miércoles, 5 de febrero de 2014

5 "sinsentidos" de la industria farmacéutica que influencian al MD

Until 2010, when the Physician Payments Sunshine Act passed, requiring doctors to disclose payments, the only thing better than working for Pharma was being a doctor wined and dined by Pharma. 

Pfizer jetted 5,000 doctors to Caribbean resorts where they enjoyed massages, golf and $2,000 honoraria charges to sell its painkiller Bextra (withdrawn from the market in 2005 for heart risks). GSK sent doctors to lavish resorts to promote Wellbutrin, the Justice Department charged. Johnson & Johnson bestowed trips, perks and honoraria on Texas Medicaid officials to get its drug Risperdal preferred on the formulary, a state lawsuit charged. Bristol-Myers Squibb enticed doctors to prescribe its drugs with access to the Los Angeles Lakers and luxury box suites for their games, California regulators say. In China GSK is charged with using a network of 700 middlemen and travel agencies to bribe doctors with cash and sexual favors, and Victory Pharma, an opioid drugs maker, was charged with treating doctors to strip shows. Nice.

Of course, Pharma reps did as well as the doctors. Thanks to their Barbie and Ken doll looks and the free samples, gifts and lunches they would bring medical staff, they would often waltz in to see the doctor before the sick and waiting patients. Some had their own lounges at medical offices. Since the 2010 sunshine law, part of the Affordable Care Act, went into effect in 2013, drug companies must display the doctors and groups they pay on their websites. That includes their payments to faux grassroots groups like Go Red For Women and the National Alliance on Mental Illness, or NAMI, which are widely seen as Pharma fronts. But will it make a difference? For years, doctors have also begun presentations with slides detailing their Pharma funding but it doesn’t seem to alter their credibility or audience cynicism. 

When it comes to acknowledging the influence of gifts and money on behavior, doctors, like everyone else, suffer from self-delusion. Most say they believe it affects the other guy, not them, and many become offended at the idea that they are “for sale.” 

My prescribing never changes because once a month a drug rep brings in a tray of sandwiches,” Maria Carmen Wilson told the Tampa Bay Times. (Wilson was Eli Lilly’s number-two earner in Florida in 2009, the paper reports.) It’s tempting to ask such doctors that if the largesse doesn’t affect them, when was the last time they prescribed the competitor’s pill? Would anyone believe or even read the journalism of a reporter who accepted an honorarium or speaker’s fee from the subject she reported on? Even if she claimed it didn’t influence her? 

Trips to resorts and strip clubs will likely continue to diminish under the Physician Payments Sunshine Act, but there are many other ways, often sneaky, that Pharma can entice doctors to prescribe its expensive, patent drugs. (Más)

1. Spying on Prescribing

2. Continuing Medical Education Courses

3. Ghostwriting

4. Speakers Bureaus

5. Clinical Trials

Martha Rosenberg frequently writes about the impact of the pharmaceutical, food and gun industries on public health. Her work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune and other outlets
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