pg
I think you understand things rather well, Former, and also think you’re right where you say, for the sake of humanity things must change.
Former pharma Marketing Exec
HC - I used to pull all nighters myself - sometimes I still do, all to keep myself on top of the game. I am not a doctor but I am very involved in CME. Contrary to what you think, I would say that I am very aware and fully understand what doctors need in relation to CME. I would further caution you not to jump to any assumptions and premature conclusions as to what my level of skill is in this area. It is uncomfortable to read your remarks and makes me feel quite embarrassed for you.
JIM - yes, medical schools offer CME
pg - thanks for your kind words. Let’s raise a glass to change and bright possibilities!
Robyn
PW – “I doubt very much if a Doctor is really influenced by a promotional cup or pen.”
Studies showing the influence of gifts and other promotional contacts on doctors were summarized in:
Wazana A.
Physicians and the pharmaceutical industry: is a gift ever just a gift?
JAMA 2000 Jan 19;283(3):373-80
http://jama.ama-assn.org/cgi/content/full/283/3/373
Also, the potential to influence behaviour does not decrease with the size of the gift. “Considerable evidence from the social sciences suggests that gifts of negligible value can influence the behavior of the recipient in ways the recipient does not always realize.”
from Katz D, Caplan AL, Merz JF.
All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving.
Am J Bioeth 2003;3(3):39-46
Nathan
FPME writes: “Contrary to what you think, I would say that I am very aware and fully understand what doctors need in relation to CME. I would further caution you not to jump to any assumptions and premature conclusions as to what my level of skill is in this area.”
You’ve only been back on this site for one day and you are already starting in with the condescending attitude and vague references to credentials that you refuse to disclose. Some thing you say make sense, and it’s clear you have some sort of experience in this industry. But no one on this site takes your word at face value. You should know that by now! I think you’d have a whole lot more credibility if you told everyone a little about your supposed role in the pharma industry…
Welcome back.
Nathan
Kathy - thank you for your response. You write “But patients need to be confident that their physician’s prescribing decisions result from careful examination of all the independent scientific evidence, not from sales pitches sweetened with gifts.”
I agree. If we were talking about gifts of substantial value, then this makes perfect sense. But as far as I can tell, we are talking about coffee mugs and notepads, not TVs and Ipods. This hardly constitutes “sales pitches sweetened with gifts.”
Yes, free lunches too. But with as busy as most doctors are these days, lunch is likely to be the only time you can catch them without a patient! They aren’t exactly going to give up thier lunch hour unless there is food provided!
HorusCat
Former,
You didn’t reply to the substance of my remarks. I wasn’t talking about CME. I was talking about what doctors learn about meds on a day-to-day basis. You may be the world’s expert on CME (as Nathan says, who really knows?), but you aren’t 1) a doctor or 2) a rep. So embarrassed as you may be for me, you don’t have the experience I do when it comes to knowing how doctors may benefit from reps.
Since I have daily experience with physicians who are unaware or don’t remember that one of my meds has a certain indication, and since these physicians are surprised by the efficacy demonstrated in clinical trials, and since once they use it, they are excited about the efficacy, I trust my experience over your smug attitude. Were a physician to have attended a CME event about this class of meds (which I did a few weeks ago as the guest of one of my physicians), in 45 minutes of the 8 hour session he would have heard about current treatments for the disease state, with my drug being mentioned as one of many–no efficacy results given for any med and no dosing information. The rest of the session was devoted to cutting edge research, use of the drugs in special populations, pediatric applications, disease state stigma and quality of life issues for people with the illness.
The fact is that you have a strong bias against reps, and a particular animosity toward me, which you have shown in the past by trying to discredit everything I say, and then making condescending remarks such as, “makes me embarrassed for you.” Since I don’t question your understanding of the CME process, I would appreciate it if you would cease to question my daily experience with the mundane education of physicians about meds with which they may not be familiar.
Your assumption of your own superiority and your obvious disdain for pharmaceutical reps makes ME embarrassed for you. You fall right in line with the majority of people on this site who feel safety in numbers as they attack those of us who defend the industry, often with personal insults such as yours, and often much worse.
