Angry Doctor

Monday, February 06, 2006

Big Pharma 1, angry doc 0

Got into my clinic room this morning to find an A4 sized 'literature' with picture of 16 (yes, sixteen! male, female, young and old) happy people on the front page, a stack of pamphlets, a couple of free pens (look nice, but experience tells me the ink will run out too soon), and a nice coffee mug with the name of the drug advertised and the logo of the company prominently displayed on my table.

The drug rep had sneaked into my room when I was not there and deposited the bribes without my consent!

So what should I do with all this stuff now? Chuck them in the bin? Donate them to the Salvation Army? Bring them to Cash Converter? Slip them onto the desk of another consultation room and let the other guy handle the problem?

What would Hippocrates do?

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35 Comments:

  • Bring the knick knacks home and be happy using it.

    You can't change the world and the world is not going to change for you :-0

    Also, I'm sure if there was a cash cheque for $1 million on your desk instead of some useless trivial, I'm sure the reaction would have been different.

    By Blogger uglybaldie, At February 06, 2006 6:01 pm  

  • Bin them, angry doc.

    I have an alternative solution for really useful gifts/bribes - I have some excellent musculoskeletal models from vioxx...I simply put white tape over all the logos and still use the models.

    But then again, I don't exactly have to worry about my Vioxx prescribing rate...which is zero ;-)

    By Blogger Dr Dork, At February 06, 2006 9:50 pm  

  • Give them to the pharmacists. They're immune, and they could always do with more pens.

    By Blogger tscd, At February 06, 2006 10:06 pm  

  • So simple: Return to sender. Just write a simple thank you note to the medical rep for the intro to the new drug/product, and you return those pens and coffee mug.

    Alternatively, pass the pens to the receptionist and the mug in the pantry.

    Qn:
    If free pens and coffee mugs for the doctor is not advisable.. You ok if the medical rep leaves a carton of pens with each pamphlet kit at the Registration counter for the patients to take one each?

    I subscribe to US edition magazines like SHAPE. There are detailed Ads on Migraine, Nasal Allergy, Asthma control drugs, etc.
    I thot these are good ways to generate awareness of the variety of drugs available and educate the common people and they can ask the doctors if they want to know more.

    By Anonymous pretzel, At February 06, 2006 10:35 pm  

  • Curiously, the drug rep did not leave his/her calling card behind...

    "You ok if the medical rep leaves a carton of pens with each pamphlet kit at the Registration counter for the patients to take one each?"

    Not sure if it's allowed for prescription-only drugs, but I give enough credit to the marketing people that if it works and is not illegal, they will do it.

    I don't have a problem with information being given to patients and the lay public, but one needs to be aware of where the information is coming from.

    Everyone who gives you information is trying to manipulate you in some ways (and that includes this blog).

    By Blogger angry doc, At February 07, 2006 5:01 pm  

  • Give freebies to the mee-sees(nurses) at the hospitals. I am sure they will greatly appreciate it. Or give it to the poor uncles or aunties, they can use it to write their favourite TOTO numbers. hurhur!

    By Blogger Flatfeet, At February 07, 2006 6:46 pm  

  • i am surprised that the medical rep could just walk in and out without being stopped or questioned?? after all, they are from another company who shouldnt have a right to be walking around the place unquestioned?? wat if things gets stolen/lost?? is the medical rep going to be listed as a suspect as well??

    By Anonymous yl, At February 07, 2006 7:40 pm  

  • i think the author forgot to ask the admin staff... could be that the med rep passed the freebies admin staff who placed the pens and mug in the room when angry dr was out for short coffee break.

    By Anonymous Anonymous, At February 07, 2006 11:01 pm  

  • I used to have one brand manager who is a trained nutritionist. She does not have nice comments about the doctors whom her staff have to visit to do medical detailing.

    By Anonymous Anonymous, At February 07, 2006 11:06 pm  

  • My wife's best friend worked as a pharmaceutical sales rep for a while and she didn't have very good experiences either. Especially with a few very infamous doctors.

    I've made friends with many of the reps I saw while I was in my previous position. In fact I became quite good friends with 2 of them. We used to have very frank coversations. And they all said that part of their training involved learning the ins and outs of the medical profession. And many of them were quite surprised and disturbed when they heard such revelations.

    The bottomline is this. When the pharma reps come to "visit" the doctor. What really is that transaction about? Business. Money. Profits. Dollars and cents.

