Most Docs Remain Positive About Pharma Marketing
35 CommentsBy Ed Silverman // June 24th, 2010 // 9:03 am
Forget all those policies about limiting marketing activities aimed at doctors. A new survey in the Archives of Surgery finds that 72 percent continue to have positive attitudes toward various marketing overtures, including small gifts and lunches, although the docs who were familiar with institutional rules on industry interactions reported having fewer positive feelings (here is the abstract).
The upshot: surgeons, trainees, and those unfamiliar with institutional policies interactions held more positive attitudes than others and were more likely to deem some gifts appropriate, including industry funding of residency programs and, among surgeons, receiving meals, travel expenses and payment for attending lectures. Nonattending physicians held more positive attitudes toward receiving meals in clinical settings, textbooks, and samples.
Most agreed that industry educational materials and industry funding of education are useful, although 68 perceive bias in sponsored lectures. Most believed it was acceptable to receive gifts and lunches, and few thought that sales reps should be banned from meeting with docs. Not surprisingly, 52 percent say their colleagues are more likely to be biased prescribers if given free food or gifts, compared with only 36 percent who believe they would succumb to temptation themselves. Meanwhile, 71 percent say industry funding is useful for financial medical school programs and 60 believe industry funding is good for underwriting residencies.
The survey canvassed 590 physicians and medical students at the Mount Sinai School of Medicine, which operates several hospitals in and around New York City. Of those who participated, 39 percent were attending physicians, and 23 percent, excluding medical students, were from surgical specialties. The authors conclude that attitudes will not change until “the culture of medicine rejects industry marketing interactions more fully.”
“The disconnect between physician and public attitudes toward industry may relate to the microenvironment in which US physicians practice. Studies of medical students and medical residents have demonstrated that trainees develop increasingly positive attitudes toward industry over time, presumably because of a ‘hidden curriculum’ in the culture of medicine that communicates the acceptability of industry contact and gifts.
“Restricting contact with industry representatives has been shown to have a long-lasting effect on medical residents, resulting in more negative attitudes toward industry interactions even after the completion of training. The positive attitudes of physicians we surveyed are likely to reflect the continuing acceptability of industry interactions and gifts within the culture of medicine despite changing guidelines.
“Physicians in practice continue to speak frequently with industry representatives, and academic physicians enjoy food and other industry gifts when they attend continuing medical educational events and national specialty meetings. Although other groups have found that education about the effect of industry contact may have a modest effect on physician attitudes, physician attitudes are not likely to align with those of the public until the culture of medicine rejects industry marketing interactions more fully.”
SteveM
Re: Most Docs Remain Positive About Pharma Marketing
That’s akin to saying that most kids remain positive about Christmas.
There are now plenty of information vehicles to convey unbiased medical information to physicians. The Big Pharmaco-Marketing Complex should be made obsolete.
If doctors can’t or won’t continue to educate themselves about best clinical practices unless they are rewarded, are in the wrong line of work.
Mark
Embarassing–as a physician I believe we can (and should) do better. Look for non-partisan, non-branded ways to get your CME and keep your education current, and lobby your state and national organizations to develop policies separating docs from PhRMA contact.
pharmavet
My impoverished medical student roomate was greatly appreciative of the medical bag provided free of charge by Lilly, the stethoscope provided free by Littmann, and the ophthalmoscope and otoscope provided free by Welch-Allyn. I recently spoke to him about these issues and he told me that these items had absolutely no influence on the drugs he prescribed or the instruments he used. So let’s cut these guys a break.
pharmavet
BTW, Mark, would you boycott a Grand Rounds in your specialty just because lunch was provided by a Pharma rep. Or would you refuse the food and be hungry the rest of the afternoon when your patients need for you to be at your best?
Justice in MI
Good article in today’s NYT about the University of Michigan’s decision to ban CME sponsored by pharma. UM was also one of the first academic medical centers to keep detailers away.
