Doctors and Pharmaceutical Companies

[Guest guest]

Well - when the professors from the British Thyroid Association interact

with the drug industry, they have been influenced enough to boycott all

products containing T3, leaving tens of thousands of hypothyroid sufferers

in the UK with no choice of treatment.

Luv - Sheila

___________________________________________________________________

From Medscape Internal Medicine <http://www.medscape.com/internalmedicine>

Roundtable Discussion

<http://www.medscape.com/px/viewindex/more?Bucket=columns & SectionId=2863>

Should Physicians Avoid Interaction With the Drug Industry?

Posted 12/02/2008

W. Donnell, MD; Désirée Lie, MD, MSEd; Haynes, MD, PhD, MACP;

Roy M. Poses, MD; P. Vega, MD, FAAFP; Bradley Fox, MD

Author Information

Information from Industry

Introduction

W. Donnell, MD

Years ago, doctors had difficulty accessing new information on drug therapy,

many relying on pharmaceutical sales representatives for updates. Modern

information technology now puts reliable information at doctors' fingertips.

Although few would argue that today's doctors need help from drug

representatives to stay current, many still interact with them.

The relationship between doctors and industry is controversial. A

groundswell of opinion holds that doctors should avoid interaction with the

drug industry.[1] One activist, Goodman, MD, New York internist and

founder of No Free Lunch,[2] urged doctors to sign a pledge against

accepting any gifts or support from the drug industry and would like to see

the pledge elevated to the status of board certification.[3]

Although those expressing such opinions are probably in the minority among

physicians, their voices can be shrill. A culture of ridicule and shame has

arisen as rank and file doctors find themselves accused of accepting bribes

and characterized as minions of the industry.[4,5] How should we respond? I

would argue for moderation. Let physicians set their own individual

boundaries. Let's examine some anticipated objections to my proposal.

Pharmaceutical company pitches are biased. Doctors are influenced by drug

company promotions. These points can be conceded, but by themselves, they do

not support a case for condemning other physicians' individual choices to

interact with drug representatives. Additional questions must be examined.

Interactions between physicians and drug representatives create conflicts of

interest. This knee-jerk reaction suffers from oversimplification. Given

that apparent conflicts exist, how real are they? Detractors have moved the

concept from one of healthy skepticism to unhealthy cynicism. Drug company

interests are not, as they imply, invariably conflicted with a doctor's duty

to act on behalf of the patient. In fact, companies have a proprietary

interest in producing good outcomes for patients.

When conflicts of interest do result from interacting with drug

representatives, they pale in comparison to others that doctors face daily.

Doctors who receive fee-for-service compensation are rewarded for exposing

patients to unnecessary procedures. Those who practice under capitated

reimbursement plans are incentivized to underserve patients. Such conflicts

are about real money and they expose patients to real risk.

Drug representatives are trying to sell a product; therefore, doctors should

ignore what they say. This is an ad hominem fallacy. It attacks the person

or persons making the claim rather than the claim itself. With primary

source information just a few mouse clicks away, doctors can critically

examine drug company promotions on their own merits.

Promotional influence on doctors harms patients. Convincing, generalizable

evidence for this statement is lacking. Critics have cited the heavily

promoted drug rofecoxib (Vioxx®), which was found to be associated with

cardiovascular events. Rofecoxib's comparator in The Vioxx Gastrointestinal

Outcomes Research (VIGOR) trial[6] was naproxen, which is singular among

nonsteroidal anti-inflammatory drugs (NSAIDs) for its cardiovascular

safety.[7] However, in real-world practice, rofecoxib was promoted as an

alternative to multiple older NSAIDs (cyclooxygenase [COX]-1 inhibitors)

that have been shown repeatedly to be associated with cardiovascular harm.

In fact, data have indicated that they may be at least as dangerous as COX-2

inhibitors.[8-10] There is no convincing evidence that industry promotions

result in patient harm.

Drug detailing sways doctors away from evidence-based practice. Studies in

support of this argument do not give a balanced view. Surveys of the effects

of drug detailing on doctors' prescribing have focused selectively on areas

of overuse, such as antibiotics in the ambulatory setting and new expensive

drugs compared with equally effective generics. Although some promotions

undermine evidence-based practice, others may enhance it. Because

promotional literature is a mix of good and bad information, the net effect

on patient care is not known. Many heavily promoted treatments are

evidence-based and known to be underutilized by doctors. A good example is

the inadequate use of low-molecular-weight heparin for thromboembolism

prophylaxis.[11] The promotion of statin drugs[12-14] and

angiotensin-converting enzyme inhibitors for appropriate patients[15-17] is

another example. Such a promotion toward best practice has been ignored in

published studies. Research in a broader range of clinical situations is

needed before conclusions can be made about the overall effect on

evidence-based practice.