Your assertion that you know so much about what you do (CME evidently) would carry a lot more weight if you granted the same knowledge to people who do jobs that you don’t.
Lew
Kathy,
While the organization may not have a stated opposition to the pharma industry, I think tha you would agree that many of your public positions are in opposition to the public positions of the pharma industry. That being the case, the survey you sponsored was designed to support your policy positions. I have no problem with that. I just wanted to point out that your organization has a strong public advocacy position that needs to be taken into account when reviewing the survey’s results. Just because your organization has no direct financial involvement doesn’t mean that there is not bias in a survey your unwrite to support your positions.
Atlex
Former pharma Marketing Exec
HC and Nathan,
Here are some more credentials for you - several years as the top sales rep in a very large and competitive big Pharma. Then several years in product management capped off with a directorship position. Outside of pharma I have had many years of experience in CME planning with a IVY league medical school. I am very active in the field, just not working for big pharma anymore.
HC - How could I have any animosity toward you, I don’t know you. This is a place where discussions happens and opinions get stated - why do you personalize everything?
Nathan - Look through the posts. You and HC do not represent the majority.
What I post here is my opinion and is based on my many years of experience in the field. If it conflicts with your opinion, so be it, that is just the way it goes. However, I can say, I haven’t entirely disagreed with everything you have both posted.
We should honor the people who post here who do express anti-pharma opinions. Some of these people have been affected in very personal ways by some of the wrong doing that happens from time to time in this industry. Good for them to come here and share their experiences so that we can learn and hopefully make the improvements necessary. There isn’t any special rulebook of how one is supposed to behave when a family member or loved one is taken away because of an error or misconduct. Their voices must be heard, and we must listen and then we must do something about it.
That is all I have ever insisted on.
To the subject of this thread. Some doctors stay “interested” in industry sponsored events only because of the threat of the power the industry has to directly impact their practice through lobbying government and other institutions for various changes. Some doctors feel compelled to “entertain” a relationship with pharma to try to understand the objectives of pharma and influence it wherever they can.
I’ve had many interviews with many top docs in the field that I work in. Now that I am no longer in Pharma it is quite interesting to hear their candid remarks and what they are really thinking.
Now back to the subject of this thread.
Atlex
Former,,
Obviously, I’m in agreement with Horus and Nathan. Your experience inside pharma is limited and dated. A “directorship” in pharma is hardly a high level position. In most companies, marketing directors are MBAs with 5 to 7 years of post-graduate experience. They are hardly senior executives. Most directors don’t even have direct reports. Given that you only have several years in the field force, it doesn’t seem as though you had management experience there, as well.
Bottom line…while you may be able to convince others that you have this incredible “expertise” given your many years of experience and “high level” position in big pharma, you don’t get close to convincing those of us who currently work in pharma.
This doesn’t make your points invalid; but, for those of us in the industry, when you cite ourself as some kind of industry expert, we take your opinion with a big grain of salt.
Atlex
pg
Former, for what its worth I take your comments seriously and also believe that some of the statements you make will bring a sense of some hope and comfort to those people who have suffered grief or pain as a result of misconduct and thank you for that.
Raising that glass to change, bright possibilities and to people like you.
Former pharma Marketing Exec
Atlex,
Gee Atlex, why am I not surprised?
As for saying that I am an industry expert, well I have never claimed that. I have on your instance merely stated some of my credentials, not all of them.
Anyway, you, Nathan and HC are interesting characters. I look forward to reading more…
Cardiologist
Interesting discussion - mostly between Drug Reps and related professions it seems. Where are the doctors and patients? I am with PP, mostly. I actually believe that marketing execs at Pharma are very clever and they know where and how they spend the company dime - mostly on strategies that work, and yes, pens and mugs do work (you may want to check some references mentioned above). Of course, they may be all dimwits, in which case they should probably stop spending stock holders money on things that DON’T work…..