Every study on these issues has shown the same thing: (1) Docs say that gifting (and sponsorship of CME doesn’t impact their rx’ing. (2) Objective measures show conclusively that they do. (Not for everyone, obviously, but proportionately.)
Medicine has to decide whether it wants to be an integral part of pharma marketing or not. So far, the answer is a long way from “not.”
Justice in MI
Re: boycotting, there are a lot of poor and hungry medical students and house officers (”No Free Lunch”, etc.) who have made precisely the decision Vet describes. As far as I know, there is no evidence that patient care has suffered as a result.
Confused
Justice in MI how would you know if patient care had suffered? Also are you in favor of banning patient advocacy groups, AARP how about large Medical Intuitions that hold undue sway over the local medical providers such as the ones in Ann Arbor. Do you protest against lobbyist in government? Where you do you draw the line?
Former Pharma Marketing Director
Well, just my two cents, but if a doctor can’t figure out how to take a few minutes to feed HIMSELF/HERSELF then we have bigger issues going on than we would like to admit….
We were all once poor starving students, we figured out a way without the graft….
Just saying….
John mack
In case you didn’t see this:
Survey That Rewarded NYC Physicians with $100 Gift Card Concludes Physicians View Pharma Gifts Positively. Duhhh! http://bit.ly/b232SN
It pays to read the small print!
Justice in MI
Confused–You have, indeed, confused _me_?
What does lobbying have to do with gifts-to-docs and industry-sponsored CME?
What are the big institutions (I assume you meant that, not “intuitions”) that are controlling medical practice in Ann Arbor? The IHA? State medical society?
Re: line-drawing, I think Howard Brody’s analysis and recommendations in _Hooked_ provides a pretty good guide.
None of it has anything to do with lobbying, AARP, etc.
Please do explain.
Anonymous
“Number of CME providers on probation doubles from last year….”
http://tinyurl.com/2eawcb3
pharmavet
I might skip the donuts and pizza myself since they usually are loaded with fat and sugar. I have yet to see Ceasar Salad at a Grand Rounds. They used to be interesting in the old days when the lantern slide viewing of the cancerous lungs was obscured by the wafting of the cigarette smoke from the doctors toking in the background.
M. Black
The product sells the drug. If it’s sold by anything that related to any kickbac ( including a box of animal crackers should be tarred, feathered, put on display, then burned. We’ve been comIng back to this time and time again. It must be mandatory for anyone that effects thought by a doctors (who, by the way went throuh 8 years of hell to get to where they are) should have at least a backround in at least one science. This is one type of “Rep screening” which shoes that they have the intelligence need to even talk about anyhing drug or scientific related manner.
The risk of changing a doctors perceptive, triple blinded (their bosses have bosses too..,) is way too risky to put this into the hands of cheerleaders who were high school dropouts in the past. Yes, I know this to be factual.
The same person also trumped sarcastically “let’s see a chemist try to land a job in pharma sales.”. So very far from the industry as it should be. Chemists, Biologists.
Non orthopedic doctors for the most part think reps are jackass tools.
~ M. Black
Salient point
It’s possible that a lot of the industry expenditure here is competition-driven, as in, We need to do it because the other guy is doing it. Wouldn’t be surprised if some industry folks would be happy to lop these costly line items off their budgets if they knew all the other guys had to lay down their arms as well.
Also wouldn’t be surprised if the doctors & med students benefiting from this largesse would be more unhappy with this development than they’re letting on.
Justice in MI
Totally agree that most docs and med students like the free stuff. Who wouldn’t, especially if you’ve grown accustomed to it? And then there’s everyone else in the office, and their families! I have a whole collection of chotches from the days when my significant other was a psychiatric resident. My fave is still the Haldol paperweight.
re: cme, here’s the link to the NYT article. I think most folks here will find it pretty balanced.
http://www.nytimes.com/2010/06/24/business/24meded.html?emc=tnt&tntemail1=y
pharmavet
I think that sometimes the marketing influence is over-rated. I have informally surveyed a couple of dozen physicians in focus groups. The question is 2-part: 1) Name the 10 most frequently prescribed drugs in your practice; 2) Name all of the drug companies that market those drugs. By my calculation the average number of correct responses provided is approximately 3.5. This is perhaps something that pharma critics can “chew” on.