Acceptance of food and gifts from drug representatives drives up medication

costs. In effect, doctors are taking money out of patients' pockets. This

argument is superficially appealing, but wrong. Because fewer doctors accept

gifts from drug representatives, the industry is diverting its marketing

resources to direct-to-consumer advertising. The money will be spent on

promotion one way or another.

Are there solutions? Perhaps, but they're not as simple as vocal detractors

would suggest. Doctors should seek unbiased information on drug therapy.

Drug company promotion, a mix of good and bad information, cannot be

considered reliable, but individual doctors must decide for themselves

whether they should allow drug detailing. Broad recommendations must await

convincing data on patient outcomes. Transparency about doctors'

interactions with industry, along with improved education on drug therapy

and the critical evaluation of medical literature, would be more effective

than the current finger-pointing and ridicule.[18]

Section 1 of 2

Next Page: Roundtable Discussion

<http://www.medscape.com/viewarticle/583286_2>

[Guest guest]

Hi Everyone,

I would go so far as to say that the nhs has been hijacked by the pharmaceutical

companies for the benefit of their high profits at the expense of those people

that it was intended for, that is us patients. Doling out profitable drugs like

statins just

like smarties and hypertension drugs to almost everybody, and denying the cheap

and

simple treatments that are actually better. They are busy banning vitamins and

melatonin

along with all the herbs that we can use to keep ourselves well. We are

becoming a jolly

profitable nation full of people with chronic conditions that require life-long

medication

with patented drugs. Our hypothyroid condition is possibly caused by the

rubbish they

put into our food and water, and then denying us effective treatment will give

us lots of

other illnesses that they will treat more profitably. If denied thyroxine we

will get heart

disease and die, thus relieving the pensions crisis.

A long time ago I used to meet an old man on the way to school every morning

with my

youngest son, and he had a caravan water carrier that he filled in a well and

took home for

his drinking water. He used to say 'The government are poisoning us by putting

stuff in

our water, so we can't collect our pensions, but they won't get me, I'm going to

have my

pension!' I thought he was mighty odd, but I don't now!!

love janet

>

> Well - when the professors from the British Thyroid Association interact

> with the drug industry, they have been influenced enough to boycott all

> products containing T3, leaving tens of thousands of hypothyroid sufferers

> in the UK with no choice of treatment.

>

> Luv - Sheila

> ___________________________________________________________________

>

> From Medscape Internal Medicine <http://www.medscape.com/internalmedicine>

> Roundtable Discussion

> <http://www.medscape.com/px/viewindex/more?Bucket=columns & SectionId=2863>

> Should Physicians Avoid Interaction With the Drug Industry?

> Posted 12/02/2008

> W. Donnell, MD; Désirée Lie, MD, MSEd; Haynes, MD, PhD, MACP;

> Roy M. Poses, MD; P. Vega, MD, FAAFP; Bradley Fox, MD

> Author Information

> Information from Industry

> Introduction

> W. Donnell, MD

>

> Years ago, doctors had difficulty accessing new information on drug therapy,

> many relying on pharmaceutical sales representatives for updates. Modern

> information technology now puts reliable information at doctors' fingertips.

> Although few would argue that today's doctors need help from drug

> representatives to stay current, many still interact with them.

> The relationship between doctors and industry is controversial. A

> groundswell of opinion holds that doctors should avoid interaction with the

> drug industry.[1] One activist, Goodman, MD, New York internist and

> founder of No Free Lunch,[2] urged doctors to sign a pledge against

> accepting any gifts or support from the drug industry and would like to see

> the pledge elevated to the status of board certification.[3]

> Although those expressing such opinions are probably in the minority among

> physicians, their voices can be shrill. A culture of ridicule and shame has

> arisen as rank and file doctors find themselves accused of accepting bribes

> and characterized as minions of the industry.[4,5] How should we respond? I

> would argue for moderation. Let physicians set their own individual

> boundaries. Let's examine some anticipated objections to my proposal.

