In his recent NY Times Magazine piece, Danny Carlat confesses to have taken 30k from Wyeth for ‘educating’ physicians about Effexor. Way to go, this takes a lot of courage. Read some of the comments he received on his Blog, or par example the WSJ health  blog, and you know why. He was called a ‘cheap thief’, ‘hypocrite’, ‘pathetic liar’. However, I admire him for his chuzpa without hesitation! What we need in healthcare is more physicians like him , and less of the all those physicians that have relation(ship)s with the pharmaceutical companies, to compromise their ethics.

 Do I say that there should be no marketing? No. The pharmaceutical industry has developed great drugs and they have every right to be proud (I am not counting the myriad of “me too” drugs, obviously). They need to be sold and thus marketed. But I expect more ethics from them than from a sleazy used car salesmen. If you buy  a Hummer, the slaesman probably won’t voluntarily discuss MPGs. With gas at an all time high, that does not sell well. If you believe your friendly neighbourhood drug rep gives you full disclosure, think of how many patients would have received Vioxx if docs had been told it caused heart attacks….. and what was a major pain medcine prescribed until 2005? If you guessed generic Ibuprofen, you guessed wrong.

I think any reader is able to tell that my question was purely rhetoric…..

Danny Carlat plans to pay back his 30k in academic detailing, also called – maybe not quite accurate – counter detailing. This is a great, constructive idea. Basically, one goes out and gives talk to health care providers based on unbiased evidence, rather than a sales pitch. Read about it on Danny’s Blog here. Looking for an academic detailer to come to you? Maybe Danny is in the area, our you could ask us at the National Physicians Alliance….

cross posted at Stupor Cordis.

The Republican Presidential CNN/YouTube debate is just around the corner (November 28th).  As with the Democratic Presidential debate hosted by CNN/YouTube, Americans are submitting videos of questions they have for the candidates. 

Above, the national leaders of the American Medical Student Association, the independent medical student organization with over 50,000 members, from which the National Physicians Alliance was born, framed the healthcare debate with a well-crafted question for the candidates.  Friends, these are the future leaders of American organized medicine, and there are thousands of them, and thankfully, they’re progressive, patient-centered, and dedicated to the public health of America.

Hope comes in many forms, and this is just one of them…

Last week, the National Physicians Alliance came together with AMSA, Consumers Union and Community Catalyst to talk about the Physician Gift Sunshine Act. Joining us was Shahram Ahari, who formerly worked as a drug rep and is now exposing their marketing tactics. We talked about the need for disclosure of the gifts and honorarium that drug companies provide to physicians.

The Senate version of the Sunshine Act has been introduced, and we are now looking to introduce a House companion bill. Our goal is to build broad support for it, including bipartisan sponsorship. Integrity of medicine is not a partisan issue.

Shahram’s testimony is the most jaw-dropping. The expense accounts, the data mining, the training on persuasiveness, the profiling of physician personalities — the lengths drug companies go to in order to alter prescribing habits is disturbing. It is stunning to hear that drug reps spent 45 minutes preparing for each encounter with a physician (which might last 3 minutes). Can you imagine if physicians had 45 minutes to review each patient’s chart before the encounter?

We are looking to have the House version dropped by the end of the month. Once it is ready, we’ll mobilize for a conference hearing to bring this issue to the light.

Health care is 16% of the GDP. That’s a statistic that we’ve all heard. But health care spending is not spread evenly throughout the population. In fact, a very small percentage of people consume the majority of our health care costs.

(Click on the image to go to the Kaiser Family Foundation report from 2007.)

Who are those high-end consumers? They are, for the most part, the patients that I’m currently caring for in the Intensive Care Unit. Thus, who controls 1% of the GDP? ICU physicians do.

