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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Phil on January 18, 2003, at 19:29:48
By LINDSEY TANNER
AP Medical WriterJanuary 18, 2003, 6:58 AM EST
CHICAGO -- Some doctors are letting drug company sales representatives sit in while they treat patients -- a practice called "shadowing" that is being questioned by at least one professional group.An organization of psychiatrists says it intends to ask the American Medical Association to review the ethics of the practice.
Sales reps have been known to sit in doctors' offices and examining rooms and observe routine checkups, various treatments and diagnostic tests, even child psychiatric therapy. Some doctors are paid hundreds of dollars in return.
Some, if not all, of the pharmaceutical companies require the doctors to obtain the patient's consent.
The companies say these preceptorship programs, as they are formally known, are purely educational, allowing sales reps to learn more about doctors' jobs and better serve physicians who use their products. But critics see the efforts as an unethical marketing attempt that violates the privacy of the doctor-patient relationship.
It is unclear how widespread the practice is, but the players include major pharmaceutical companies like Eli Lilly and Co.
Lilly spokesman Ed Sagebiel said the practice began at Lilly at least five years ago and involves doctors of many types around the country. Sagebiel said Lilly's reps are told just to observe, not participate. Lilly's policy says participating doctors must obtain patient consent.
But critics say confidentiality and consent are especially problematic when psychiatric patients and children are involved. Some question whether parents can adequately represent their children's wishes.
The American Academy of Child and Adolescent Psychiatry plans to raise the issue at the AMA's annual meeting in June in Chicago.
Dr. David Fassler, a Vermont psychiatrist and member of the academy's governing council, said he wants the AMA to come out against the practice unless patients have "full knowledge and informed consent."
"It seems quite inappropriate to have non-clinical personnel present during therapy sessions," Fassler said in an interview this week. "I'm also concerned that patients may not always feel free to say no when asked by their doctor if something like this would be OK."
The AMA does not have policy on shadowing, but one is needed -- especially if doctors are being paid, said Dr. J. Edward Hill, chairman of the AMA Board of Trustees.
"I would be extremely concerned about that being an ethical behavior," he said. He added: "We don't want anybody interfering with the patient-physician relationship, whether it's a pharmaceutical representative or anybody. That's such a sacred trust."
While the extravagant freebies that drug companies have lavished on doctors have come under increased scrutiny in recent years, the industry's presence in examining rooms is less well-known. But some recent cases have raised concern among doctors and prompted calls for an end to the practice.
In one of those cases, a Lilly sales rep in Maryland sat in on a psychiatric therapy session involving children.
In another case, Parke-Davis, now part of Pfizer Inc., is accused of illegally marketing the epilepsy drug Neurontin for unapproved uses through tactics that included sitting in on patient visits. The allegations were contained in a whistle-blower lawsuit filed last year in Boston. The case has prompted an investigation into Parke-Davis' marketing practices in 47 states.
David Waterbury, an assistant attorney general in Washington state who is overseeing the Parke-Davis probe, said that even if sales reps are not overtly marketing, their presence would probably make a doctor reluctant to recommend another company's drug to a patient.
"If the person's there from `X' company, is the doctor going to have a lot of discussions about the virtues of `Y' company's drug? I think not," Waterbury said.
Lilly pays doctors $250 for one half-day session or $500 for allowing a sales rep to accompany a doctor all day, Sagebiel said. Doctors may be paid directly or their fee can be donated in the physician's name to a medical school or a charity, he said.
Sagebiel said paying doctors is appropriate because they are providing a valuable service. "It helps the reps have a hands-on observation to the challenges of a physician and helps them to be a better partner," he said.
Dr. Bill Arnold, an Indianapolis psychiatrist, said he has been paid to take part in several such programs involving Lilly and others. He defended the practice as a way to give sales reps exposure to medicine the way it is practiced.
"They've heard about schizophrenia and heard about Alzheimer's; here it is -- live," Arnold said. "They're going to market their products anyway, so instead of them trying to beat down my door, why not have them learn about what the market's really like?"
Arnold said the money is minimal given the amount of time shadowing takes away from his practice: "It's not a lucrative thing to do at all."
A Pfizer spokesman declined to comment on the Neurontin case.