    After all in the past 10 years what real new groundbreaking drugs have we seen released on the market? To me what we are seeing are all simply improved or changed exisiting drugs that are already on the market. My cousin in law who works in the pharma industry has said that the pharma industry is doing very badly because there are no new drugs coming out. There are much much cheaper generic versions of these "new" drugs around which are just as effective.

    Profit margins for the doctors who dispense generic drugs is higher than dispensing the trade version, because the cost of the generic is much much cheaper to the doctor. So why do doctors prescribe trade versions? Some do so for richer patients, some do so because they have certain relationships with the drug rep or drug company, or some truly believe that trade versions are better than generics. But it's not a constant similar reason among the different doctors out there.

    People generally do not like to hear of doctors talking about making profits in their practice. Neither does the medical profession like doctors or people talking about them in that manner. But realistically, when the drug rep visits the doctor, it's business talk time. The drug rep wants to get the order and hit the sales targets (which incidentally are rasied every year). The doctor wants to get value for money. Good bonusing rates, etc.

    That's where the whole image of the good doctor goes down the drain for some reps. At the same time, many of the consultants in hospital treat sales reps like dirt because they have no benefit in prescribing some new slightly improved new drug formula that is twice as expensive. But yet it is these consultants who are the ones who determine if the drug gets into the hospital's formulary. So sometimes push comes to shove and both parties get irritated with one another.

    Personally I feel that pharmas should not be allowed to advertise. No sales reps. No advertisements. No free lunches. No free pens. Let the product (drug) speak for itself. Let the doctors decide what drugs they want to teach the junior staff to prescribe with no monetary benefits. After all doctors will need to prescribe something right? So why worry about that? If the drug is good, let the consultants decide unbiased.

    Alternatively, advertise to the direct consumer and let the consumer decide which brand name or generic version of the same class of drug they want. And let the consumer be responsible for their own choices. I know in Singapore this type of direct advertising is not allowed and various arguments and reasons have been put forth. Frankly I think neither should drug companies be allowed to advertise to doctors.

    By Blogger Dr Oz bloke, At February 08, 2006 10:10 am  

  • There is another potential pitfall also where doctors buy lots of stock in a particular pharma and prescribe heavily drugs produced by that company. This is especially effective in large medical groups.

    I wonder if there is any monitoring of such activities?

    By Blogger Dr Oz bloke, At February 08, 2006 10:13 am  

  • Dr Oz,

    "But yet it is these consultants who are the ones who determine if the drug gets into the hospital's formulary."

    There is a P&T Committee that decides, with Evidence Based Med, if a particular drug goes into the formulary.

    There arent only consultants within the com.

    And position/ authority is not enuf to get a drug into the formulary.

    Evidence and other factors like, therapeutic duplication, cost and pt population, are pivotal in making that decision.


    "There is another potential pitfall also where doctors buy lots of stock in a particular pharma and prescribe heavily drugs produced by that company....I wonder if there is any monitoring of such activities?"

    What kind of monitoring are U referring to?

    drugged

    By Anonymous Anonymous, At February 08, 2006 12:32 pm  

  • Friggin' doctors usually treat pharma salespeople like dirt.

    And we, the patients (some of us anyway) treat these doctors like dirt too. To me, the junior doctors are no better than the newly graduated pharmacists at an "established" chain of pharmacists, crap.

    And yes sir, in the books of the pharma salespeople, doctors in Singapore are the stingiest sons of bitches that ever walked the earth! And crooks too, prescribe indian made generics that cost 2 cents for S$2 each!

    By Blogger uglybaldie, At February 08, 2006 12:33 pm  

  • Uglybaldie,

    Its healthier and more rational to not generalise things. Anything.

    Having fixed mindsets and inflexible 'perceptions' of people or any issues around U, place limitations on yrself.

    Of cors, yr opinions are yr own.

    But dont U wish U can be a happier person??

    No 2 persons are the same, neither are any 2 doctors or houes officers or med officers the same.

    In general, newbies are less experienced den the senior ones. Im sure U've been a newbie yrself.

    Its interesting dat U contribute soo many comments to this blog, but yet U dont blog yrself. I know, Uve mentioned U registered to comment. But U seemed very opinionated... so, makes me wonder.

    drugged

    By Anonymous Anonymous, At February 08, 2006 12:43 pm  

  • Alamak, why you so excited huh?