First, Republican 2008 presidential contender Rudolph Giuliani (the “other” candidate from New York) derides “socialized” medicine by comparing prostate cancer survival rates (he had prostate cancer “five, six years ago”) in the U.S. to those under the U.K.’s National Health Service. “Thank God”, he says, he didn’t get his care from a backwards, archaic government system like THAT or he and his prostate would’ve been toast!

Well, it’s been all over the news (here, here, and here, for example) and the blogosphere that he used fudged numbers to argue his case against government-sponsored medicine. Way to fact-check there, Rudy!

You’d think the debate over and done…but here’s where it gets really juicy…

Turns out that Giuliani’s cancer was diagnosed and cured while he was a recipient of government-sponsored, tax-payer financed healthcare…

From Salon.com

“…Giuliani was serving as mayor and participating in a city of New York health plan when his doctor informed him that his prostate biopsy had come up positive. The coverage he enjoyed — which resembles the Federal Employees Health Benefits Plan — permits all city employees, from trash haulers and subway clerks up to the mayor himself, to select from a variety of insurance providers, and it is not much different from the reform proposals adopted by his nemesis Hillary Clinton.”

Maybe we should recruit him. Then again, maybe not.

A friend posted this on Cure This, and I’d like to share an excerpt of it here — it’s one of many perspectives on healthcare, a perspective we may see from the other side when treating patients but often don’t experience in regards to these powerful emotions:

i just had to take a moment to note, that today, i went to the doctor for the first time in years and years with *real* health insurance–that is, insurance that is not poor people/county offered health insurance. I got to go to a real doctor (as opposed to a medical student) at a real office (as opposed to a makeshift building transformed every tuesday and thursday into a doctors office)–and lawdy lawdy, it was like i was in heaven or something. the doctor even told me, well, instead of getting you all drugged up with pain medications, let’s see what we can do to make sure that this doesn’t happen again. it was like angels came from the heavens and shared with me a piece of what the lord must promise to those who have clean souls.i was on pins and needles the whole time, however–asking every five minutes–are you sure my insurance covers this? are you sure my insurance covers that? i want to make sure my insurance covers that!! please don’t schedule me for anything until i’ve checked to make sure my insurance covers that!!!

i am waiting for the reply of four different emails to the same person begging them to make sure that everything is covered.

if you have ever wondered, what’s so wrong with being poor–this is it: if somebody is gentle with you, if somebody takes time to talk to you, if somebody wants to help you heal instead of drugging you until the pain goes away, if somebody believes you when you say it hurts–there must be a mistake. there must be something wrong, somebody must be tricking you or must’ve filed the wrong paper work or fucked something up some where.

it’s not right, it’s not normal or natural, for a poor person to walk into the doctor’s office and not expect an all out fight with the office bill collectors, roughness and shortness in conversation from the doctors, raised eyebrows in disbelief from all concerned and a final dismissal of “well, you’re insurance doesn’t cover it anyway, so take lots of aspirin and you’ll feel better eventually.”

From Drug companies attacked over gifts for Third World doctors:

Multinational drug companies are showering doctors in the developing world with gifts and inducements to persuade them to prescribe drugs of dubious value, an investigation has revealed.

Intense marketing of medicines has resulted in up to half of drugs being wrongly prescribed, the campaign group Consumers International says in its report “Drugs, Doctors and Dinners”. It calls for a ban on gifts to doctors. [...]

In Pakistan, doctors who wrote 200 prescriptions for one high-price drug were offered the down payment on a new car.

Multinational companies are turning to the developing world as profits stagnate in the West. But regulation in these countries is weak and drug sales representatives can influence prescribing by the inducements they offer [...]

Richard Lloyd, of Consumers International, said: “The pharma industry sees the developing world as a trillion-dollar opportunity… but consumer health expenditure in these countries can ill afford to be squandered.” He added: “The best way to ensure patients in the developing world get rational impartial treatment is… to ban gifts for doctors.”

Check out the full report “Drugs, Doctors and Dinners” (PDF, 1.49mb, 44pages) published by Consumers International.