My partners and I have gotten rid of all pharma paraphernalia in our office and we do not see drug reps. In a break with the past, I do not go to drug dinners or eat free pharma food. Paid travel is out of the question. I may be a better doctor now, certainly not a worse on, I am a few pounds lighter. Maybe a few bucks are missing from my bank account - c’mon fellow docs, you can afford to spring for a sandwich! If we all picked up an unbiased resource like the Medical Letter, or even a journal, instead of listening to another sales pitch, none would be lost, and our sometimes quite corrupted profession would be better off.
I think the survey is as unbiased as they come - would PP publish it if it was not in their favor? Probably not, but I do not believe that my patients would feel comfortable if they knew I was cutting their visit short to ’squeeze in’ a rep or planning my next “consulting” session in Las Vegas.
HorusCat
Cardiologist,
Would your patients feel comfortable is your 2-minute meeting with a rep alerted you to a patient-assistance program that saved them money? There aren’t many cardiology drugs these days that aren’t available in generics, nor do many of the branded ones carry really hefty co-pays, but the same is not true in other specialties. The Medical Letter or a journal is not going to explain the details of a patient co-pay program, nor is it going to provide the details of a visiting nurse program, a 24-hour hotline to call for support of any kind (not just med-related), or put patients in touch with fellow-sufferers who have found ways to remain active despite debilitating disease.
Nor will the ML or a journal article persuade a physician to try a new med when s/he is perfectly comfortable using what s/he learned in residency. This is true even if a newer med offers significant benefits over older meds. Surely a patient would appreciate a physician trying a newer medicine after said physician read a few articles and then also talked to a rep to clarify dosing, side effects and the intangibles of patient experience.
One of the questionable benefits of being a rep is I get a pretty clear picture of who I would allow to treat me and my family and who I would avoid. Sadly, the former list is short–and it consists of those physicians who not only read journals, but those who talk to reps. I find that these physicians are usually those most willing to use a variety of therapies, not just one or two drugs they’ve gotten comfortable with over the years. Are there docs I would consider pharma whores? Yes. But there are an equal number of docs I would consider pharma dinosaurs, using outmoded therapies that have even been proven dangerous because these docs never bother to move outside their comfort zone.
It would be nice to think that careful reading and attendance at CME would be enough to spur all physicians to become familiar with new therapies–including non-medication therapies. Then reps would be superfluous. What will happen as more and more physicians consider reps and the industry somehow corrupt (and yet how could you practice without us?) is that fewer and fewer new meds will be used. Great! you say? Perhaps. But fewer new meds being used means less profit and less R&D. So I hope that the anti-arrhythmics you have now are sufficient. Probably we don’t need anymore anti-hypertensives; certainly we don’t need more statins. The cholesterol/heart disease/inflammation picture is pretty foggy–but we can probably get by without much more research in the area. After all, if you’re an interventional cardiologist, you make most of your money in the cath lab, anyway. Why would you want a $150/month med that reduces heart disease when you can do a $5,000 (or more) angioplasty?
And how about the conflict of interest arising from you cardiologists owning Heart Hospitals, and the orthopods owning Surgery Centers? The money you siphon off the general hospitals leaves little profit to be found to subsidize the less-profitable specialties. Not to mention the advertising done for big physician groups and hospitals. And the “studies” that show this or that Heart Hospital to be “among the Top 100 in the Country!!!”
The corruption/COI barrel is round, doc, and the self-righteous attitude becomes questionable when those of us who are not just reps but also patients get marketing phone calls from big cardiology groups (had a 30-minute marketing call just last weekend; it was fascinating–multiple, multiple questions about the local Heart Hospitals and where would I go if I had CV symptoms…) Exactly how is it that you are holier than I am?
HorusCat
And how interesting is it that most of the anti-pharma push comes from internal medicine and the specialties where not a lot of R&D is being done. Internists do fine with generics–99% of what they do involves diabetes, hypertension, heart disease and the pain and other problems deriving from obesity. Not much research being done there.
Of course, the $13 billion/year generated by Lipitor funds further research into what exactly it is statins do (who’d of thought that simvastatin might have an effect on prion disease?), since it is clearly much more than lowering LDL.