Copyright © 2003, The Associated Press
Posted by mikhail99 on January 18, 2003, at 21:16:02
In reply to The beloved drug companies their pals., posted by Phil on January 18, 2003, at 19:29:48
I can't for the life of me see how any of that can be appropriate. I certainly wouldn't allow it during my sessions. Why in the hell does a sales rep need to see a shrink or a therapist in action? How is that going to make them better understand the drug that they're marketing?
Thanks for posting that article Phil, it was very interesting.
Mik
Posted by Ginjoint on January 18, 2003, at 21:19:35
In reply to The beloved drug companies their pals., posted by Phil on January 18, 2003, at 19:29:48
There's no way I'd ever allow a sales rep to sit in on ANY doctor appointment of mine (psychiatric or other), or for any child I might have. Talk about a boundary crossing, fer cryin' out loud! I worry for patients who may feel intimidated saying "no" to a doctor who's all enthusiastic about this appalling practice.
Ginjoint
Posted by Phil on January 18, 2003, at 22:02:05
In reply to Well, this made me sick(er)....., posted by Ginjoint on January 18, 2003, at 21:19:35
I don't know if it's me but it seems that every seedy practice of the drug companies lately has Lilly's name at the top. Production facilities not passing inspection, patents running out on drugs so they market the exact same thing under a different name, 'accidental' mailouts in Florida of weekly Prozac to make people switch to a less effective delivery system.
Putting Prozac together with Zyprexa. I can hear a consumer saying they are on new Prozac with some other drug in it. Focusing on Prozac while not knowing about TD.
I hope the drug companies are given a hard look by, say, Mike Wallace.
Finally, could you imagine your doc introducing this character. Phil, this is Jim Dandy with Pinche' Pharm and he's sitting in today. Why?
Well, he doesn't know how to sell his drugs plus he gave me 500 bucks for me to teach him how to sell his product over what's working for you. 'Will I have to switch?'
If I can teach him well, he'll sell me and yes, we'll probably switch you.
Posted by Dinah on January 19, 2003, at 7:18:27
In reply to The beloved drug companies their pals., posted by Phil on January 18, 2003, at 19:29:48
I don't understand how it is legal, much less left unsanctioned by the licensing boards. I don't blame the companies nearly as much as the doctors here. Their responsibility is supposed to be to us.
Posted by Noa on January 19, 2003, at 8:25:46
In reply to The beloved drug companies their pals., posted by Phil on January 18, 2003, at 19:29:48
1) I don't blame the drug companies because they are being what they are--salesmen.
2) I DO blame the doctors who engage in this practice. They should remember what THEY are, and the ethics of the profession.
3) If anyone is going to be paid for this, it should be the patients, not the doctors!!
4) Even if they have consent, I question the quality of the information given to the patient before consenting.
5) To me, consent is beside the point because the situation produces undue influence--many patients would not say "no".
6) Consent is beside the point because by turning the treatment situation into something with dual purposes--treatment of the patient as well as service to the drug company that earns the doctor a fee--the doctor has violated a basic ethic of his or her profession.
7) The doctors need to be the gatekeepers based on their professional standards, and realize that salesmen are going to try to push the envelope more and more (sorry for mixed metaphor!), and that the intrusion into the doctor-patient relationship of the doctor-drug salesman relationship is going to produce undue influence both on the doctor's prescribing habits as well as on a patient's decisions about medication.
8) If the drug companies want to learn more about psychiatry or any branch of medicine, let them hire doctors of their own to train salesmen.
Posted by Noa on January 19, 2003, at 8:31:43
In reply to Re: Well, this made me sick(er)....., posted by Phil on January 18, 2003, at 22:02:05
> I hope the drug companies are given a hard look by, say, Mike Wallace.
Phil, why don't you clip the article and send it with a letter to Mike or to Stone and Jane at Dateline?
Posted by mikhail99 on January 19, 2003, at 11:23:42
In reply to Re: Well, this made me sick(er)..... » Phil, posted by Noa on January 19, 2003, at 8:31:43
> > I hope the drug companies are given a hard look by, say, Mike Wallace.
