Tuesday, May 01, 2007
Doctors & drug companies
I'm back today after being away for a little while. I was out spreading the word about "Chasing Life," a CNN special and an accompanying book. Thanks to many of you, the book is a New York Times and national best seller. I hope all of you get a chance to chase life. I decided to write the book after the birth of my first daughter, and now I truly practice what I preach. While I never really thought about mortality, I do know that I want to be around as long as possible, and I believe this book could help us all.

On my first day back, I'm reporting about the cozy relationship between the pharmaceutical industry and doctors, based on a new survey published in the New England Journal of Medicine. I was surprised to learn that 94 percent of physicians have some sort of relationship with the pharmaceutical industry. That means just about every physician that cares for you has interacted with the industry in some way. Most of the time (83 percent), the relationship is based on food and beverages provided to doctors, such as a catered lunch. Another popular icebreaker (78 percent) is free drug samples, and about a third of the time the relationship involves money-- actual payments to doctors for consulting services or for lectures.

Breaking it down even further, the survey found that family practitioners are most likely to meet with representatives from the pharmaceutical industry, and cardiologists are most likely to accept payments. Doctors at hospitals and clinics were less likely to meet with the drug companies than physicians in solo practice.

So, what does this all mean for you? On one hand, an argument can be made that these drug representatives help educate doctors about new medications and therapies. That certainly could be in your best interest. Others argue that relationships, ANY relationships, between doctors and the pharmaceutical industry are unscrupulous and should be questioned. Where do you come down on this issue? Again, keep in mind- as it stands now, more than nine out of 10 doctors interact with the pharmaceutical industry in some way.
Not all relationships are bad relationships. Doctors pass on those free drug samples to their patients, often to those without insurance and no financial means to acquire the drugs themselves. Many physicians accepting these samples refuse the other perks, mainly catered lunches. I also think that the drug reps do provide a service in educating physicians about the new drugs that are available, as long as their "lectures" are heard with a degree of skeptisism. It now takes well over 10 years for new technologies and therapies to propagate through the medical system, anything that can speed up this process is clearly benificial to the patient. As a future physician, I have already taken the stand that I will not accept any free lunches, that money should be used to provide drugs to needy patients, but I do plan on accepting the free samples to pass along to my patients.
Hi Dr. Gupta,
Drugs, Drugs, and more Drugs. We've become a society of pill poppers who live and die for the next new drug advertised on TV the night before. Maybe some day soon, Doctors will become Doctors again and "first do no harm." Perhaps the doctors and drug companies should be sent to prison the next time another "New Pill," turns out to be the source of death from it's side effects. Cozy relationships with drug companies? Only the Doctors can examine their own conscience on that one. Take Care
Docters also receive commission on pharmacutical Rx's they write. I have worked in healthcare for 27 years, we would not let the drug reps in without lunch. And I might add it had to be anexcellent catered lunch at that. Otherwise the docter was to busy to see the rep..
Yes, drugs, drugs and more drugs.
We have increased length of life for Americans with patients continuing to embrace unhealthy life styles. Cardiac mortality has decreased despite obesity and diabetes skyrocketing. How do you think physicians accomplished this? Drugs, drugs and more drugs is the answer.
Of course I take advantage of free lunches, pens and samples. The business of America is business and always will be. Did the American patient really think they will get more for less. Give me a break! I guess the average television game show is really aimed towards the typical moron!
Medicine is already overly regulated and we have become a second rate power in research. I am only glad that as of today I only have 80 months left to practice. We are facing a future health care crisis. I hope Ms. Clinton has the answer, as most physicians I know are planning to make an early exit from the practice of healthcare.
I believe that the free lunches and free samples provided by the drug companies prevent the doctors from seriously looking at alternative, contemporary and natural remedies. My mother-in-law was switched from one arthritis prescription to another; each leaving her body weaker than before. Fed up with the side effects, she finally threw up her hands and refused to take these drugs. Her doctor THEN told her to start taking a glucosamine supplement!!
Hi Dr. Gupta! I just got your book yesterday and I'm really looking forward to reading it!