Doc
M. Black - spot on. The vast majority of pharma reps have MAYBE Biology 101 as their “science background”.
randy brown
you don’t need an MD to be able to discuss small number of diseases and products. it would be helpful but most of the science , not all, doesn’t really matter anyway.
does the medicine work? what are the side effects? who has been studied and what are the indications?
those are the issues that matter. and you don’t need 10 years of training to know the answers.
if you worry about pharmacology, metabolism, excretion, etc. you’re just making it too complicated. it doesn’t have to be.
and that’s why just about anybody can converse about it.
as long as you have studies which answer efficacy and tolerability, the rest is irrelevant.
something for the pharmacists to argue about.
Greg
Oh come on docs get off you high horse. All reps are college educated and some have strong health care backgrounds suc as physical Therapy, etc. sure not all reps are great at what they do but thats the same in medicine too. One doesn’t have to have a medical degree to know a disease state and learn how the disease is usually treated. What? For instance one can’t learn how asthma is evaluated with Fev, pft ,etc and treated with beta agonist , inhaled Corticio steroid, Oral steroid if severe. I mean come on as a rep I’ve been selling asthma drugs for years. You think I don’t know about it to talk intelligently as a rep??? As a matter of fact some of your doc primary care counterparts treat asthma first line with LABA. Wow see not so smart and he has a medical degree. Wow even against GINA guidelines. Anyways Remember reps only focus on 1-2 diseases and drugs classes out of thousands so it’s not very difficult to understand. We don’t treat patients nor do we have too. So please you don’t have a monopoly on medical knowledge and get over yourself
Greg
Wow its amazing how regulated you physicians like to be. Wow a rep talks to you oh my god it’s the end of the world ha ha . Let individual docs make up their minds about industry. If docs don’t want to see a rep in a hospital that their decision. It shouldn’t be imposed on them. I used to work in health care and I’m educated and adult enough to make a decision whether I want to see a rep or not. Our whole country is being so over regulated on everything we do. I wish you docs would take a stand and use your own judgement. Do you like being told you cant eat a lunch, take a pen, or a post it pad??? Or you cant go out to a dinner??? I wouldn’t like it one bit
pharmavet
Randy, I hate to break it to you but most docs take the reprints you give them and toss them in the circular file. They know the studies that you so capably discuss are biased. I know that for a fact for I worked in Big Pharma for 28 years in clinical development, and can therefore can tell you that Marketing will not sign off on a protocol, especially a Phase IV protocol unless the dice are loaded in their favor. Doctors you speak with base their prescribing decisions on their personal experience with the drug, not on the script you have committed to memory.
harpy
“Participants believed that other physicians were more likely than they to be influenced by industry marketing (284 [52.2%] vs 194 [35.6%]).”
fools.
I find it illuminating to review a company’s rules on their own people receiving gifts. you’ll find most don’t allow it at all. I wonder why that would be?
shhhhh
I have an adorable little wooden table and chair set perfect for a little girl’s tea party, handed down to my daughter from the daughters of a physician. He received it from a drug rep. Some of the gifts are way more personal than pens and notepads.
medo
Wow. I think the most salient point of this article is that the authors are highly concerned about the “disconnect” between the public opinion and the their own internal opinion. Amazing. What greater proof does one need that physicians are truly sheep(conformists) that are easily lead to their own demise by people such as lawyers and politicians. How else can you explain that physicians would willingly let the government determine their income for 40+ yrs. Even a plumber would never do something so stupid. Imagine your local tradesman like an electrician falling for such a reimbursement scheme like Medicare.