    I'm just doing some rabble rousing to put some controversial juice to this sleepy blog what with all you men of medicine speaking amongst yourselves and to yourselves. ;-)

    Cannot write blog lah, my english not up to scratch!

    And boy, quit telling me how to be happy or be a good guy. I'm old enough to be your granddad.:-)

    By Blogger uglybaldie, At February 08, 2006 12:55 pm  

  • Dear drugged, from the way you put it, it seems the drug reps do not have any influence on whether a drug gets into the formulary or not. But yet we still see these drug reps around. What gives?

    I was told by the drug rep that if more doctors prescribe the drug, then the better the chances for the drug being accepted. And the senior doctors have a role because they teach the junior doctors what drugs to give.

    So if the influence of prescribing practice is pretty low in the final assessment, then shouldn't we tell the pharmas so they will waste less money on fruitless stuff?

    I suspect that politics is the real determinant. All these "indicator values" are just there for the sake of accountability. But in the final decision, the powerful men with much influence get more say.

    By Blogger Dr Oz bloke, At February 08, 2006 1:26 pm  

  • Dear uglybaldie,

    your comments way too negative liao lah.

    You want to be rabble rouser can. But you sooooo negative, make people turn off lah.

    You tone down a bit, play devil's advocate would be more effective that's how I feel.

    By Blogger Dr Oz bloke, At February 08, 2006 1:28 pm  

  • Err.. the Brand Mgr I was referring to was gossiping about HUMSUP doctors who only willing to entertain pretty gals. She was very particular with her team about personal grooming and dressing. :P

    By Anonymous Anonymous, At February 08, 2006 1:33 pm  

  • OZ,

    You're truly a brother.

    Oki Doki, your advice sounds good to me.

    I will tone down. Be bad but be subtle.

    Play Devil's Advocate instead of Uglybaddie.

    Kool.

    By the way, Bro. how come no more delicious posts on your blog huh? Your fans including flatfeet and myself are waiting............

    By Blogger uglybaldie, At February 08, 2006 1:35 pm  

  • Well that's part of the training what. That's why I said after their training courses, a lot of sales reps very shocked and disappointed with doctors.

    Humsup....hmmm uglybaldie should be very familiar with that. He would pay top dollar to see pretty private specialist consultant also!

    By Blogger Dr Oz bloke, At February 08, 2006 1:37 pm  

  • huh, doctors also humsup meh?

    I thought they have seen enough and is still seeing and touching?

    But I've seen pretty pharma salesgirl waiting until kingdom come in some docs clinics and still no audience with the great King! One in particular started filing her nails, another called her boyfriend to yak. I think the docs should give these poor people more respect. After all, everyone is just trying to earn a living.

    By Blogger uglybaldie, At February 08, 2006 1:39 pm  

  • Huh? 85 friggin' bucks top dollar?

    I would gladly go back to the same doc and spend quality time with her but currently there is no medical problems or symptoms!

    She must think I belong to the IMH if I just go to her with a cold huh? And I don't want our relationship to be clouded with an inkling of insanity!

    By Blogger uglybaldie, At February 08, 2006 1:49 pm  

  • Sales reps must get doctor to sign something to log that they have seen him.

    Their work is quite tough actually. They have to write reports at the end of the day regarding their daily visits to various doctors.

    Tough job.

    And advice to drug reps out there. Please check who has purchasing power in the clinic before talking to the doctor there. Sometimes the doctor is just an employee and has no purchasing decision making powers. The clinic assistant might be better but clinic assistant would pretend she doesn't know anything about drugs.

    Trick is to make friend with them. I still see drug reps coming to talk to me when I have no purchasing power. Really no use to them leh.

    See in the end a balance is needed too. We might be angry with the pharma company for giving free lunches etc but should we take it out on the sales reps just trying to do their jobs?

    By Blogger Dr Oz bloke, At February 08, 2006 2:00 pm  

  • Yeah right.

    The reps like to talk to you because you are probably chatty and nice.

    Try talking to some docs who look and act like our honourable CJ and you would be having a bad hair day too!

    I've always wondered why intelligent,personable young people take up this job.Better sell insurance or hdb apartments. At least you don't need to see modern day monkeys who think they are a gift from God.

    By Blogger uglybaldie, At February 08, 2006 2:08 pm  

  • Well it's tough to get a job these days.

