When Gene Carbona sold drugs for Merck in the 1980s and '90s, he spent a "couple hundred thousand" dollars a year on breakfasts, lunches, happy hours, dinners and perks like football tickets to make the doctors on his route happy.
All of it was to build "relationships" with the physicians so that when it was time to break out the prescribing pen, Carbona — and Merck drugs such as the heartburn remedy Prilosec — would be remembered.
Today, Carbona is the executive director of New Rochelle, N.Y.-based The Medical Letter, one of the most respected sources of drug information in the health industry. He's also one of the country's leading voices in an emerging debate over the traditionally cozy relationship between doctors and drugmakers.
A small but vocal cadre of doctors — including those at top academic medical centers such as Stanford and Yale, as well as patient advocates such as the AARP and Consumers Union — say these ties hurt the health-care system because they expose patients to the newest, riskiest and costliest drugs.
"Pharmaceutical representatives push the high-cost drugs when we believe there are older name-brand drugs or generics that are just as effective," said William Ferris, a lobbyist for the AARP in New York state.
The average price of a prescription rose 8.3 percent a year between 1994 and 2005 — from $28.67 in 1994 to $64.86 in 2005. That's more than triple the 2.5 percent rate of inflation, according to the Kaiser Family Foundation.
Doctors are ordering more drugs, too. In 1994, doctors wrote 2.1 billion prescriptions. In 2005, they wrote 3.6 billion. That's a 71 percent hike — during a time when the population rose 9 percent.
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