As a ten year pharma vet who is married to a highly qualified specialty physician, allow me to weigh in on some of the nonsense here.
First, physicians are highly educated–within a very narrow field. Most know virtually nothing about economics, business, law, etc. Along the line of a previous rep comment, how feasible is it for a reasonably educated (college, most are science related degrees)to learn a narrow disease state and become a credible resource to the physician? I would say as feasible as it is for your own primary care physicians to practice medicine that is way out of line of national treatment guidelines that your own expert physicians created. Hence the need for my profession.
As for the wrongs of industry, ie gifts, absolutely this occurred (note the past tense.)Most of what this article and conversation discussed is ancient history, over 5+ yrs. In fact, for several years not so much as a pen is allowed to be gifted by industry rep or recipient. Go to an office, good luck finding enough pens.
As for the reps, they are like any other industry, full of good and bad. Like doctors who accost reps for payments or gifts, ask any seasoned rep, it happens. Pharma’s greatest crime is its overexpansion, an onslaught of reps at offices. It lowered standards, increased the number of bad apples. Financial pressure combined with physician backlash has mostly rectified this situation; again, a lagging not an ongoing issue.
I could go on…I guess my final thought is this…I would caution any physician about overconfidence, arrogance and a rush to scapegoat pharma reps. I get that the typical consensus seeking, conformist physician mentality is concerned about undue influence. I don’t get that you casually allow such “inferior intellects” as lawyers and politicians to thoroughly dominate your profession. Ponder that ethics question the next time you waffle over a treatment option: the highly reimbursed, but less safe procedure versus a safer, conservative, non-invasive therapy? Or, when you would like to alter your fee schedule(up or down) in the patients best interest, but you can’t or face medicare fraud prosecution by the aforementioned lawyer. Is the gorilla in the room the government/legal control of your profession? or, a little drug rep pen? Think about it. Perhaps it is your very nature, a psyche of conformity and submission to control mechanisms.
Just some food for thought from an inferior intellect, liberal arts educated pharma rep.
pharmavet
Gosh, Medo, brevity is certainly not your specialty (mine neither, but I’m not a rep). How do you ever manage to deliver that 30 second commercial that used to be called detailing? You probably hope that the doctor chews slowly on that pizza your brought him, since that, and certainly not your professed scientific expertise are the keys to his kingdom. And BTW since you accuse us of being anachronistic you should know that it’s been a long time since mostly science majors were drugs reps. That disappeared a long time ago when companies like Lilly quit hiring pharmacists that were too expensive. I do commend you for talking like a doctor, although those of us such as myself who are actually doctors can separate the wheat from the chaff. I also commend you on your ability to make a $500 off-the-rack HSM suit look like a $2000 Zegna. Spending 2 hours/day at the gym helps you fill that suit out nicely. A little less hair gel please, however. We don’t want it dripping on the magazines that the patients are reading in the waiting room while you deliver your 30 second oratory to the pizza-munching physician.
You are smart enough to know however that your business is moving towards contract reps who will not receive your bloated salaries and benefits.
Greg
Seems like we have an MD thats jealous. Well you should be since under obama care you’ll be a gov’t employee.
pharmavet
Sorry, Greg. Maybe I forgot your favorite term of endearment: Reppie. BTW, hold the anchovies on my next pie, and hold on to your seat as well when you realize that you’ll be paying $14,000/year for health insurance for a family of four if and when you are a contract rep. I may ultimately be a gov’t employee, but at least I’ll have a job. That’s what a real degree from a real university will get you, not a BA in Communications from State U with a minor in binge drinking.
Don’t wear out those Florsheims standing on the unemployment line, Greg,. Good luck, reppie.
Cheers
SteveM
Re:pharmavet
Elitist insults absent panache are completely banal.