As for the relationship with doctors... I am wondering if perhaps this can lead to doctors pushing drugs when they may not be needed, or, picking a particular drug over another because of that relationship. Not really sure how I feel about that, except I'm leaning towards "people being overmedicated"!!
It has been reported that some $15 billion is spent marketing pharmaceuticals with half of those efforts directly to MD's. Is this true and doesn't this go back to the Flexner Report, the Rockefellers and the monopoly on health care. And isn't the US in the lower echelon in health. So in my mind, something isn't working
The more I learn about the pharmaceutical industry, the more I wish I didn't rely on it so much. The truth of the matter is that only a portion of the cost passed down to consumers comes from research and development. The rest of it comes from pricey catered lunches, monetary incentives to get doctors to push expensive perscription drugs on their patients, and generous compensation for the representatives. I know of more than one fresh college graduate who has been schmoozed by a pharmaceutical company, wined and dined at five-star restaurants, then relocated with all expenses paid by the company. And I wonder why my migraine medications cost $20 per pill. Meanwhile, I'm having trouble finding a doctor who will try to figure out the cause of my migraines, rather than simply medicating me and sending me on my way. This is the exact reason why I decided against medical school, I could never take the hippocratic oath along with such hypocrites.
This is a tough one, and the potential influence on doctors is mixed, as you say: positive, on the educational side; potentially negative, because personal relationship or the sense of "owing" someone can cloud medical judgment. Medical science is not an entirely "neutral" science, for a lot of reasons, but especially because doctors are people whose perceptions are shaped by a whole range of factors, including their relationships. Drug companies know this well. Hence the lunches, payment-for-service arrangements, and so on. It is hard to fix the undue influence on pharmaceutical companies entirely by more regulations, but I do think certain restrictions need to be put in place -- e.g. the direct payments for prescriptions given, and the catered lunches are too much, and ought to be officially considered unethical.
Healthcare is big business in America. If pharmas weren't so competitive they could put all of their heads together to come up with solutions to eradicate diseases and help the world. But business comes first and catered lunches and other perks are just part of the process. So what is so startling about the findings in NJM? This is the business of medicine in the USA; either we come to terms or turn to a socialized system.
I think that the main problem we are facing is that the doctors are pushed into a system that is designed not to cure patients, but to keep them sick enough so that they buy each time more drugs or just different drugs. All drugs are toxics, and this is a true that we cannot forget. So, all drugs create secondary effects. It is time to invest in another way of helping the doctors to cure the illness without creating another one. The technology is already there, we only need to have the willingness to push for it.
Just a couple of thoughts. I'm a solo family doc in a growing community practice that sees "drug reps" throughout the day between pt appointments. I love providing samples to my pts who cannot otherwise afford them. However, drug companies track which doctors prescribe what, so if you don't prescribe their med once in a while, the volume of samples can slow to a trickle. Catered lunches are nice, in that my hard-working staff gets to take advantage of a perk while I get to spend some time learning about a new drug, instead of getting 30 second snippets. I don't spend my free nights going to the fancy dinner programs that are routinely available, not because I'm noble, but because I have a life outside of medicine. I hope everyone recognizes that learning doesn't end at graduation, especially in medicine, so if getting all the latest info available can be done while keeping the samples coming, I'll put up with an occasional lunch. I'm sorry that more money isn't placed into research, etc, but I agree that pharmaceuticals companies are just like any other business that has the responsibility to do what it needs to do to survive (marketting is necessary- see Economics 101).Many do have programs to provide free meds to the needy. Surely a PR move on some level, but I've steered patients toward it with good results. Marketting with goodies like pens, paper pads, even exam table paper, can be cynically thought of as exerting too much influence, but I believe that influence has been positive: the more you see a product, the more likely you are to inquire about it and therefore address problems you might otherwise ignore or forget. Most doctors are NOT drug-pushers, because we know better than most the dangerous potential of long drug lists (see Hippocratic Oath- and my malpractice insurance bill!). BTW-It's upsetting to hear when people suffer without satisfying explanations, even worse to be the one suffering (re: migraine sufferer), but this problem is usually a reflection of the lack of time allowed by doctors to spend teaching their patients in order for their practice to survive. It's a difficult balance and is constantly being squeezed. I don't know how long I'll be able to stay in business with 20-minute appointments, but I hope it will be at least a few more years- I've school loans as large as my mortgage! Drug company money is NOT keeping me or any doc I know afloat, so I resent the implication. Doctors who do talks do so with the freedom to address any medication (ie, competitors) of the class of meds they're reviewing, including generics. They can even discuss experimental trials if prompted. Are they biased? Maybe. But medicines are constantly evolving and the competition is a GOOD thing! Whoever thinks that the quality of healthcare in this the US is sub-par has never lived elsewhere. It's not the QUALITY of healthcare, but ACCESS that is the problem in the US. Which is more important? Thus far, our culture demanded quality over access, but the pendulum seems to be swinging toward access. I hope we can find a happy medium (possibly a Universal Healthcare compromise?). I don't want to have to go to a US-trained doctor in a US-tech-fitted facility in India to have my gallbladder out because my insurance no longer covers it!
When doctors benefit monetarily from the pharmaceuticals, they have effectively left the field of medicine and entered the world of business. Therefore, it's no wonder that this cozy relationship has spawned a country that leads the world in drug consumption. Are we really that sick, or are we being massively manipulated into believing that popping a pill will cure what ails us? Talk about a conspiracy theory!
Really, the important question is whether or not the lunches and free samples really influence phsyicians to prescribe medications they wouldn't otherwise. Personally, I think it is an insult to most physicians to assume that a catered lunch is all it takes to woo them into prescribing a pharmaceutical company's new drug. Doctors are trained to be skeptical, and most aren't going to just prescribe a new drug unless it has tangible benefits for the patient. While the kickbacks for prescriptions obviously constitute a conflict of interest, I think catered lunches merely serve as a forum for the drug rep to help educate doctors on new medications. Ultimately, this knowledge benefits patients as they are prescribed drugs with fewer side effects or greater efficacy.
Do you honestly think that a slice of Pizza and a Pepsi are going to "buy" your physician's prescription ? He or she make an average of $ 250,000 a year !