>
>
> Phil, why don't you clip the article and send it with a letter to Mike or to Stone and Jane at Dateline?That's an excellent idea Noa!!! DO IT PHIL!!! :-)
Posted by Phil on January 19, 2003, at 12:11:33
In reply to Re: Well, this made me sick(er)..... » Noa, posted by mikhail99 on January 19, 2003, at 11:23:42
Drug Companies, Doctors and Deception January 19, 2003
I would like to suggest a segment on big drug companies' based partly on the examples and links below. Unfortunately, doctors are often complicit with drug company whims and schemes. The consumer suffers while doctors are bought and paid for.
If you have a chronic mental condition, it's many rolls of the dice to find the right medications. Negative sexual side effects occur in 70-80% of patients on these drugs. Drug companies report 10-20%, maybe less.
The whole process of getting the drug to the consumer is a joke. From initial testing, sponsered by the drug company, to the skewed results, through marketing loopholes, 'giving away the farm' to doctors.
I heard a drug rep say actual face time with a doctor per appointment is 1.5 minutes.
Do they discuss their product or their new trip incentives?
I. A few examples
GlaxoSmithKline recently threatening to pull out of the Canadian market because
of Americans obtaining meds there-including my doctor. Why the price
difference? Would this company really pull their medications off of the shelves?
In N. Florida, Lilly 'accidentally' mailed out the medicine 'Prozac weekly' to people who
were taking the original product(patent expired). They did this through
cooperating psychiatrists and primary care docs. Lilly fired a DM and two sales
reps for doing this. a 16 year old boy was the recipient of one mailout. The
program had been discussed at Lilly meetings. Prozac weekly does not work as
well as the original. They didn't mail coupons, they mailed you the drug.
Lilly is inventing diseases to create a market for their drugs. Repackaged Prozac
into another cap, call it Sarafem and treat PMDD.
Lilly's plants not being up to acceptible standards delays a few new product
introductions.
Lilly, again, is offering doctors $500.00 a day to let their sales reps shadow them.
This includes pediatric psychiatric visits.
Sexual side effects of antidepressants run as high as 70-80% in users, possibly
higher. Their package inserts claim 10%, maybe 20 or 6%.
Thank you for your consideration,
Phil _________
http://www.dr-bob.org/babble/social/20030111/msgs/35463.html
http://www.lasvegassun.com/sunbin/stories/thrive/2003/jan/11/011106995.html
http://www.thestreet.com/funds/ericgillin/10019708.html
http://www.vaccinationnews.com/DailyNews/July2002/RenounceUnethical16.htm
http://bmj.com/cgi/content/full/321/7276/1563
http://bmj.com/cgi/content/full/319/7202/69
Posted by noa on January 19, 2003, at 14:55:12
In reply to Re: Okay, Dateline it is., posted by Phil on January 19, 2003, at 12:11:33
Go PHIL!
Posted by Ritch on January 19, 2003, at 15:35:45
In reply to The beloved drug companies their pals., posted by Phil on January 18, 2003, at 19:29:48
Phil,
That happened to me the last time I went into see my endocrinologist. He just asked me if it was OK if a drug sales rep sat in on the office visit. I don't know who the rep worked for, but they were marketing some diabetes medication from what I remember. At first, I didn't think much about it and said it was OK, but after we got into the interview process and the rep came in I felt like there were some things I wanted to bring up to my endo. but didn't because of the presence of a stranger being there. I think what they are up to is this (from your original post):
"David Waterbury, an assistant attorney general in Washington state who is overseeing the Parke-Davis probe, said that even if sales reps are not overtly marketing, their presence would probably make a doctor reluctant to recommend another company's drug to a patient."
Geez, are we going to reach a point where they are going to do a complete physical in a surgical suite with windows (or online with a WebCAM) so ALL the drug companies can be equally represented??
Posted by Kar on January 19, 2003, at 15:55:14
In reply to Re: Okay, Dateline it is., posted by Phil on January 19, 2003, at 12:11:33
Phil- that's so cool! The letter is perfect. How about 60 Minutes because Mike Wallace has talked openly about his depression and is still very active in supporting research, getting funding, etc. for psych disorders. It might just get his attention. Or ooh, how about Michael Moore? He's be all over it...
I can just see them beating down the front door at Lilly's CEO's house...
Posted by Phil on January 19, 2003, at 16:41:22
In reply to Mike Wallace? » Phil, posted by Kar on January 19, 2003, at 15:55:14
http://www.cbsnews.com/stories/2002/12/20/60minutes/main533860.shtml
Might check this out, too.