I find that I can see my docs in ways that doesn’t reduce the precious time they have with their patients. Bringing a cup of coffee by 10 minutes before they start office hours, a quick 5 minute chat at lunch, running into them in the hospital hallway and getting literally 2 minutes…and the time I can spend informing their staff of the ins and outs of patient programs, formulary access, etc. is invaluable to the patients. When was the last time you bothered to educate yourself about the formulary placement of every drug you prescribe? Do you even know which insurance plan each of your patients has? Or do just prescribe a med and leave it to your nurse to field the calls from the pharmacy when a product isn’t covered? How often does your practice spend the money to produce patient education materials to be placed in the waiting room…non-drug related material that covers issues like sexual intimacy and cardiovascular disease, nutrition and exercise, etc. I haven’t noticed the academic medical center I cover rushing to publish pamphlets dealing with the myriad of non-drug related issues their patients with chronic disease have to face every day.
Reps do much more than just regurgitate the latest clinical study.
HorusCat
Former,
Your choice of words makes it personal. It is possible even with mere words on a screen to come across as smug and self-righteous. For instance, calling Nathan and me “interesting characters.” Exactly what is an “interesting character?” I think of Howard Hughes as an interesting character, although since he was rich he merits being called “eccentric.”
Neither Nathan nor Atlex nor I have ever suggested that the anti-pharma folks on this site don’t have legitimate grievances. We have pointed out that we don’t accept their claims as prima facie evidence of malfeasance. We point out that no product is perfect, and also that bad things happen all the time and aren’t necessarily CAUSED by a drug that was taken co-incidentally. Without medical records, no one here really knows what happened.
We also happen to be proud of an industry that has saved lives and continues to save lives. Medical care today requires pharmaceuticals, period. Even if we all took care of our health–ate right, avoided toxins, exercised, took care of our spiritual/mental/emotional needs, etc., disease would persist. Much less of it, to be sure, but it would still be here. After all, our prehistoric forbears had no manmade toxins, ate whole foods, exercised in order to survive, evidently had robust spiritual beliefs, and still died when they were about 30.
About the worst you can accuse me and my cohorts here of is defensiveness. Defensiveness is not an admirable trait and can stifle constructive conversation, I will admit. Nonetheless, what I see in others on this site is a blatant hypocrisy–not one of them would turn down the newest antibiotic marketed by an evil company like Pfizer if they contracted MRSA from their local gym or subway car. Not one of them would say, “No thanks, I’d rather die” than accept a clot-buster when they have an ischemic stroke.
And defensiveness is not surprising when one is accused variously of being a liar, a murderer, or asked how one can sleep at night.
Nonetheless, as I have decided that since I leave this site on the whole feeling like someone has defecated on me, I am going to cease participating. I do enjoy what you have to say when you aren’t being patronizing, and you are welcome to email me at cathorus@yahoo.com.
laura
HorusCat,
I’m sorry to see you go. Even though I don’t usually agree with your opinions, I value your insight. I hope you aren’t leaving because you feel that all on this site who disagree with you accuse you of being a “liar, a murderer, or an ‘insomniac’” ;). I think there are a few who tag you in that way, but most of us understand that this is a forum where ideas are exchanged and opinions are expressed. We all have our situations and motivations and, if we can look with empathy at each other, some very significant discourse can occur.
Dr. Sal Giorgianni
I believe Ms. HoursCat is used to ernest discussions and spirited debates but, as I do, I suspect that she would far prefer a modicum of civillity from all bloggers to guide these posts.
‘Tiz a shame.
truthman30
It is a shame that you are leaving HorusCat and contrary to what you might believe, I think it would be a shame if you were to go.. your insight is very valuable here, and although we disagree most of the time, I do think your input is for the most part, intelligent, interesting and concise…
Also I would just like to clarify, I am and never have been anti-pharma, yes I am vocal about Paxil and the issues which come with that but I am not anti-pharma or anti-drugs. What I would like to see though is an ethical industry which puts patients before profits as I think that is in everyone’s interest…
We all need access to safe drugs and the industry should always put safety before profits and maybe if people like myself and others didn’t speak out nothing would ever be done..