Ok...maybe two slices will do it !!!
Great work, Dr. Gupta. The advice of the investigative skeptic is still true: FOLLOW THE MONEY! Dig a little deeper still: How about the cozy relationship between Big Pharma and the FDA? The ranks of the agency are infiltrated by industry lobbyists and insiders, and perhaps some 40% of funding comes from the very companies seeking FDA approval to market new products. Another timeworn adage applies to the FDA: The Best Agency Money Can Buy...
Enjoy your work,
Anonymous
What's the incentive for research and finding possible cures for devastating diseases like cancer or diabetes? It seems that physicians and pharmaceutical companies are making way too much money at the patients' expense and wouldn't want to ruin a good thing!
The relationship between drug rep and doctor usually does stay educational. Most reps dont get more than a few minutes so they're required to give the doc the most clinical information in the least amount of time.

About the marketting and lunches - every industry has this type of activity. In addition to that, since doctors have such busy schedules, the only have sufficient time over lunch or breakfast, sometimes dinner to discuss medication use with representatives. It's only customary that the reps provide the meal for the office and sometimes pizzas are the standard not always elaborate setups. Most primary care physicians dont read up on new meds and the only way they are educated on these therapies is by drug reps who leave clinical studies and compare to current therapies...all over lunches and breakfasts.

Overall, the relationship is what the physicain makes of it. If he is objective and listens to both sides of arguments for which therapy is best for patients he/she is more educated on the options. There are overzealous physicians that require money/lunches/breakfasts to determine which med they write when there are very similar options available (Lipitor/Zocor).
What is the harm? The implication of the article is that patients are in some way being harmed by a "relationship" between the pharmaceutical industry and doctors. I seriously doubt those free writing pens and posted note pads that clutter up my office have much influence on my prescriptions I write or choice of medications!