    It is easy to become an agent, spend money printing and distributing all those flyers in people's mailboxes etc, but making money to pay the bills is a different matter altogether.

    So got job people happy like crazy liao. After a while of course when they get damn fed up with the job then it's a different story.

    But hang cheng bo ho lah.

    By Blogger Dr Oz bloke, At February 08, 2006 2:14 pm  

  • Bro OZ,

    What talking you, "hang cheng bo ho"?

    Don't you read our Straight Times? Everyday got good news. STI at one of its highest. Shopping malls full of people. Good restaurants no place to sit. Got to wait like a goondu for some nitwits to vacate their seats and there was this guy who spent 15 friggin' minutes picking his teeth after the turtle soup and still don't want to get up!

    Everything is going fine mate. I think the reason why they like to see docs is because they think this is an upmarket job. You know, snob appeal? Whereas if you sell property or insurances, you have to see all the Ah Ter and Ah Kows as well.

    OK bro. I gotta go croon Frank Sinatra and Andy Williams evergreens. Write something on your blog soon huh?

    By Blogger uglybaldie, At February 08, 2006 2:33 pm  

  • Hang cheng bo ho lah.

    Elections coming that's why got all the good news. Got bad news also but they don't put it on front page. Remember Toshiba factory closing?

    The shopping centre near my place, shops all closing down also.

    Employment percentages is high but mostly because of creative calculations using foreign work permit holders to boost the numerator.

    The rich people ok lah no problem. The needy and poor jia lat. That's why the govt also starting to sit up and address these problems. Or else they are going to lose those votes too and they are the majority unfortunately. But don't worry lah. We all know things will go back to status quo after elections right? *wink wink*

    By Blogger Dr Oz bloke, At February 08, 2006 2:52 pm  

  • Uglybaldie,


    From Dr Oz:"You want to be rabble rouser can. But you sooooo negative, make people turn off lah."

    Im not turned off. Just thot U tend to generalise every single issue.

    I retract the prev comment abt how happy I think U could be, becoz it wasnt my intention to tell U wat to do or that I care... Apologies if I stepped on toes.



    To yr prev comments "To me, the junior doctors are no better than the newly graduated pharmacists at an "established" chain of pharmacists, crap...",

    Pharmacists and doctors are different professionals.

    Its illogical to lump the 2 together, and disrespectful to belittle d pharmacy profession.

    drugged

    By Anonymous Anonymous, At February 08, 2006 6:17 pm  

  • Dr Oz,

    "...it seems the drug reps do not have any influence on whether a drug gets into the formulary or not. But yet we still see these drug reps around. What gives?"

    Who the reps try to influence,are the prescribers.

    The P&T decides the formulary... not w/o debates though.

    If a prescriber succumbs, den that gives the rep the inertia to advertise and push his drug more.

    Thats wat any kinda sales rep do: Selling.

    Hence, the most impt thing is to give wat the patient needs...


    "I was told by the drug rep that if more doctors prescribe the drug, then the better the chances for the drug being accepted."

    Hehe... tell the reps that kinda 'time' is gone.

    Its EBM now. Wats more, already in many institutions, there are limits as to how much honey the reps can give.

    Maybe U can update yrself on their situation... Ask them if increasing Rx rates of a new drug get that drug into the formulary. I wld guess for now, its a "Y and N" answer.

    If there is not a strong enuf reason to reject the drug from the application, vs those for the drug into the formulary, den it is not wrong for the drug to be in the formulary.

    Eg, a safer alternative for an indication (with evidence), without an increase in cost, and the doc has a substantial pool of pts who will benefit from the drug.

    Anywae, it can be pulled from the formulary if usage is too low. Or if in future, another safer and cheaper alternative comes along.


    "So if the influence of prescribing practice is pretty low in the final assessment, then shouldn't we tell the pharmas so they will waste less money on fruitless stuff?"


    Nono... the influence will still be around on prescribers.

    Just that when deciding on the formulary, its not up to their marketing ability anymore.

    I guess there will still be reserves aside for advertising.

    The pharma co will never be able to survive if they dun. And it doesnt benefit anyone if these co eventually fails. There wouldnt be new drugs and no research into new drugs for diseases.

    It will be more beneficial if there are less conflicts of interest, while attracting professionals to learn more abt wat their new product can do for the pts.


    "I suspect that politics is the real determinant...But in the final decision, the powerful men with much influence get more say."