I hope the intellectual mediocrity does not extend to your practice of medicine.
pharmavet
Hi Steve. What does “panache” mean? My degree is in Physics, not English. Besides, working 80-90 hours/week doesn’t leave me much time to get to the dictionary. I try to decompress a few minutes each day on Pharmalot, but the banal comments of the apologists for the drug rep industry leave me wanting for real substance.
I do agree with you on the elitist part, however. You are spot on with that one. As for intellectual mediocrity, patients are generally not interested in witty banter or idle chortle. I do admit to cutting the class on bedside manner, but at least my dog loves me. It might have something to do with the treats.
SteveM
Re: pharmavet
panache: dash or flamboyance in style and action
My degrees are in Chemistry and Applied Mathematics. Fortunately, the work leaves me plenty of time for dilettantism.
I dunno. I suppose your patients may not expect witty banter or idle chortles. But they probably don’t expect misanthropic exchanges either. Too bad for them…
P.S. misanthropic: marked by a hatred or contempt for humankind
MsPiggy
Doc’s can’t help but defend their BLING BLING, no matter the cost to their profession
pharmavet
Thanks, Steve. With your degree in Applied Mathematics and mine in Physics, perhaps together we could write an equation to describe my misanthropic behavior, which like Pi would an irrational number.
Ms Piggy, the only “Bling Bling” that I wear is my Phi Beta Kappa key, a society unknown to many of those of dubious intelligence and anti-intellectualism, who unfortunately frequent these boards more times than not.
Mark Lee
What an interesting discussion. As a former nurse, lifelong self student, and current Alpha Beta Kappa heading toward a career in research and writing I find this discussion vindicating. As a former nurse (predominently female oriented at that time) I was gladly accepted into the “men’s medical club.” Drinking like fish out of water (among other activities) was the major weekend activity. I knew residents who were so badly hung over on their rounds I have no clue how they could remember their names! Only to be scolded harshly a few years later when adolescent onset Cystic Fibrosis caused me several attacks of pancreatitis.
The small college town I am in now has never heard of such a thing. They see no reason why I should be in such pain. While former classmates treated me correctly with enzymes, controled release Morphine (as I make none of the endorphin/enkephlin series), physicians at the prestigious Mayo Clinic felt an SSNRI was appropriate treatment. As well, no enzymes were prescribed, nor was vitamin replacement. Wondering why I could get no treatment around this little town, I requested my records; that is how I discovered my diagnosis.
How dare I drink with them with such a disease was the gist of what I was reading. I must be dependent on alcohol (U of I was the last time I drank, period). Oh but they made sure to put it in my records.
Now, without some major salesmanship, can someone please tell me how serotonin toxicity in the CNS and Norepinephrine (the autonomic nervous system’s fight or flight response neurotransmitter) will help me in ANY way? Or how this will help chronic biological (CNS damage from a fever when I was 4) anxiety? Or help me to produce the enzymes I am lacking? I watched him look up preferred medications from his Eli Lilly pocket PDR. This form of treatment was sold to this physician like snake oil of old! It’ll cure what ails ye’.
My misanthropic behavior ended when I was found out as a nurse. I am too proactive in my treatment to allow salesmanship treat me with serotonin intoxication (LSD), or norepinephrine (speed). Or to endure cortisol increases with my condition (a well known side effect). I now have to go to Minneapolis for the correct treatment. This is criminal and puts an added stress that I do not need.
My first project will be to find and create a potent endorphin/enkephlin series stimulant. I make none, exercise junkies and people with naturally high pain tollerances make high quantities. There is an easily discoverable/isolatable compound in the offing here! A real pain reliever that no physician need fear prescribing! A real end to addiction, tolerance, and no BNDD controls!
Any interested takers? I assure you serotonin, norepinephrine, nor dopamine are it! Pain (chronic) depletes many things from the body, do not let that fool you!
pharmavet
Ground Control to Mark…
Roget
Conceited - “having an exaggerated opinion of oneself or one’s achievenments”