Does it damage patients that I should be paid by the pharmaceutical industry to give a lecture to educate other doctors about a new product?

Does it damage patients that I should accept free samples that are given to patients who want to try a new product advertised on television or to patients that can't afford their medications?

I certainly think there is much less harm and more good being done especially if you compare it to all the lobbying private industry does before the Congress and State Legislatures.

Michael J. Whiteley, D.O.
1015 West Main St.
Tomball, Texas 77375
Troubling. The whole discussion is troubling.

As a young physician who entered medicine to help people, I have become more disillusioned by what I percieve as public distrust of doctors. No doctor or person in their right mind would prescribe a drug, which may be harmful, because someone bought them lunch. I think that we forget that doctors are your neighbors and children who went to medical school. They are the guys or girls who studied instead of going to the fraternity party.

Perhaps pharmaceutical reps should not have access to talking to doctors because of inappropiate influence. However, the pharm companies do sponsor unbiased education at conferences, which is valuable.

I cant help but thinking that public focus on this topic seems slanted in a fault-finding light. Are we trying to catch naughty doctors doing something else wrong? From my standpoint, it is yet another negative with regard to my career choice. Businessmen dont get criticized for having dinner with clients who provide them materials...They dont face malpractice lawsuits under the pretext of lawers protecting the innocent public from malfiesant doctors.

Becareful what you wish for... most of my peers (young doctors) feel that the career choice has been negative in some way. By in large, we really do want to help people... A free pen, or free lunch isn't going to make me ever forget that.
A Subway sandwich in exchange for spending my lunch looking over the data for a drug is hard to paint as bribery. I can buy myself a much nicer lunch. A lunch is not going to change my mind about a research study. Evidence is evidence and doctors are trained to evaluate it. Of note for a couple of these blog entries is the suggestion that doctors can get a 'fee' for writing particular prescriptions. I have never seen that or heard of it except as urban myth and I believe it is illegal. The reason drug companies have reduced the number of reps they have and gone to TV advertising is becuase its much easier to sell the public on a bad drug than to sell doctors on a bad drug. There are many new and highly effective drugs available and they reach patients faster if doctors have the opportunity to evaluate them. The job of reps is to provide that opportunity. With increasing pressure from Medicare and insurers to see more patients in less time there are certainly bigger problems in the health care than a few free lunches.
Dr. Sanjay Gupta
My mom was just recently been told she has Peritoneal Mesothelioma, The envoriment Cancer. She went to the Doctor with side pain, they then did a contrast CT scan that showed a 8 cm tumor on the left side they atempted surgery with no results she was open and then closed due to the amount of tumors in her peritonal. They are now doing Chemetherapy to try and shrink the tumors. My question is when we went to her cancer doctor there is very little information on her cancer , and they are treating her as best they can but there is no quarantees of remisson. Why is there not more studies on envoriment cancer and where do we get the information needed to help cop with this It is just you see all kinds of booklet on colon ,breast and all other cancer but there is no inforamtion on Mesothelioma at all and it leave us all feeling in the dark.
As a naturopathic doctor, I learned early on in my clinical training with M.D.'s and N.D.'s that all doctors are approached by companies who wish them to sell and endorse their products. While I believe that there is nothing inappropriate with companies sending doctors educational materials and samples, it is another story when doctors accept gifts and financial incentives for prescribing specific products. As doctors, we are required to complete ongoing requirements in board-approved continuing education programs taught by medical experts, and I believe that this is the correct forum for doctors to receive and discuss updated information about pharmacy and healthcare, not from a visiting sales rep. Our effectiveness and reputation as health professionals relies upon our objectivity and our due diligence in researching the best treatments for our patients, not our wallets.
It is very interesting to see how misinformed and uniformed people of our country can be about health care. Yes, the relationship between physicians and the pharmaceutical industry can be shady at times to say the least. Unfortunately, this is a by-product of the demands that our society has placed on health care. We place a higher value on "cures" as opposed to "prevention," i.e. quick fixes. This translates to drugs and biomedical equipment used in procedures being more widely implemented than convervative measures such as diet, exercies, and other lifestyle changes.
Since most pharmaceutical companies are publicly traded, they have share holders to whom they answer just like any other business. Our society wanted this because we felt that capitalism and industry was a great drive to the innovation of new medicines and cures.
This has been a great thing for health care in the 70s, 80s, and 90s as many new medications have greatly improved our quality and duration of life despite our ballooning weight, diabetes, and accompanying co-morbidities. The pharmaceutical industry has done this despite increasing regulations being put in place before new drugs/equipment can be brought to market.
It takes over 13 years and millions of dollars from the initial filing of a New Drug Entity to the FDA before it can be brought to market. And this is no guarantee. For every Lipitor there are hundreds of flops that the general public does not hear about. Semi-loads of papers about clinical trials and studies are trucked to the FDA where they investigate the clinical safety and efficacy of these potential drugs.
Patent protection of a drug does not start once it is released to market, it actually starts once the "New Drug Entity" is filed. So in order to recoup r&d costs as well as make some money for their shareholders, they charge a lot of money for the medication and also put a lot of marketing behind it.
Since new medications are risky to stand behind, the pharmaceutical industry has leaned on the "me too" medications or "controlled-release" forms that are much more likely to get FDA approval. From a medical standpoint, this would be unethical b/c a lot of times these drugs are clinically no better than the medication that just went off patent.
It is these ethically questionable practices that future doctors and other health care providers are being taught about. The next generation physician will do a much better job when it comes to dealing with new medications and procedures because we have grown up with evidence based medicine and the thought processes needed to evaluate it. We have to since the new wave of pharmaceutical manipulation is direct-to-consumer advertising. Just think about all of the prime-time commercials, magazine ads, and websites that are catered to you, the health care consumer. You walk into your physicians office wanting or even demanding to try a new medication that you read or heard about. This forces doctors to stay up to date concerning all of these new medications.
I guess my point is that there are a lot of things that are wrong with health care in our country. Doctors and Pharma companies are part of the problem but so is every person in this country who utilizes our services. Our society cannot expect this to be a consumer driven "business" with all of the positives, none of the negatives, while still holding the ideology of altruistic medicine to all of the providers involved.
Who do you think pays for those expensive lunches and other gifts? The cost is passed on to the already overburdened patient in the form of increasingly expensive drugs.
I agree with a lot of what Jake said. The best way to control or correct the most common chronic conditions is through eating right and exercising, but most patients aren't willing to put forth the effort to do so- hence all the drugs.

