The drug firms buy prescribing information from health informatics companies who purchase de-identified records from pharmacies, then match each record with the doctor's prescriber number sold to them by the American Medical Association. In 2006, the AMA allowed doctors to opt out of the reporting and withhold most prescribing information from drug reps and their supervisors. But few do.posted by mulligan at 10:17 PM on August 27, 2013 [5 favorites]
"Obamacare bureaucrats claimed the government¡¯s EMR mandate would save money and modernize health care. As of December 2012, $4 billion had already gone out to 82,535 professionals and 1,474 hospitals; a total of $6 billion will be doled out by 2016. What have taxpayers and health-care consumers received in return from this boondoggle? After hyping the alleged benefits for nearly a decade, the RAND Corporation finally admitted in January that its cost-savings predictions of $81 billion a year ¡ª used repeatedly to support the Obama EMR mandate ¡ª were, um, grossly overstated.What a disaster.
"Question: If these subsidized data-sharing systems aren¡¯t built to share data to improve health outcomes, why exactly are we subsidizing them? And what exactly are companies [...] doing with this enhanced power to consolidate and control Americans¡¯ private health information?"
For a while, it was a stalemate as the practitioners debated what to do. In 2004, however, they hired another physician, Dr. Gary Plant, shifting the balance of the internal politics. Plant was accustomed to choosing generics over brand-name drugs and was bothered by the notion that patients were being prescribed drugs that were not better, just more expensive.and, here quoting a drug-company-rep-turned-physician
They offered reps a compromise. They would listen to the sales pitch if the reps would give them the money they would normally spend on lunches and promotional materials so they could help low-income patients buy generic drugs.
¡°Don't buy us lunch; give us $100 and we'll buy 25 people a month's worth of their blood-pressure pills," Plant said.
...
¡°Of course, that went over like a lead balloon," Lieuallen said.
Samples are primarily given to promote the use of the more expensive, brand-name drugs, which in the end may be no more effective than lower-cost generics. But studies show that once a patient is started on a medication with a free sample, he is rarely switched to a lower-cost alternative.
¡°It's not really charity, or that we're giving out drugs because we're nice people," Ahari said. ¡°Once you're on it and you establish a therapeutic effect, most doctors will be reluctant to switch you to an equally effective but cheaper generic."
Studies have also shown that most samples don't end up in the hands of the most needy patients anyway. They're more likely to end up in the hands of higher-income, insured patients, or taken home by staff for their own family.
¡°There are some physicians who manage to get samples for their poor patients, but they're the exception, not the rule," Ahari said. ¡°And if the drug rep generally speaking isn't getting something out of it, you'll see your supply dry up."
Samples tend to be the most expensive drugs, new drugs that companies are trying to establish, or drugs that are vying for market share after another drug has left the market. In 2002, for example, the most widely distributed sample was Vioxx.[which as detailed in the article turned out to be not so awesome if you're trying to avoid having heart attacks for no good reason]furthermore
¡°Truthfully, the pharmacy reps don't leave anything that's useful to our patients," said Judy Carroll, a nurse at Madras Medical. ¡°It's the expensive stuff that no one in this area can afford."
As long as the doctors had a sample closet, they could convince themselves they were helping patients by giving them free medications. Removal of the sample closet, they said, forced them to prescribe more based on cost and efficacy, eliminating their irrational prescribing patterns.So there's that too.
For example, patients might come in with a garden-variety infection needing antibiotic therapy. If they couldn't afford it, doctors wouldn't have any first-line antibiotics to give them. The samples invariably were for newer broad-spectrum antibiotics best reserved for treating difficult, drug-resistant cases.
¡°When you're getting it out of the sample closet," Lieuallen said, ¡°what you've got is the latest gorillacillin."
The drug firms buy prescribing information from health informatics companies who purchase de-identified records from pharmacies, then match each record with the doctor's prescriber number sold to them by the American Medical Association. In 2006, the AMA allowed doctors to opt out of the reporting and withhold most prescribing information from drug reps and their supervisors. But few do.I might not be able to convince my doctors to ban reps, but I can talk to them about opting out of reporting, dadgumit.
"First, Madras Medical staff collected data on the extent of detailers¡¯ presence. They found that over a six-month period detailers visited the clinic 199 times, or an average of just more than 33 times monthly, and sponsored 23 in-clinic lunches over a nine-month stretch.
Staff also found that for 46 drugs identified in the sample cabinet, ¡°reasonable less expensive alternatives could be found for 38¡å saving ¡°the ultimate payer $70 per therapy per month.¡±
In interviews with the clinic¡¯s staff, researchers found they enjoyed getting coffee mugs, pens and pads from the pharma detailers and brought the items home: that they also used the contents of the drug sample cabinet themselves; and enjoyed the pharma-sponsored lunches with work colleagues.
The two provider ¡°champions¡± of reform within the practice presented during staff meetings peer-reviewed articles on the effects of pharmaceutical marketing on prescribing practices, patient safety and drug costs, and also initiated talks on the ¡°the ethics of gifting.¡± As a result the doctors and staff agreed to initiate a ¡°pharma-free policy.¡±
The practice covered the cost of monthly staff lunches instead of relying on pharma sales personnel to do so, and also found objective educational materials to shape discussion of new and old drugs, at monthly educational meetings. All branded office supplies from pharma firms was disposed of and replaced, at a cost of less than $200.
Evans and co-authors write that less than one quarter of the 800,000 U.S. doctors work in academic medical settings, where policies restricting the influence of Big Pharma marketing are more likely to have been adopted. So it¡¯s especially important, they maintain, that smaller and independent medical practices be able and willing to consider taking the kinds of steps demonstrated by Madras Medical.
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posted by Trochanter at 9:11 PM on August 27, 2013 [2 favorites]