“They might not be training the peds to rx the drugs, but parents who have them recommended by a specialist will ask the advice of their ped or other physicians. As a parent who has been told, “I would not give this to my child”, I can see ped rheums wanting/needing peds to be on board.”

I think you are correct that kids with rheumatologic conditions need their PCPs to be on board with the rheumatologist. I have exactly two pediatric rheumatologist who I trust - they are also the only two PEDIARIC rheumatologists for several hundred miles (fortunately, they travel to satellite clinics).

I know that if one of ‘my’ rheumatologists has prescribed an anti-TNF drug, they believe this child has severe/aggressive enough disease to warrant the use of these medicines. That is because I know how conservative these two are. If the child is treated by an adult rheumatologist, MY reaction is more likely to be “why don’t we get a second opinion?”

Another principle from medical school (and life) is that “a little knowledge is a dangerous thing.” Pharmaceutical marketing (and sales) is geared to deliver just enough information to make doctors (staff and patients) FEEL that they have sufficient understanding to confidently prescribe medicines.

The newer medicines in particular (ie the ones subject to the most promotional push) are generally not well-studied enough to justify the degree of confidence placed in them. This also applies to new indications (such as for pediatric patients)for older, but still “on patent” medications. FDA approval doesn’t generally mean that you can stop worrying about individual risk-benefit factors, and which of several choices should be the first-line approach. Nevertheless, the presence of educational pamplets for arthiritis treatments in your pediatrician’s office is evidence of a marketing push to make anti-TNF agents a “first-line” choice even in pediatrics.

The marketing problem of “confidence,” and the “little knowledge” issue, in my opinion, are the reasons there are still (and likely always to be) drug reps. There is too profit potential which would be lost if drug adoption was dictated by clinical experience and good science.

Wow. I have been puzzled all week over the “Arthritis” patient/caregiver educational material piled on all the tables in our ped’s waiting room. It seemed so out of place, I took one so I could identify the source later.

They might not be training the peds to rx the drugs, but parents who have them recommended by a specialist will ask the advice of their ped or other physicians. As a parent who has been told, “I would not give this to my child”, I can see ped rheums wanting/needing peds to be on board.

;-)

condescention

By the way- It seems that there used to be this little form which patients had to fill out and sign before their cases were discussed with an outside party. Avoiding a name and speaking in generalities is not enough. The reason being that it is not in the best interest of the patient for a drug company to have someone’s records to try to dispute a problem with a product. Electronic records are going to be a huge problem in this area. As it is- FDA cherry picks info out of reports- reducing the complexities of a situation.
We really need our doctors to protect our information. And it is their information too, as everything they have done may be equally scrutinized.

As a physician, I see danger in doctors treating conditions about which they know less than the drug rep. I do not believe that it is a service to train primary care doctors on how to prescribe anti-TNF drugs (just for example) or other specialty/orphan drugs. There are many medications/ treatments which should be left to the specialists. (For the anti-TNF drugs, it is not entirely clear that these offer a significant benefit over “standard treatments” in rheumatoid arthritis. As usual, adherence to treatment is more likely a greater factor in outcomes than the actual choice of treatment. Nevertheless, it seems that anti-TNF treatment is being positioned - in the US anyway - as the first-line treatment.)

As a pediatrician, I may understand the indications, value and mechanics of a ventricular-peroteneal shunt, but I’m an idiot if think I can put one in. Similarly, if a newborn screen indicates an inborn error of metabolism, I make the appropriate referral. I know the folks to whom I refer these patients have a greater understanding of the disease and treatments than I. I’m also confident that they know more than the drug reps. I also accept that the patient families affected by a few specific, rare conditions will likely know more than I do about it, even if I have read everything I can find. In other words, I hope that both of you are wrong about the MD knowing less than the rep. I would advise any patient being treated by such an MD to find a smarter doctor.

I was taught that there are key concepts to practicing good medicine. Among others, these include to: 1) know what you know you know, and know where to find (or - not as good - who to ask for) the answer when you don’t know, 2) remember that half of what we think we know about medicine today is utterly wrong, 3)never be afraid to say “I don’t know,” but whenever possible follow this with “But I will find out.”

I agree that pharmavet’s question about the cost of Cerezyme would be an appropriate question for a drug rep, but if the doc needs a pathophysiology/molecular biology lecture, they’ve got no business trying to treat. Another possibly appropriate question for the drug rep in this situation might be “who treats this condition more in this area than anyone else?” Though even that answer will likely be skewed if there is more than one treatment for a condition.

Egads!

Trust your patients. No one knows better what they are experiencing and no one will do more research than those looking out for their own welfare. This relationship is a partnership. Doctors are advisors long before they are healers. Whether or not your advice is taken depends on trust. Condecension is a huge mistake. One that drug companies make regularly.

The doctor doesn’t need your expertise to find the medical information he needs. I think that four years of med school, four years of residency and two years of fellowship have equipped him on how to use a medical library or do a medline search. The questions I have posed above are those that he/she is more likely to be interested in.

Caveat Emptor - patients are led like lambs to the slaughter in many cases. Doctors who do their own research and are innovative leaders are few and far between.

Do you homework, the only one who really cares whether you ever recover is you.