I hate the fact that pharma companies are publicly traded- they're responsible to the best interests of their stockholders, while physicians are responsible to the best interests of their patients; these two goals are often out of sync. What makes it especially tricky is that when a new drug comes out, physicians don't even have all the information the drug company has, because many, many drug trials are never published. If I pick up a journal article describing a trial for a new therapy, I might come to the conclusion that it could be useful, however, I wouldn't find out about the three other trials on the same drug concluding it did no better than placebo.

Many drugs are wonderful things that save lives and prolong years of quality life. Ideally, physicians should have all the information, presented objectively and compared to similar alternatives before having to decide which ones to prescribe to which patients. Unfortunately, this is far from what actually happens, and nothing much will change without a major overhaul in the process of drug manufacturing.
This isn't directly relevent to this post, but I wanted to say I was extremely annoyed to see Dr Gupta refer to Adderall as an antipsychotic two or three times in a segment on teenagers taking this medication to combat obesity. Adderall is not, and cannot be used as, an antipsychotic.
The FDA approves drugs based on the amount of money they receive from the companies seeking approval which is why despite harmful side effects they continue to find their way to the market. Also propagandic pamplets and literature promoting medications with harmful side effects which out weigh the benefit of the drug are written by ghost writers assigned to spin, not by medical experts.
Businesses, including "innovator" drug companies that develop new medicines ("innovator" is as opposed "generic" drug companies that copy older drugs from "innovator" companies whose patents have expired), have a right (and an obligation to their shareholders) to market their products. That is called capitalism, and it works reasonably well for providing the resources and incentives to develop new medicines in what is a high-risk business. You don't see innovative lifesaving or life-prolonging drugs coming out of other economic systems (China, North Korea, etc.)! Consumers (patients) can choose instead to buy an older (possibly less effective--e.g., simvastatin is generic and less effective than the non-generic Lipitor and Crestor, but may be "good enough" and a lot cheaper for most people) product that has gone generic, or to decide whether the cost of a new drug is worth the potential health benefit. The US has the cheapest generic drugs in the world, thanks to our system that both encourages innovation (by providing a financial incentive to develop new drugs) and also guarantees that new drugs can eventually become generics once the patents expire.