> Pharmaceutical company pitches are biased. Doctors are influenced by drug

> company promotions. These points can be conceded, but by themselves, they do

> not support a case for condemning other physicians' individual choices to

> interact with drug representatives. Additional questions must be examined.

> Interactions between physicians and drug representatives create conflicts of

> interest. This knee-jerk reaction suffers from oversimplification. Given

> that apparent conflicts exist, how real are they? Detractors have moved the

> concept from one of healthy skepticism to unhealthy cynicism. Drug company

> interests are not, as they imply, invariably conflicted with a doctor's duty

> to act on behalf of the patient. In fact, companies have a proprietary

> interest in producing good outcomes for patients.

> When conflicts of interest do result from interacting with drug

> representatives, they pale in comparison to others that doctors face daily.

> Doctors who receive fee-for-service compensation are rewarded for exposing

> patients to unnecessary procedures. Those who practice under capitated

> reimbursement plans are incentivized to underserve patients. Such conflicts

> are about real money and they expose patients to real risk.

> Drug representatives are trying to sell a product; therefore, doctors should

> ignore what they say. This is an ad hominem fallacy. It attacks the person

> or persons making the claim rather than the claim itself. With primary

> source information just a few mouse clicks away, doctors can critically

> examine drug company promotions on their own merits.

> Promotional influence on doctors harms patients. Convincing, generalizable

> evidence for this statement is lacking. Critics have cited the heavily

> promoted drug rofecoxib (Vioxx®), which was found to be associated with

> cardiovascular events. Rofecoxib's comparator in The Vioxx Gastrointestinal

> Outcomes Research (VIGOR) trial[6] was naproxen, which is singular among

> nonsteroidal anti-inflammatory drugs (NSAIDs) for its cardiovascular

> safety.[7] However, in real-world practice, rofecoxib was promoted as an

> alternative to multiple older NSAIDs (cyclooxygenase [COX]-1 inhibitors)

> that have been shown repeatedly to be associated with cardiovascular harm.

> In fact, data have indicated that they may be at least as dangerous as COX-2

> inhibitors.[8-10] There is no convincing evidence that industry promotions

> result in patient harm.

> Drug detailing sways doctors away from evidence-based practice. Studies in

> support of this argument do not give a balanced view. Surveys of the effects

> of drug detailing on doctors' prescribing have focused selectively on areas

> of overuse, such as antibiotics in the ambulatory setting and new expensive

> drugs compared with equally effective generics. Although some promotions

> undermine evidence-based practice, others may enhance it. Because

> promotional literature is a mix of good and bad information, the net effect

> on patient care is not known. Many heavily promoted treatments are

> evidence-based and known to be underutilized by doctors. A good example is

> the inadequate use of low-molecular-weight heparin for thromboembolism

> prophylaxis.[11] The promotion of statin drugs[12-14] and

> angiotensin-converting enzyme inhibitors for appropriate patients[15-17] is

> another example. Such a promotion toward best practice has been ignored in

> published studies. Research in a broader range of clinical situations is

> needed before conclusions can be made about the overall effect on

> evidence-based practice.

> Acceptance of food and gifts from drug representatives drives up medication

> costs. In effect, doctors are taking money out of patients' pockets. This

> argument is superficially appealing, but wrong. Because fewer doctors accept

> gifts from drug representatives, the industry is diverting its marketing

> resources to direct-to-consumer advertising. The money will be spent on

> promotion one way or another.

> Are there solutions? Perhaps, but they're not as simple as vocal detractors

> would suggest. Doctors should seek unbiased information on drug therapy.

> Drug company promotion, a mix of good and bad information, cannot be

> considered reliable, but individual doctors must decide for themselves

> whether they should allow drug detailing. Broad recommendations must await

> convincing data on patient outcomes. Transparency about doctors'

> interactions with industry, along with improved education on drug therapy

> and the critical evaluation of medical literature, would be more effective

> than the current finger-pointing and ridicule.[18]

> Section 1 of 2

> Next Page: Roundtable Discussion

> <http://www.medscape.com/viewarticle/583286_2>

>

[Guest guest]

You should read 'Trick and Treat' by Barry Groves. He explains it very comprehensively.

Lilian

I would go so far as to say that the nhs has been hijacked by the pharmaceutical companies for the benefit of their high profits at the expense of those people that it was intended for, that is us patients. Doling out profitable drugs like statins just like smarties and hypertension drugs to almost everybody, and denying the cheap and simple treatments that are actually better.