I do hope that the because of the efforts of the many voices of change one day an industry which values humanity and ethics above all else will be the “norm” for future generations…
Little ripples can become waves ..
Nathan
Horus,
I’ve come very close to giving up on this site a few times. But Truthman, pg, and FPME seem to know just the right words to say to get me so pissed-off that I can’t help but chime in… It’s funny, but when I take breaks from this site from time-to-time, I realize that most people are not generally anti-pharma. This site just seems to attract them somehow. Part of it (sorry Ed) is the stories that Ed chooses to run.
I often come away from this site completely bumed about the line of work I entered. Partly from the conversation on this site and partly from the negative stories I have to read every single day. (Ed, do you think you could pick one day a week as a “positive” day and only run feel-good stories about the good the pharmaceuticals accomplish? ;-> Ha! That’ll be the day!)
Anyway, like the others, I’m sorry to see you go - but I certainly don’t blame you. Let me know if you post on any other sites. I enjoy reading your insites. I get to hear pharma research perspectives all the time, but I almost never interact with people on the marketing end of the buisness.
Best of luck.
Bob Freeman
It would be a pity if you left, HC. You will be missed.
HorusCat
Nathan,
You can always email me at cathorus@yahoo.com. I will respond to anyone who emails me in good faith. I am thinking about starting my own blog, but not sure I am detail-oriented enough to pull it all together. I enjoy the back-and-forth on a blog–as Dr. Sal puts it: earnest discussion and spirited debate. I just don’t ken to being called a baby-killer. I did like Jesus Freak, I have to say, although truthman meant it as an insult.
Anyway, I’ll check back in now and then, I just won’t be posting. And maybe coming soon to a website near you…
Jaynesday
HC,
It is a shame that you have been so offended by some. How easy it is for us to use words in a mean spirited way. The power of the word can be very, very good or equally bad. It is our choice.
There are so many good things that can come from this kind of communications but obviously it has its weakness. That weakness only originates in our hearts and is often a selfish desire to elevate ourselves above others. When we do this we destroy any really meaningful communications.
I am sure that if we met person to person we would never be so bold but in this kind of forum we can only see the letters on a screen. With anonymity sometimes we act like children, I admit, myself included; but what a loss when we cross the line and allow our emotions to destroy our connections. I remember Ed framing this forum as a lawn party. How different we would act if we came here with that mindset.
Sorry for being so preachy but HC you will be missed. I don’t think that I would be so interested in visiting this party if all I heard was one side of the story. I really want to understand the pharmaceutical industry and your insight has helped.
Thanks
Justice in MI
In the usual interest of being a contrarian - I have already expressed, and mean, my regret that HC is leaving. And I am honored to have (at least mostly) been on her list of relative good guys, despite our different perspectives.
But I will say that no one here has been above, or below, flaming and personalized attacks. That was, frankly, my view of HC when she first arrived. I believe this site contributed to her own sense of wider possibilities. I suspect she gained from that, just as most of us have since gained from her.
If, now, it is curtain call I suppose I can’t help but see it as a kind of full-circle. If there have been, and continue to be, direct and personal attacks, of course, I do understand. There are folks who visit here to whom I would not engage in discussion, and - trust me on this - they are as often on the (relative) “anti” side re: the industry as the “pro” side. As I look up this thread, I see ad hominem attacks on several sides and fronts.
People who do this persistently can be avoided. And direct, off-the-wall attacks (I’ve experienced a few) can be responded to directly. It’s hard for me to understand what is gained by ditching a whole site because of these episodes, but wudda I know? Maybe (and I mean this) I have missed some of the more hostile responses.
So a good night to all, and I hope onward and forward as much as we are able.
Ed Silverman
To All,
In response to some private notes, I’d like to share a few thoughts that, hopefully, some of you will find helpful.
First, as a journalist, the one responsbility that was new to me when this site launched 18 months ago is the role of moderator. Unlike TV talk shows, such as Meet the Press, the format and medium are obviously different, so I have been feeling my way ever since.