If we made all the drugs cheap from the get-go, we can as a society decide to do that--but we won't get any new ones, or maybe just much lower-risk ones like "me too" drugs. We are getting older, fatter (well I am anyway)...and we need drug companies to take on high-risk drug development projects ($800 million or more EACH these days--look up the recent torcetrapib story for an example of just such a high-risk project) if we want that really effective drug to treat obesity, or cancer, or whatever. When I'm old enough to get Alzheimer's I personally would rather that there were a bunch of really effective drugs to treat it, and the only way to get that is to keep giving innovator drug companies an incentive to develop those drugs...and part of that is letting them market their products, so that they can get paid for developing them. Incidentally, a bunch of drug companies have significantly cut down on their reps recently, presumably because this marketing method is not as effective as they had hoped.

People talk about the "cost of drugs" because that is easy to measure; but few talk about the "savings of prevented illness" because that is hard to measure and not obvious to the average consumer.

Finally, if we want to really decrease health care costs (not just drug costs, which are only a small fraction of health care costs albeit the most apparent one to the consumer--and thus the easiest one to score cheap political points on) we need to all choose to live healthier.
As medical students, we're taught to avoid any conflict of interest that even appears to affect the patient's rights and needs. The 900+ doctors here have all agreed to a strict policy of zero drug reps. They can no longer set foot in the clinics or hospitals here. I believe both doctors and pharm companies are to blame, but the most effective course of action would be to have tighter government regulation of pharm companies. This would be difficult as their lobbying presence at WA DC is the largest of any sector.
I believe that these relationships that include money in the form of payoffs (lunches, dinners etc.) should be considered a conflict of interest..
If a doc knows that they will get these perks for prescribing specific meds over others are they really watching out for their patients interest??
As a patient I am angry with what I see going on between the doctors and the pharmaceutical companies..
I have an illness that has caused me to be put into clinical trials..
The docs are paid per patient (from what I understand) for their patients participating..I spent almost 2 years in the last trial and was not given the recommended dosage for my illness..
After I completed that trial I asked my doc about getting that recommended dosage and was told that it would cost me thousands of dollars.. In my mind, if it wasn't for people like me that help these drug companies to get these drugs approved they would be lost..
It would be logical for the drug companies to make the drugs, once approved, available free of charge to the people that made it possible to get approval..
Did my doc advocate for me to that drug company, of course not, was my doc out for his patient or the drug company that paid him for my participation??
Are doctors really writing the prescriptions because it is the best choice for their patient or because they want that "perk" that comes with using that drug company?
You want to rub shoulders with the drug companies? Fine. But if you're recommending me a drug because one company's bribing you, when there is another drug that would be better for me that didn't bribe you, that's where you need to take a hike. If my wanting quality care frustrates my doctor such that he or she wants to leave the profession - GOOD! We don't need people like that hiding behind a mask of pretending to help people. Yes, you need money to live. But if a doctor has money as his primary concern, before the patient, they have no business telling me what to do with my body.

I am VERY suspicious of any doctor who prescribes me something too quickly, without explaining to me WHY it's being prescribed, why I should use this treatment over something else. If I ask a question and get answered with hostility, you can bet I'm never going to your office again. And I probably won't fill the prescription you wrote me without a second opinion. (No, I do NOT demand to know about drugs, in fact, I admire a doctor who's not afraid to tell me there's a drugles method I can use to treat what I've got. Only thing I've ever directly asked a doctor about is lasik for my eyes, but I had spoken for years to people who have had it, to decide whether I should broach the subject, given I can only see about 4 inches in front of my face without lenses.)

