Taken from KeelyNet BBS (214) 324-3501 Sponsored by Vangard Sciences PO BOX 1031 Mesquite, TX 75150 This article was taken from the DALLAS TIMES HERALD Sunday, December 24,1989 By Robin Lichtenstein from Newhouse News Service DOCTORS, DOLLARS & DRUGS Is your physician helping the medical industry `push' pills? For most people, the idea of pushing drugs conjures visions of criminals hunkering over piles of cash and illegal white, powdery substances. But drug pushing - the legal kind - happens every day in a medical world that's invisible to patients. It happens in virtually every doctors' office through face- to-face meetings with gift-bearing drug salespeople, during company-sponsored seminars held in vacation resorts and hotel conference centers, and whenever a physician opens a medical journal to page after page of colorful ads espousing the virtues of prescription medication. "It's third-party marketing" to a middleman - the doctor - whose prescribing behavior helps determine company profits, according to a drug company salesman who requested anonymity. "It's not like getting [a consumer] to sign on the dotted line." Industry spokespeople and some doctors say that marketing efforts generally result in a better-informed physician who is better able to care for his or her patients. Other doctors call third-party, or indirect, marketing a waste of time and money. Drug industry critics have produced some evidence suggesting that drug marketing has combined with other factors to prompt doctors into sometimes prescribing useless or harmful drugs. Doctors also can be influenced be patient requests for certain drugs, research suggests. Ideally, a doctor prescribes a drug because the scientific evidence shows it will help the patient. To what extent prescribing decisions are based on science and to what extent on marketing are issues of considerable debate. And, with the average prescription cost at about $17.00, according to a 1988 survey of 1,850 pharmacies nationwide, many people are asking whether drug companies ought to devote some of its marketing budget to reducing drug prices. Robert Wood Johnson Clinical Scholar Dr. Michael S. Wilkes of the University of California-Los Angeles estimates that drug companies spent more than $2 billion on indirect marketing on the country's 479,000 doctors in 1988. While in medical school, students on tight budgets are frequently invited to lunches or dinners sponsored by drug companies. Many received their first stethoscope, neurological hammer, penlight and doctor's black bag from a drug firm. According to a 1982 study of 85 Boston area physicians, however, marketing may have a much stronger influence on doctors' prescribing behavior than doctors realize or admit. The study, by Dr. Jerry Avorn of the Department of Social Medicine and Health Policy at Harvard Medical School, found that the vast majority of doctors surveyed said drug ads and marketing efforts were "minimally important" factors influencing their prescribing habits. The majority also believed that two heavily advertised drugs, vasodilators and propoxyphene analgesics (such as Darvon), were effective treatments for senile dementia and certain kinds of pain, respectively. Meanwhile, "the clinical literature overwhelmingly indicates that they are not useful for these indications," Avorn and his colleagues wrote in the American Journal of Medicine. The most controversial way companies market to doctors is by sponsoring or underwriting medical education seminars, many of which offer continuing medical education credits, or CMECs. Doctors need a certain number of CMECs to maintain their licenses. Occasionally, the seminars are held in enticing locales such as Florida or in Colorado during ski season. Wealthier drug companies may cover air fare and accommodations for doctors whom they perceive to be opinion leaders in their local medical communities. In addition to sponsoring seminars and buying advertisements in medical journals, drug firms hire armies of sales representatives, also known as "detail personnel," to conduct face-to-face sales pitches with any doctor who will listen to them. Nearly every doctor's office sports an array of desk-top items bearing a drug name or company logo. Personalized prescription pads, pens and paperweights and other "reminder items" all come from detail people, doctors say. In addition to the perks, detail people leave behind medical literature, free drug samples and patient-educational leaflets. One potential way to neutralize biased sales pitches is "academic detailing," according to Avorn's research. In academic detailing, a doctor learns about drugs from a university-based expert with no allegiance to a drug company. These one-on-one meetings in the doctor's office are even more effective when supplemented by "unadvertisements," which point out a medication's adverse side effects as prominently as its benefits, research suggests. *************************************************** I would suggest two good books to read that give an excellent perspective view on this subject of drug companies and the medical profession. 1. Murder by Injection; by Eustace Mullins written in 1988 2. 100,000,000 Guinea Pigs, written in the 1930's Submitted by Ronald Barker Vangard Sciences