In general, my approach has been to let grown ups act like grown ups. I have never seen the benefit in playing school marm and enforcing a vague set of rules on people as they go about having an informed discussion. Some of you may recall my analogy to the sprawling lawn party where different discussions take place simultaneously, and one is free to flit and listen and chime in when the urge strikes.
Unfortunately, the possibility exists that, at times, unnecessary language or schoolyard namecalling can take place at such gatherings, which can have the affect of throwing a wine glass at the lawn party.
To an extent, this is predictable. Pharma is a challenged industry right now and its many problems - pipelines, patents, promotion, pricing and safety - are hot button issues for our society as a whole. The discussions that take place here reflect those concerns and, I suspect, will continue for some time because the solutions do not appear to be right around the corner.
That said, I would like to encourage everyone to address others with a degree of civility. What does that mean? Speak to others in the same way you want them to speak to you. This is a gentle reminder and is not directed at any one individual. The emotions that pop up in the debates here do cut both ways.
As a journalist, I learned a long time ago the notion that it is possible to learn something from each and every other person. This forum offers one such possibility. Enjoy it.
Regards,
ed
HorusCat
To all,
I appreciate the kind words. I take full responsibility for my part in adding to the rancor. Especially when I first got on, I used very inflammatory language. The editor in my frontal lobe only works sporadically (as my husband points out frequently) (and no, truthman, I don’t think it is the Zoloft; it is the J****** gene shared by an entire family tree of blurters).
Recently, though, I have tried to modulate my language. In response to things posted by pg, truthman, Lisa Van S, AA and others, I have re-thought my position on the rampant use of neuroactive medications. Hence, my recent use of words like “judicious” when advocating the employment of neuroactive drugs. I have also repeatedly noted that I and my counterparts never promoted Zoloft for childhood depression, nor did we advocate the use of antipsychotics in children. I did try to note that there may be instances where such use is warranted–as the mother of a special-needs child and as a person who has spent time in medical waiting rooms (both as a rep and as a mom with a kid), I have learned to be very cautious about criticizing the decisions another parent makes for his/her kids.
What I perceived to happen was the more common ground I tried to find with the more vociferous posters here, the more assaultive their replies got. Perhaps I need to get a thicker skin, but right now, things are very tough with my son (as we try to REDUCE the meds he is on) and anti-pharma sentiment is growing at the academic med center where I work. I am an Eeyore by nature trying to evolve into a Tigger, because I think that Tiggers are more fun to be around and generally are happier people. Being called brain-damaged and delusional, child-murderer, greedy and selfish doesn’t enlighten me, it just effectively shuts down the argument. It is a conservative being called “mean-spirited” or “racist” when he advances an argument–instantly you are put in the position of proving you are NOT whatever name you’ve been called, instead of being able to put forth reasons why you hold the position you do.
I will continue to lurk–this is the best site I’ve found for pharmaceutical discussion. I value the anti-pharma leanings more than I value the pro-pharma stuff on other sites, because the only way those of us in pharma can evolve is by hearing what the other side has to say.
As I’ve noted before, anyone (you too, truthman) is welcome to email me at cathorus@yahoo.com. If it’s a civil email, I will respond. In the meantime, perhaps a breather and a chance to get things under control with my son will lead me to reengaging here in the future.
Thanks all.
HC
Justice in MI
Just a word to say I appreciate how many people - myself and HC and others - first come to Phamalot thinking it is some sort of wrestling match. But, if we are lucky (and most of us are), we learn it is a unique opportunity to learn from people who, way too often, write each other off as not possibly informed, smart, trained, mentally balanced, etc. enough to engaged in useful dialogue.
The great majority of times, we have succeeded when these prejudgments have been transcended. As I said recently (to HC), that is the grace and uniqueness of this site. We have had some truly amazing and useful discussions. As far as I know, of the sort that one virtually never finds on these issues.
There are a solid core who are committed to keeping it that way, and letting new folks know that if they enter the room with guns blazing, without even knowing whether there is a war on.
Once again, onward.