I find it ironic that I often trust a pharmacist's opinion over some doctors'. But again, it very much depends on who I'm dealing with and how they respond to my questions.

I will note, though, that there is a difference between the companies educating a doctor about their product, and trying to schmooze them into using it to the exclusion of other drugs. Got samples? Great! Trying to pressure me into a drug I know is bad for me? You won't be seeing me again.
I decided in my second year of residency, after examining my conscience and discussing the issue with colleagues on both sides, that accepting any gifts or lunches from drug reps is unethical. As a practicing Internist, I continue to avoid any contact with the pharma industry because I don't feel that the information they provide is balanced and the samples are always of the most expensive drugs. I am doing my patients no favors by giving them samples of drugs they cannot afford to pay for once the samples run out! I would encourage patients to ask their doctors about these issues before accepting these "free" samples. There are often alternatives that are much cheaper, have an established safety record, and come without the strings of pharma reps. We are all paying for these "free" lunches.
We all wonder why our healthcare costs are skyrocketing. I will tell you why. Some pharmaceutical reps make upwards of 300,000 per year to entice doctors to write scripts for their drugs. Mind you, most of these pharmaceutical reps have no medical backgroud and read from a rehearsed script when the speak to doctors. Unbelieveable!
Any doctor or patient that wants reliable information about a medication could get it from a pharmacist without fear of bias. The relationship with drug reps is a business one; the relationship with pharmacists is a medical one.
Ultimately, it is the patients who pay for all these "free lunches" and "perks". The cost is factored into the price of the drugs.It is no wonder why the cost of medicine is astronomical.

Geoff Hasler
My Free Medicine, President
I think that the free meds and even lunches are fine. However, worse is the fact that medical organizations and societies are just "fronts" for the pharmaceutical industry as they are heavily funded by them. I was previously employed by the National Medical Association which is an association of black doctors. Over 80% of all of their revenue came from the drug companies either from the convention (this year Hawaii) which is always held is some expensive city where doctors and familes are wined and dined or from the "journal" which is another front for drug promotion. The organization would be called and asked to speak up for a pharmaceutical industry issue and true to form, they would if they were given enough money. This organization is supposed to represent black physicians and patients-- it really is a hoax and a disgrace. I want to be clear, most black doctors don't belong to the organization-- despite what they put in print...while I worked there only about 1,700 physicians belonged although they would put that over 20,000 were members in the publications. I think that this is a crime. The conferences which we had to attend as employees were filled with huge exhibits and the scientific meetings were barely attended and were usually just promotion for a drug. Each year the drug companies are paraded in and given "awards" based on how much money they gave to the organization. In the meantime, patients suffer while doctors continue to take the perks. I had to leave and am now working another organization that has absolutely no drug company influence and I can sleep better at night.
I am also familiar with the National Medical Association and its dependence on drug companies. In an letter to the editor in a major medical journal they were cited for taking $750,000 from Astra Zeneca to form a health policy institute that the the drug company would have input on. I am a physician at a major academic institution and I cannot in good consciousness join because of the ethics and undue influence that they allow the drug companies to exert. I am not sure that American Medical Association is a lot better but it is not flaunted as much. Shame on them, the organization is a disgrace to Black physicians.
I have long been appalled by the "purchase" of the National Medical Association by the pharmaceutical companies. As an African American physician, I was a member of the organization and wanted to support the NMA. However, the journal is full of second rate articles with questional research and worse a playground for the drug companies. I refused to renew any membership after attending two of the national conferences that were a large advertising convention for the drug companies. As a doc that works in the inner city in Chicago, I was mortified that awards were given to the pharmaceutical industry at the same level if not with more enthusiasm than physicians that take care of the poor. Upon further investigation I realized that the organization depends on the funding of the drug companies, makes political statements for them and supports their efforts vs. that of patients. I agree with the previous writer-- this is a disgrace.
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