    Issit the case where U are now?? I dun think the powerful men will want to challenge evidence just to get a taste of honey.

    drugged

    By Anonymous Anonymous, At February 08, 2006 6:39 pm  

  • "I guess there will still be reserves aside for advertising.

    The pharma co will never be able to survive if they dun. And it doesnt benefit anyone if these co eventually fails. There wouldnt be new drugs and no research into new drugs for diseases."

    That's a belief that we should examine.

    As it is they spend more money on marketing than research. Sort of tells you where the priority is.

    We can force them to change their focus (not that I hope it will come to 'forcing'). If they close, someone else will pick up the business - afterall, where else are all those research scientists going to work at?

    I think the first step is to recognise that we as consumers have more clout than they. Don't let people who earn your money threaten you.

    The whole business of course is more complex than that (there are some conspiracy theories regarding pharmaceutical companies too), but angry doc is a simple minded person.

    By Blogger angry doc, At February 08, 2006 7:27 pm  

  • New drugs that make a difference?

    Have we seen such drugs on the market yet?

    All I see are new combination packages of 2 drugs (a patent expired and patent still intact drug), and other derivatives.

    What's really new?

    And how many years has it been since PDE inhibitors came on the market? To me that's the last real "new" drug we've seen (although it isn't really NEW if you know the history). Oh maybe Botox but then it isn't really new either.

    So what's the big deal about the research and need for all these pharmas? Maybe 30 years ago I would have said you were right to say that. But these days it's becoming more clear we might be better off with generic producers.

    As it is the pharma industry is facing a lot of challenges. I have insider information. One of the key points is a lack of new research and new products. Hence the emphasis on marketing.

    It's clear that the product can no longer speak for itself. And those that do, no longer belong solely to the pharmas.

    By Blogger Dr Oz bloke, At February 08, 2006 7:46 pm  

  • Angry Dr

    "As it is they spend more money on marketing than research. Sort of tells you where the priority is."

    Research is much more costly den marketing.

    How much goes to marketing,after the drug goes into mkt etc, is a portion of the profits definitely.

    Marketing is one of the tools complanies use to help prolong the product life. Just like how celebrities use publicity to remind the masses of themselves.

    And the 2nd person who comes along to take over the co (actually, merging into bigger companies is the trend & necessity now... and dat merging will concentrate resources), will market their products.

    drugged

    By Anonymous Anonymous, At February 08, 2006 8:58 pm  

  • Dr Oz,

    "Have we seen such drugs on the market yet?

    All I see are new combination packages of 2 drugs (a patent expired and patent still intact drug), and other derivatives."

    Yup. With the drought of new drug entities, co fight to stay in the game like dat... Producing new combi products that promise to reduce pill burden.

    But nonetheless, for these co to survive in the long run, their research cannot stop. And there are research goin on for some dx, like cancer.

    They too are running a business.

    But if one can interpret CT methodology and results, one will be able to judge for himself if the new drug is really superior to another. There is always drug info for more information.

    drugged

    By Anonymous Anonymous, At February 08, 2006 9:09 pm  

  • drugged,

    "Research is much more costly den marketing."

    Do a google search on 'how much do pharmaceutical companies spend on research/marketing' or a variant thereof, and you will find sources quoting figures like 2.5 to 3 times more on marketing than research.

    "How much goes to marketing,after the drug goes into mkt etc, is a portion of the profits definitely."

    No, you don't spend profits. What you spend is called expenditure, what you make is called profits. Marketing is expenditure.

    I am not against marketing per se, but when a company claims that the high drug costs are necessary to fund research, and yet spend a few times more on marketing and reap in multi-billion profits, one gets a feeling that things do not quite add up.

    "But if one can interpret CT methodology and results, one will be able to judge for himself if the new drug is really superior to another. There is always drug info for more information."

    So why all the 'happy people' ads? Well, this topic was discussed extensively on Dr Crippen's blog, so I won't rehash it here. Suffice to say that my solution to this is to refuse to accept ads.

    When I get a chance to refuse, anyway...

    By Blogger angry doc, At February 08, 2006 10:05 pm  

  • The ER could always use the pens and the pads.

    Toss the ad.

    If the pamphlets actually have information your patients can use AND you actively prescribe the drug, they may be useful.

    I'm a sucker for a good mug. If it is hefty and solid, keep it. If it is cheap, give it to someone else
    : )

    By Blogger Kim, At February 09, 2006 3:38 pm  

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