Posted by Phil on January 19, 2003, at 17:16:47
In reply to Mike Wallace? » Phil, posted by Kar on January 19, 2003, at 15:55:14
If he reads this, I'll sh*t. If he does a story, I'll freak out.
I know these guys build stories over years sometimes but this should be quicker.
I have been in awe of Mike Wallace for years. They say he still stays busier than the rest of the staff, that's remarkable. Don't know why this letter writing campaign has come along for me. I don't have my hopes up but every email helps.Mr. Mike
Wallace January 19, 2003
60 Minutes
_________
Here are some issues the drug companies are involved in. There are a few stories here that are worth pusuing. That's my opinion.
Suffering from depression for over 20 years, I've learned a lot about drugs and, unfortunately, the companies that mfg. and sell them.
Most schemes take the cooperation of a few psychiatrists or primary care docs.
Below are links to various stories. I truly admire your work, your courage, and your openness about your depression. Thank you very much.
Sincerely,
Philip __________
Austin, TX ______ --See Below--
Drug Companies, Doctors and Deception January 19, 2003
I would like to suggest a segment on big drug companies' based partly on the examples and links below. Unfortunately, doctors are often complicit with drug company whims and schemes. The consumer suffers while doctors are bought and paid for.If you have a chronic mental condition, it's many rolls of the dice to find the right medications. Negative sexual side effects occur in 70-80% of patients on these drugs. Drug companies report 10-20%, maybe less.
The whole process of getting the drug to the consumer is a joke. From initial testing, sponsered by the drug company, to the skewed results, through marketing loopholes, 'giving away the farm' to doctors.I heard a drug rep say actual face time with a doctor per appointment is 1.5 minutes.
Do they discuss their product or their new trip incentives?I. A few examples
GlaxoSmithKline recently threatening to pull out of the Canadian market because
of Americans obtaining meds there-including my doctor. Why the price
difference? Would this company really pull their medications off of the shelves?In N. Florida, Lilly 'accidentally' mailed out the medicine 'Prozac weekly' to people who
were taking the original product(patent expired). They did this through
cooperating psychiatrists and primary care docs. Lilly fired a DM and two sales
reps for doing this. a 16 year old boy was the recipient of one mailout. The
program had been discussed at Lilly meetings. Prozac weekly does not work as
well as the original. They didn't mail coupons, they mailed you the drug.Lilly is inventing diseases to create a market for their drugs. Repackaged Prozac
into another cap, call it Sarafem and treat PMDD.Lilly's plants not being up to acceptible standards delays a few new product
introductions.Lilly, again, is offering doctors $500.00 a day to let their sales reps shadow them.
This includes pediatric psychiatric visits.Sexual side effects of antidepressants run as high as 70-80% in users, possibly
higher. Their package inserts claim 10%, maybe 20 or 6%.Thank you for your consideration,
Philip Jordan
http://www.dr-bob.org/babble/social/20030111/msgs/35463.html
http://www.lasvegassun.com/sunbin/stories/thrive/2003/jan/11/011106995.html
http://www.thestreet.com/funds/ericgillin/10019708.html
http://www.vaccinationnews.com/DailyNews/July2002/RenounceUnethical16.htm
http://bmj.com/cgi/content/full/321/7276/1563
http://bmj.com/cgi/content/full/319/7202/69
Posted by Kar on January 19, 2003, at 18:16:36
In reply to Re: Mike Wallace has a copy, I hope., posted by Phil on January 19, 2003, at 17:16:47
> If he reads this, I'll sh*t.
Well grab yourself a new box of Depends, mister. I think it will be done. Mike's cool.
Just think, you could be interviewed with a paper bag on your head for anonymity...
I've been wanting to write Mike for a while now (what, we're on a first-name basis? In my head, maybe. No, I'm not stalking him...) just to let him know how important I think it is that he's done what he's done. And it's much better than celebs getting in the news for streaking down the city streets in a manic state. Gives us "normal" bipolar folk a bad rap.Hey Phil, how bout Oprah?
Oh look what you've started now!
-K
Posted by noa on January 19, 2003, at 18:59:36
In reply to Re: Mike Wallace-Trying to find his email., posted by Phil on January 19, 2003, at 16:41:22
That CBS story about the lack of oversisght of drugs as they are in the distribution lines is downright scary!
This is the end of the thread.
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